Cape Girardeau County spars over autopsy costs

A man is shot in East Cape Girardeau, Ill.

An ambulance is called and the man is rushed to a Cape Girardeau hospital. His heart stops beating on the Missouri side of the bridge. He is pronounced dead in the emergency room.

An Illinois state attorney needs an autopsy to describe the course of the bullet through the body, to verify the entrance and exit wounds, to retrieve the bullet, examine gunshot residue and conduct toxicology tests.

So who pays for that autopsy?

Not Cape Girardeau County. At least not until someone with a higher authority tells the commission it has to.

The county commission sent a letter last week to Illinois state's attorneys in Alexander, Pulaski and Union counties saying Cape Girardeau County would no longer conduct autopsies of homicide victims from Illinois who die at Cape Girardeau County hospitals or who die before they arrive.

The letter addressed an issue that's been ongoing for several years, but it kicks off a game of chicken. Illinois law doesn't give Illinois coroners the authority to perform or pay for autopsies that happen outside their county.

Missouri law doesn't require autopsies on any death except for in cases of children ages 2 weeks to 1 year.

Neither state has authority over the other state's coroners so it is unclear what will happen the next time this situation occurs. If the matter doesn't get cleared up, it could make for a jurisdictional nightmare. Unless a compromise is reached, Cape Girardeau County commissioners will have to reverse their opinion or Illinois coroners will have to step outside Illinois law.

According to Cape Girardeau County Coroner John Clifton the aforementioned scenario plays out roughly four or five times a year. Each time, it costs the county taxpayers $1,700 to $2,000. There is also the travel time of transporting the body to Farmington, where the nearest forensic pathologists can be found. Beyond that, the Cape Girardeau County coroner may be asked later to testify in court.

"It's more far reaching than just the cost of the autopsy," Clifton said.

Clifton said this is an argument between county commissions and attorneys not between coroners. He brought the situation to the county commission's attention only because he wanted to know how to handle it when the matter came up, he said.

Clifton said the coroner's investigation tools are limited when he goes about determining a manner of death on a crime case that started in Illinois. He says a coroner from Missouri has no jurisdiction to investigate anything across the Mississippi River.

"I may be able to say the victim died of a gunshot wound, but I would have no authority to conduct an investigation on whether the shot was self-inflicted or homicidal," Clifton said.

David Barkett, coroner for Alexander County, disagrees with Cape Girardeau County's position.

"We pay for autopsies from Kentucky, Tennessee, wherever," Barkett said. "We take care of business."

Barkett said the position was a penny-pinching venture on Cape Girardeau County's part. He added that Alexander County has referred the situation to the Illinois attorney general's office.

Neither the Missouri nor the Illinois attorney general offices offered reaction to the situation.

Darryl Rendleman, the coroner in Union County, said on Tuesday he had been out of town and hadn't had time yet to go over the letter. But he said he has no obligations when it "goes out of my jurisdiction. The only way I could be involved is if they die in this county."

Jerry Goin, a deputy coroner from Scott County and Troop E director of the Missouri Coroners' and Medical Examiners' Association, has worked for the last two years on legislation that would give coroners the statutorial authority to "revert" homicide, suicide and accidental cases back to the counties in which the death began.

He said he knows of a case where the pathologist said a homicide victim from Illinois was dead before he entered the ambulance. But he wasn't pronounced dead until he reached the hospital. Then, Cape Girardeau County handled the autopsy.

Two years ago, then governor Bob Holden vetoed the bill, and according to Goin the governor later apologized, said he made a mistake and told Goin to introduce the measure again. Goin and the coroner's association couldn't get a consensus on the measure last year and the bill died before it came to a vote.

Dr. Mary Case, the medical examiner in St. Louis County and several other counties in the St. Louis area, said she didn't agree with the legislation because it would have forced counties to revert cases.

She said that wouldn't make sense for metropolitan areas because many Missouri counties would simply have to bring the bodies back to her for examination. Most Missouri counties don't have forensic pathologists or medical examiners. Currently, she said, the bodies that come from other states or counties but die in the county are built into her department's workload. The medical examiner's department in St. Louis County has 15 full-time and nine part-time positions.

If the department reverted cases, Case said, the counties that she doesn't work for would have to pay her extra.

As for the Illinois situation, she said laws would have to be re-written in all the bordering states in order to make the legislation work. Otherwise, no one would have jurisdiction. "It would be just like throwing a body out in space," she said. "I think that's a very irresponsible thing to do."

However, Case said, counties now already have the right to revert cases. They're just not forced to.

Goin said counties in Southeast Missouri already have an understanding and revert import homicide cases back to the original county. Illinois counties don't participate in that agreement.

bmiller@semissourian.com

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