The Jackson County Medical Examiner's Office does "one of the best jobs in the country of providing ME services," according to Dr. Roger Mitchell, the chief medical examiner in Washington, D.C. He conducts accreditation inspections of ME offices across the nation on behalf of the National Association of Medical Examiners (NAME). The Jackson County office made such an impression on him that he wanted to personally present the NAME accreditation certificate to the county’s Chief Medical Examiner, Dr. Mary Dudley, and County Executive Mike Sanders.
During the accreditation visit to Jackson County, NAME inspectors found zero deficiencies on a checklist of more than 350 items. "That is exceptional," stressed Dr. Mitchell.
"This accreditation means our ME’s office is not only meeting, but exceeding the highest professional standards," said County Executive Sanders. "The fact that the inspectors found zero deficiencies is a testament to the good work and good leadership in the Jackson County Medical Examiner’s Office."
Zero Deficiencies In 2014 & 2009
Jackson County is home to the only NAME-accredited medical examiner’s office in Missouri. The county's ME Office also had zero deficiencies in 2009 when it first earned the five-year NAME accreditation.
"Believe me, I tried to find a deficiency," Dr. Mitchell said during Monday afternoon's Jackson County Legislative meeting. "We want to make sure that we don’t hand out zero deficiencies in a way that just anyone can get them."
In a letter to Dr. Dudley announcing the accreditation renewal, Dr. David R. Fowler, chairman of the NAME Inspection and Accreditation Committee, stated, "NAME accredited offices represent the highest quality of [the] death investigation system. The citizens can be proud of the hard work, dedication and leadership made by you and your staff in attaining this accreditation."
The NAME inspection checklist covers everything from office space and safety guidelines to tissue donations and mass disaster plans. As many as 25 Phase I deficiencies are allowed, but a single Phase II deficiency (e.g. "Are the facilities and all work areas clean, structurally sound, and well maintained?") will automatically prevent an ME's office from receiving accreditation.
"This accreditation with zero deficiencies means we have a medical examiner's office that is one of the best in the nation," Sanders stated. "I’m not just saying that. The National Association of Medical Examiners and its leaders are saying it."
Dr. Fowler's letter included the NAME Inspection and Accreditation Site Visit Report, which concluded:
"The Jackson County Medical Examiner’s Office operates in a highly professional manner. The office takes care to ensure that medicolegal death investigation for the purposes of establishing cause and manner of death occurs at the highest level. The JCMEO team takes pride in its organizational framework and work product. The inspectors were impressed by the work environment and attention to detail."
A reflection of NAME's appreciation for the quality of work being done in the Jackson County ME's Office can be found on the association's website. Members logging in to download samples of how best to draft and implement policies will be shown documents from Jackson County, Missouri.
"I like that," said Dr. Dudley proudly.
Dr. Dudley has been through the arduous NAME accreditation process four times—twice as the chief medical examiner in Sedgwick County, Kansas, and now twice in Jackson County. The paperwork, alone, last year filled three six-inch binders.
"When I was in Wichita, it was important to me that we be accredited, and Sedgwick County is still the only one in the state of Kansas that is NAME accredited," Dudley said. "It means your office is qualified. Your pathologists should be certified by the American Board of Pathology and your forensic investigators by the American Board of Medicolegal Death Investigation.
"Ours are in Jackson County, and they are doing continuing education to remain certified."
A Call For Mandatory Accreditation
In 2009, NAME issued a study, Strengthening Forensic Science in the United States: A Path Forward, which was presented to Congress. It called for mandatory accreditation, emphasizing, "No person should be allowed to practice forensics without certification and all medicolegal autopsies should be performed by board-certified forensic pathologists."
Dr. Dudley pointed out in most Missouri counties the elected coroner can, despite possibly having no medical training, issue death certificates and determine when an autopsy is necessary. "In one county a high school student was elected coroner," she said.
Dr. Dudley expects it is only a matter of time before the system changes. The Jackson County Medical Examiner’s Office already provides what she calls "full-service death investigations" for Cass, Clay and Platte counties. Those counties pay Jackson County about $500,000 a year for those services. All told, 26 different counties have referred cases to the Jackson County ME's Office in recent years.
"By being accredited, I think we're ahead of the curve," Dr. Dudley said. "Obviously, not every county can get accredited. They don't have the staff or the facilities. We do.
"I think you're going to see medical examiner offices like Jackson County's become more regional."