Forensic pathologist ends relationship with county

Dr. Michael Sikirica

Back in early April I did a short post about how the executive in Oneida County New York was looking to end the long-standing coroner system and introduce a medical examiner system.  As a result of this decision, Dr. Michael Sikirica, the forensic pathologist who has provided autopsy services for many years to the county, has recently announced his intention to quit.

According to the executive, Dr. Sikirica was loyal to the coroners and would only stay if they stayed.

The District Attorney, Scott McNamara has brought on the medical examiner of a nearby county to perform forensic pathology services in Dr. Sikirica’s place.

The executive is ending the coroner system because:

… for years coroners had failed to file key paperwork on time. The problems resulted in a lawsuit from the state, as well as late payments to outside contractors, including those who transport bodies.

St. Elizabeth Medical Center also threatened to stop serving as the county’s morgue because of administrative issues. Also, some critics of the coroners, including McNamara, said they had sought Sikirica’s more expensive services more often than necessary.

St. Elizabeth Medical Center is apparently where Oneida County’s autopsies are performed.

 

Source:  Pathologist ends relationship with county – Utica, NY – The Observer-Dispatch, Utica, New York

 

ONEIDA COUNTY —

In another chapter of the ongoing saga of the Oneida County coroners, the forensic pathologist who has worked for the county for many years has quit.

County Executive Anthony Picente said Friday Dr. Michael Sikirica told him last week that he would cease working for the county Monday because Picente is replacing the coroners with a medical examiner.

“He was loyal to the coroners,” Picente said. “He said he would stay if I kept the coroners. I said I had crossed that bridge already.”

Picente said District Attorney Scott McNamara already has set up an agreement with Onondaga County’s medical examiner for the services that Sikirica provided.

It’s also possible Onondaga County will continue the role after January 1, when the coroner system officially ceases. Picente said he is also in discussions with some other possible providers and will probably announce a plan when he makes his 2013 budget proposal this coming Friday.

Picente said he had known Sikirica was leaving since August but believed the doctor was retiring. It wasn’t until the face-to-face meeting that he heard Sikirica, who also serves as Rensselaer County medical examiner and does autopsies for a number of counties, was separating from Oneida County, he said.

Sikirica could not be reached for comment.

Picente proposed eliminating the current system, with its four separately elected coroners, earlier this year. The county Board of legislators approved the move in May with a change to the county charter.

The move came amid revelations that for years coroners had failed to file key paperwork on time. The problems resulted in a lawsuit from the state, as well as late payments to outside contractors, including those who transport bodies.

St. Elizabeth Medical Center also threatened to stop serving as the county’s morgue because of administrative issues. Also, some critics of the coroners, including McNamara, said they had sought Sikirica’s more expensive services more often than necessary.

Sikirica performs the county’s more complicated autopsies, including those that are related to violent deaths. Other autopsies are performed by pathologists from St. Elizabeth Medical Center.

It’s up to the coroners to decide whether to request Sikirica’s services, St. Elizabeth’s or no autopsy at all.

Sikirica’s forensic autopsies cost between $1,000 and $1,400. St. Elizabeth’s cost between $600 and $700, county records show.

Depending on the type of autopsy, the cost of autopsies performed by Onondaga County could range from $565 to $1,800. Picente said it is rare that an autopsy would as much $1,800.

Because the coroners are separately elected, Picente does not have authority over them, though the county pays for their roughly $500,000 annual budget.

Coroner Kevin Barry said he understands Sikirica’s wish to end his relationship with Oneida County, but it’s a loss for the county.

“I feel bad he is leaving,” he said. “He would be a great asset for Oneida County.”

Dr. Stephen Cina named new Cook County medical examiner

Stephen Cina, MD

Meet Stephen Cina, MD

Dr. Stephen Cina has been named the new Chief Medical Examiner for Cook County, Illinois.  His immediate predecessor, Dr. Nancy Jones, is resigning effective July 31, 2012 amidst some problems at the Office.  Interestingly, the search for her replacement began on June 19, and Dr. Cina was named only three weeks later.

According to his CV, Dr. Cina’s medical education is as follows:

  • Medical school-Vanderbilt
  • Anatomic pathology residency-Medical University of South Carolina
  • Clinical fellowship in surgical pathology-Johns Hopkins
  • Forensic pathology fellowship-Office of the Chief Medical Examiner in Maryland.

He is currently the deputy chief medical examiner in Broward County Florida (Fort Lauderdale).  He applied to be the chief medical examiner of Broward County last spring, but was not selected.

Chief medical examiner will not be Dr. Cina’s only job

Dr. Cina will make $300,000 a year in his new position.  That does not, however, include what he makes for consulting on the side.

If you want to talk to Dr. Cina on the phone about a case, that will cost you $400 per hour.  If you want him to testify out of town, that will cost you $5,000 per day plus expenses.  Not too shabby at all.

Cook County employees are allowed to do up to 20 hours per week of outside work, but Dr. Cina states that he expects to only do 8 hours per week of outside work while at Cook County.

Will he actually have time to do consulting work?

Some question whether he will able to do much consulting at all when he sees the condition of the Office.

The Cook County ME office performs around 5,200 autopsies per year according to its website and has experienced some significant disarray of late.  The fact that there are only 5 forensic pathologists in the office (not including Dr. Cina) when there should be 15 does not help.

Given the caseload at Cook County, each pathologist will have to perform approximately 866 autopsies to keep up.

As I brought up in a previous post, Dr. Kris Sperry, the chief medical examiner of the Georgia Bureau of Investigation, considers 250 forensic autopsies per year to be the maximum a forensic pathologist should perform.  Quality suffers in his opinion if one does more than that.  Dr. Vincent DiMaio and the National Association of Medical Examiners (NAME) feel the same way.

In fact, NAME will not accredit any program in which a forensic pathologist performs more than 325 autopsies in a year.

Perhaps Dr. Cina should consider hiring Dr. Steven Hayne to help out at Cook County.  Dr. Hayne, who reportedly does not possess anatomic or forensic pathology board certification from the American Board of Pathology, has testified that he personally performs more than 1,500 forensic autopsies per year.  That would help immensely.

This is a very interesting article about Dr. Hayne.

Good luck to Dr. Cina

I in no way begrudge Dr. Cina his success.  Forensic pathology is a small specialty, with only about 400 board certified forensic pathologists in the US, and he is being paid what the market will bear for his expertise.  I simply found this article and the challenges he faces in his new position to be interesting, which is why I am writing about it.

Hopefully Dr. Cina will be able to find a balance between his jobs and bring the office back up to where it needs to be.  I wish him the best of luck.

 

Source:  New morgue boss not giving up his $5,000-a-day side job – Chicago Sun-Times

 

Nearly five thousand bodies a year go through the Cook County medical examiner’s office, an office that — whoever was to blame — found itself in disarray this past year, with bodies piling up in the morgue cooler and staffers snapping photos of grisly refuse to send to the press.

You’d think that cleaning up and then running the ME’s office, which now pays $300,000 a year, would be a full-time job.

But the newly designated medical examiner, Dr. Stephen J. Cina, whose selection was announced Tuesday, also has a long-time lucrative side job as a forensic pathology consultant for high-profile lawsuits, pulling down $5,000 a day, plus expenses.

A job he plans to keep once he takes over for sacked predecessor, Dr. Nancy Jones.

“We allow our employees to have second jobs, as long as they don’t conflict with county work,” Cook County Board President Toni Preckwinkle said.

Nor is Cina — pronounced “See-nah” — licensed yet to practice medicine in Illinois, so he cannot sign death certificates.

“He does not have a license right now, but he is applying and by the time he gets here, he will have it by then,” said Mary Paleologos, a spokeswoman for Preckwinkle’s office.

The good news is it shouldn’t take him too long to get his license in Illinois.

“Usually a week or two,” said Susan Hofer, of the Department of Financial and Professional Regulation. “We try to provide customer service.”

Once his licensing is in place, Cina, 46, will find himself in an office that is, despite his arrival, still seriously understaffed, with only five forensic pathologists available to help him perform autopsies — there are supposed to be 15, though Preckwinkle has promised more hiring.

Cina is now the associate medical director and chief administrative officer of the University of Miami’s Tissue Bank. Before that, he served as deputy chief medical examiner in Broward County, Fla., from 2007 to 2011. Last spring, he applied for the position of Broward County medical examiner when it became open, but he wasn’t selected.

All the while, he worked both his day jobs and kept up his big-bucks consulting business, charging $400 an hour to advise over the phone, plus testifying at more than 200 trials, charging $5,000 a day for out-of-town work, no credit cards or personal checks accepted.

“If you need an autopsy report reviewed or a patterned injury on an assault victim analyzed, consider a consultation with Dr. Stephen J. Cina,” his website, autopsyreview.org, ballyhoos.

His wife, Julie, an MBA, handles the business aspects.

County employees are permitted to do up to 20 hours a week of outside work, though that might not be possible once Cina sees the mess he needs to clean up and the political hoops he must jump through.

“I think he’s going to find that his duties as chief will interfere with his ability to continue his consulting practice,” said outgoing medical examiner Nancy Jones, who herself did legal work before joining Cook County — but stopped once she became medical examiner.

Cina said Tuesday he plans to work “up to eight hours a week” at his side business and promised not to take on work from any clients in Illinois.

“The job is 24/7, which doesn’t leave much time for outside work,” Jones said.

Speaking through Preckwinkle’s office, Cina declined an interview to explain the challenge of balancing consultation work with his new role of medical examiner.

He’ll have to scrupulously keep his business separate from county work. Medical examiners with private businesses have gotten themselves into trouble in other parts of the country in the past.

For instance, Cyril Wecht, a Pennsylvania pathologist, was accused of doing $400,000 worth of private work at public facilities and on public time while Allegheny County coroner in the early 1980s. The case dragged on for years, and he was eventually acquitted of criminal charges but ended up repaying the county $200,000 after a civil lawsuit.

Preckwinkle said she is not concerned that Broward County just passed on the chance to hire Cina last May.

“No, we’re grateful he’s willing to take the challenge,” she said. “He was recommended by his predecessor.”

Dr. Jones?

“No, Dr. [Edmund] Donoghue,” Preckwinkle said, referring to the ME before Jones. “Then we did a pretty thorough search.”

The search consisted of evaluating three of the 300 to 400 medical examiners nationwide who qualify for the position.

“Not like people were banging at the door trying to be chief medical examiner of Cook County,” Paleologos said. “We needed to act swiftly. We were under the gun. He was very interested in the position. He approached us.”

The board of county commissioners votes on his appointment July 24.

 

Too many bodies, too few forensic pathologists

This is a story out of Georgia that talks about the relative paucity of board certified forensic pathologists in the state and nationwide as well as the importance of having properly trained forensic pathologists.  According to the article, there are only 400 board certified forensic pathologists in the country, which seems a bit low to me.  Perhaps that’s just the number that practice full time.

The story goes on to explain that there are 14 board certified forensic pathologists at the Georgia Bureau of Investigation (GBI) for around 3,000 autopsies per year.  According to Dr. Sperry, chief medical examiner of the GBI, each pathologist does around 250 cases/year, which he considers the maximum.  More than that and he feels the quality of the work suffers.

I spent a month at the Office of the Medical Examiner (OMI) in Albuquerque back in residency, when I thought I wanted to do forensics.  That office serves the entire state of New Mexico as well as some of western Texas; there were no regional offices.  If someone died anywhere in the state and needed to be posted, they were brought to the OMI.  At that time, there were 5 (maybe 6) medical examiners, plus about 4 fellows.  The fellows were limited to no more than 2 posts/day, plus a protected paperwork day per week roughly.  There was usually only one ME on per day, and sometimes we would have 25 posts in a single day.  I would say an average day was 10-15 autopsies.  Sometimes an ME would do 10-15 autopsies in one day by themselves.  Now, they had amazing autopsy technicians, on site X-ray, an army of investigators, etc, but they did a ton of work.  The quality of their work seemed just fine; they had some very good and well-known MEs.  But I suppose while they did an excellent job, perhaps they could have done even better if they had more people and more time.

Forensics is not the best compensated specialty within pathology, and the lifestyle can vary.  You have to deal with attorneys, law enforcement, bureaucrats and dismal-never-increasing budgets.  All of these reasons likely contribute to the dearth of properly trained forensic pathologists.  While I found the subject matter fascinating and the job a very valuable public service, I just simply didn’t want to see that stuff day in and day out.  I applaud those that do.

We definitely don’t have enough board certified forensic pathologists in this country, and when there are not enough to go around, jurisdictions will have to make do with what they can find, and that doesn’t always turn out so well.  Like in Calgary, where a pathologist who had not passed AP or forensics boards got a $300K per annum job because authorities were desperate.

From WALB.com:

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