Ramsey County medical examiner Michael McGee under investigation
by Madeleine Baran, Minnesota Public Radio
September 6, 2011
St. Paul, Minn. — Ramsey County is investigating the work of Dr. Michael McGee, who has served as the county's chief medical examiner for 26 years, after a Douglas County judge found he gave false testimony in a murder trial.
The case has raised questions about the quality of McGee's work and the lack of oversight of medical examiners in the state. McGee is a private contractor, not a county employee, and his company, M.B. McGee, P.A., earned nearly $1 million last year, most of it from a $700,000 contract with Ramsey County.
No one monitors McGee's day-to-day work, and, like all medical examiners in Minnesota, he is not required to follow any state or national guidelines on child death investigations. His company employs four physicians, but only two — McGee and Dr. Kelly Mills — are board-certified forensic pathologists.
McGee's work on the Hansen case has been criticized by nearly a dozen physicians and experts on child death investigations, including two medical examiners and three other physicians who reviewed the case for free at the request of Hansen's defense team.
McGee told the jury that 4-month-old Avryonna Hansen died of a skull fracture that could have been caused by being thrown against the concrete wall or floor in the basement room where she was sleeping. He ruled the death a homicide.
McGee declined to discuss the Hansen case. "There's a lot I can say about it, but given the fact it's pending litigation, I think I will not comment on that," he said.
None of the five physicians who reviewed the case agreed with McGee on the cause and manner of death. They found the skull fracture showed signs of healing and could have been caused by an accident six days before the baby died. They found it's more likely that Avryonna accidentally suffocated to death while sleeping on a futon with her father and three-year-old sister.
Dr. Lindsay Thomas, the medical examiner for Dakota County and seven other counties, was among those who disagreed with McGee's findings. She said McGee created a story about what happened to the baby, instead of sticking to the facts.
"It's not like Sherlock Holmes," she said. "It's not like we do an autopsy and we find something and then we invent a story to explain it. That's not our job. Our job is to do the autopsy, to find what we find, and then say to everyone who was involved, 'What's the story?'"
Ramsey County manager Julie Kleinschmidt, who supervises McGee, said the county is investigating his work in the Hansen case. "We're in discussions with Dr. McGee," she said.
Kleinschmidt declined to provide details of the investigation. When asked whether the county has a routine process for handling concerns about the medical examiner, she said, "There is a process, but ... I don't know what the process is. I don't have that level of detail."
Ramsey County Attorney John Choi, in a written statement, said his office takes concerns about McGee's work seriously.
"While I believe that we should not rush to judgment about the difficult work of medical examiners, which often times is challenged by differing opinions offered by competing medical examiners at trial, we will also not hesitate to initiate a review of that work when it is warranted by specific circumstances," the statement said.
Choi noted that his office recently completed an internal review of McGee's interpretation of a laboratory test used in sexual assault cases in Ramsey County. The review was prompted by allegations raised last year by St. Louis County Medical Examiner Dr. Thomas Uncini that McGee miscalculated test results in hundreds of rape cases in the 1980s.
"That assessment found that those cases were handled properly by the Ramsey County Medical Examiner," the statement said. "If necessary, we will undertake a similar assessment upon resolution of the Douglas County case to ensure that justice and public safety are served."
McGee also serves as the medical examiner for at least 14 other counties, some of them hundreds of miles away from his office in St. Paul. He does not conduct his own investigation of deaths that occur outside of Ramsey and Washington counties and instead relies on local law enforcement to describe the scene, interview family members, and take photographs. McGee said officers are well equipped to investigate deaths, and he offers voluntary trainings to officers throughout the state.
However, medical examiners contacted by MPR News criticized McGee's reliance on law enforcement. They say police are more likely to find evidence of a crime and less likely to find evidence of an illness or accident.
EXAMINER BRINGS IN MONEY FOR RAMSEY COUNTY
The county expenditures for the medical examiner's office totaled $2.3 million last year. That includes the cost of performing an estimated 500 autopsies as part of the contract with Ramsey County. McGee's office also performs another 500 autopsies a year for counties throughout the state. Those autopsies bring in money for McGee and for the county. Counties pay McGee's company a $500 pathology fee per autopsy, and they pay Ramsey County for the use of the building and supplies.
The arrangement keeps costs down for Ramsey County. Last year, the office brought in $1.2 million in revenue, cutting the total cost in half. Ramsey County Commissioner Victoria Reinhardt said McGee's work for other counties not only saves money — it also indicates that he's doing a good job.
"I know that he is nationally recognized and has been called upon to provide assistance many, many times outside of Ramsey County, and to me that speaks to his professionalism and integrity," she said.
Reinhardt said the county board also measures McGee's job performance by the number of tissue and eye donations, and by the percentage of homicides that are cleared by investigators.
By both measures, McGee is above the national average, she said.
"I'm just glad that there are people that can do that work because I couldn't," she said, laughing. "I'm just very pleased with the work that he's been doing for us and his office."
MPR News spoke with Reinhardt before the county manager said she was investigating McGee's work on the Hansen case. Reinhardt said she was not aware that a judge found McGee gave false testimony in Douglas County.
"I really can't talk about that," she said. "Obviously as a contractor we have certain requirements, and as far as I know, he has handled everything professionally in everything that he's done for us."
Reinhardt notes that McGee's office has been accredited by the National Association of Medical Examiners. The professional organization provides accreditation based on a checklist of policies and procedures. They do not conduct random inspections or examine individual cases.
Normally, McGee's work would be presented to the state's Child Mortality Review Panel, a group that includes doctors, child abuse experts, medical examiners, and other specialists. The panel reviews individual cases and makes recommendations for changes to child death investigations. It can also request that officials take another look at a case that they believe was mishandled.
That's not what happened with the Hansen case. The panel never reviewed the baby's death because Douglas County Social Services failed to report it, said Erin Sullivan Sutton, the assistant commissioner for children and family's services at the Department of Human Services.
Sutton said she first learned of the case when contacted by MPR News. "I don't know what happened here," she said.
PERFORMING AN AUTOPSY
Medical examiners perform autopsies to help determine the cause and manner of death. In some cases, the cause of death is obvious, like a gunshot wound to the head or a drug overdose, but the manner of death is not. A medical examiner might have enough information to say that a person drowned, for example, but not enough information to say whether the manner of death was natural, an accident, a suicide, or a homicide. In those cases, medical examiners have two more options. They can classify the manner of death as undetermined or pending investigation.
McGee had to try to find out what caused Avryonna's death and made a decision about whether it was a homicide, an accident, or something else. He was not required to follow any particular guidelines, including guidelines established by the state's Department of Health that recommend all infant death investigations include a re-enactment of the death scene with the person who found the baby.
McGee did not travel to the scene or send one of his investigators. Although he said he sometimes uses a doll to recreate how the baby was found, he did not do that in the Hansen case, nor did he investigate the baby's sleeping conditions. He said he stopped looking for another cause of death when he saw the baby's massive skull fracture.
At trial, McGee disagreed with a medical examiner hired by the defense who argued that the skull fracture occurred six days before Avryonna died, when she fell out of a shopping cart in a Wal-Mart parking lot.
McGee told jurors that the Wal-Mart accident could not have caused the skull fracture, and he said it wasn't possible for a baby with that injury to survive for more than a few hours.
"She would not be acting in a normal fashion and would be displaying symptoms," McGee told the jury. "From our experience in cases like this, the child will slowly become more and more quiet, and eventually come to a point where they will lose consciousness, and then eventually die."
But McGee has never treated a patient who survived a skull fracture. Like most medical examiners, he's never treated any living patients. In cases this complicated, other medical examiners said, they would ask a neuropathologist or other specialist to review the case.
"I would not have done that on my own," said Uncini, the St. Louis County medical examiner. "You're making the difference between homicide and accidental death. That's huge."
Douglas County Judge Peter Irvine ordered a new trial based on new evidence on infant deaths caused by accidental suffocation and on his finding that McGee provided false testimony in the original trial.
"Dr. McGee's testimony regarding the symptoms and clinical course of a child with a skull fracture like Avryonna's and Avryonna's shopping cart fall was false or incorrect," he wrote. "The jury might have reached a different conclusion in Mr. Hansen's case without this testimony."
Irvine wrote that McGee stopped looking for a cause of death when he found the skull fracture, "even though he could identify no anatomical injury sufficient to explain her death." He also noted McGee did not take samples from the skull bone, "even though he knew that the timing of Avryonna's injury would be a key issue."
A LOOK INSIDE THE MEDICAL EXAMINER'S OFFICE
Although McGee declined to comment on the Hansen case, he agreed to provide a tour of the office he's overseen since 1985.
The Ramsey County Medical Examiner's office sits next door to Region's Hospital in St. Paul. It's a compact, one-story tan brick building with a front door for the living and a back door loading dock for the dead.
Visitors wait in a lobby with thin gray carpet, a soda vending machine, several potted plants, and a table that displays brochures about eye donation.
McGee, who is 63, began by apologizing. He needed to rush a bit, he said, because the body of a young man had just been brought in. He didn't want the family to have to wait until the next day to find out how he died.
A body's first stop is the intake room. One side of the room opens up onto the loading dock. The room's tile walls and metal doors suggest a vaguely industrial purpose.
"It's not really meant to be inviting," McGee said.
He explained that each body is brought inside and placed on a shiny silver metal cart and rolled into an autopsy room. A tray of razor sharp knives and scissors is kept close at hand. A scale dangles from the ceiling. It's used to weigh organs. The room is bright and clinical, but not all autopsies are performed here.
One room is kept separate from all others. McGee walks inside. The room is small and silent. The walls are thick. There's a drain in the floor. A single fly buzzes by.
"If you have someone who was alive last night, they've been found dead at home, they look completely normal, they probably would be autopsied out there," he said, gesturing to the bright room outside.
"If you have someone who's been missing for two weeks and they find them in the river and they're badly decomposed, they would be done in here."
McGee moved on to a small room where tissues are sliced for sampling. He picks up a plastic bag. "This is brain tissue," he said. It's sliced into sections about an inch thick and submerged in formalin, a liquid preservative.
Most of the samples are stored right there, but others are taken to the cooler or the freezer. Before McGee opens the door, he cautions that it might be a bit noisy because the fans have been turned on.
Metal autopsy trays are lined up along the walls. Most are empty, but three of the trays each hold a blue plastic body bag.
"The people that you see, or the bodies that are present in these bags, have been examined by the office, and they're in the process of being ready for release," McGee said, shouting to be heard above the whir of the fans.
"It is pretty cold in here, and if you stay in here any amount of time, you need a coat on," he said. "And if you're cold in here now, you're going to get colder in just a second."
McGee opens the door to the freezer and steps inside. The air is thick with chemicals and an odor unlike any other. Not exactly a smell. More like a taste.
"There's no outside air coming in," McGee explained. "Everything's inside, like your refrigerator."
The room is outfitted with sensors to make sure it stays between 25 and 30 degrees.
"We freeze bodies in here," he said. "Many of the bodies we examine are decomposed, and so they have to be frozen."
He counts, "Right now there's one, two, three, four, five."
McGee said he's gotten used to the smell. "You have to get past that because the job is to try to figure out why the person died," he said. "And if you can't get past the smell, how do you plan on doing that?"
Not all of the medical examiner's time is spent peering over dead bodies. There's also paperwork to fill out and family members to call. McGee ended the tour on what he calls "the business side" of the office, which, he noted, "really isn't that much different than any insurance or bank company."
Investigators hang out in the break room, or nap in a sleeping room, equipped with a twin-sized bed, a set of weights, and an inflatable balance ball.
McGee talked a bit about the pressures of the job — the long commute, the physical toll of standing for hours at a time, the endless paperwork.
His career began in an era when even less attention was paid to the job of autopsying bodies. When he arrived at the Ramsey County office, he was given boxes of decades-old hand-written autopsy reports, some of them written by people without a medical license. Years later, McGee still prefers to hand-write his reports, but he also runs an office equipped with DNA storage units, a portable x-ray machine, and yellow cassettes to store tiny samples of tissue.
Unlike many people who've held a prominent position for decades, McGee didn't brag about his accomplishments. He walked quickly past a framed courtroom drawing of one of his most famous cases — the murder of 22-year-old Dru Sjodin, whose body was found decomposed in a ravine near Crookston, Minn. in 2004.
The sketch shows the medical examiner standing next to a drawing board in front of a jury. There's an outline of a person's upper body. McGee is using a marker to draw a red line on the neck.
"The attorney said, 'I want you to get up there and show people where the slice mark was,' so we did that," he explained.
When asked whether the public has misconceptions about death investigations, he offered a rare joke, "For one thing, not everybody in the medical examiner's office or the police department is handsome, and not everyone is pretty."
McGee said he sees his work as a public service. He's provided answers for the public, for families, for the legal system. Decades later, he still doesn't know what to expect when he comes to work in the morning, and that's the way he likes it.
"The job is interesting. The job has become busy, and it's been enjoyable. This is the only thing I've ever done."
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