Children’s Hospital Links to Coroner’s Office Questioned

Pediatric pathologists affiliated with Children’s Hospital and Health Center in San Diego should not be allowed to perform autopsies for the county coroner’s office, because they are vulnerable to pressure from fellow doctors who zealously pursue child abuse prosecutions with little regard for the rights of the accused, local defense attorneys say.

In two recent cases, parents accused of murdering their young children were later exonerated when second autopsies refuted or cast doubt upon the conclusions of coroner’s examinations completed by Children’s Hospital pathologists.

Dr. Stephen Baird, president of the San Diego County Pathology Society, said the informal relationship between the coroner and the hospital allowing pathologists who work for Children’s to review the work of their colleagues on patients who died at the hospital represents at least the appearance of a conflict that should be avoided.

“Everybody knows that in any organization of human beings there’s more of a tendency toward forgiveness in people who are closely associated with each other than people who aren’t,” said Baird, director of pathology at the Veteran’s Administration Hospital in La Jolla. “I think the pathologists at Children’s Hospital will do their job in a professional manner and report on mistakes they find, but I think you could eliminate even the appearance of an ethical problem by having cases like that done by a completely independent agency.”

But Dr. David Chadwick, the former medical director at Children’s and now head of a special child abuse prevention team at the hospital, called the criticism “absurd.”

County Coroner David Stark said he does not believe the relationship is “an unnatural one.”

The Children’s Hospital pathologists have been working for the coroner on a per-case basis since 1981, when persistent complaints from the district attorney’s office and Chadwick persuaded Stark to make the change.

“The criticism . . . used to be that we did inadequate autopsies and did not identify obvious injuries that just had to be child abuse,” Stark said. “Consequently, cases were being lost and child abusers were going unpunished. Now we’re doing too good a job. Our homicide success rate has increased and naturally, the defense attorneys are losing cases.”

Stark is among those named in a $1 million claim filed in July against the county after a Municipal Court judge dismissed for insufficient evidence murder charges against Carol Phinney, an Oceanside woman whose son died at Children’s Hospital a month after she said she found him unconscious in a bathtub. The claim alleges libel, slander and medical malpractice in connection with the coroner’s autopsy on Phinney’s son, Travis.

In their murder case against Phinney, prosecutors alleged that she struck 2 1/2-year-old Travis in the head or shook him violently before placing him in the bathtub to cover her crime. The first autopsy on Travis, performed by Children’s Hospital pathologist Dr. R. Steve Phillips, concluded that swelling on the right side of the boy’s brain could only have been caused by “blunt trauma” and listed his death as “non-accidental.”

Phillips, a pathologist who works on contract with Children’s Hospital, performed the autopsy Oct. 10 but did not list a cause of death until later, after discussing the case several times with Chadwick, Dr. Bradley Peterson, director of the pediatric intensive care unit at Children’s, and Dr. Robert Bucklin, the coroner’s supervising pathologist, who helped perform the autopsy.

Phinney’s attorney, David Thompson, contends Chadwick and the other doctors pressured Phillips to describe Travis’ death as “non-accidental”--a finding that enabled prosecutors to file murder charges against Phinney. Phillips denied in court testimony that he was pressured to make such a finding. He declined to be interviewed on the subject when contacted by The Times.

In a preliminary hearing in Vista Municipal Court before murder charges were dismissed, and in Phinney’s ongoing trial on child abuse charges, Thompson has called three doctors who have testified that Travis, who had seizures the first three months of his life, could have suffered another one the day his mother found him in the bathtub.

The two neurologists and a forensic pathologist testified that the swelling found on the right side of Travis’ brain likely came not from a slap on the head but from the insertion by pediatric surgeons of a bolt-like monitor used to measure pressure inside the head.

Dr. Richard Lindenberg, a Maryland neuropathologist, said the insertion of the bolt was the only sign of trauma on Travis’ head.

“Dr. Phillips determined the cause of death to be pneumonia and blunt injury caused by non-accidental trauma,” Lindenberg said. “He had no right from his findings to say there was blunt trauma. He had no leg to stand on.”

During the autopsy, Phillips found a small cyst on the left side of the boy’s brain, and though he noted it, he decided that the lesion was unrelated to Travis’ death and did not save it for further microscopic study. Phillips also testified that he apparently did not check for bite marks on Travis’ tongue, a sign of seizures, and that he did not consult a neurologist on the importance of the cyst.

“The coroner’s office, which purports to be an independent agency representing all the people of this county, is now conducting autopsies by a pathologist paid by a hospital with a pre-existing bias in favor of children and against adults,” Thompson said. “They’re well-intentioned, but they’re not operating in an objective atmosphere.”

Attorney Elisabeth Semel, president of the Criminal Defense Lawyers Club, is also critical of Chadwick and the hospital’s relationship to the coroner’s office.

Semel handled a case in 1983 in which an El Cajon couple was accused of killing their 2-year-old daughter after the coroner’s autopsy said the cause of death was heart failure “due to hypoxic shock due to bronchial aspiration (breathing in) of food,” a conclusion that left the parents’ role in the death open to suspicion. The district attorney dropped all charges against the couple after a second, private autopsy found that the child died from an undiagnosed, congenital heart disease.

“There’s a difference between being protective and conscientious and being knee-jerk,” Semel said. “When you accuse a family, a mother and father, of sexually abusing or physically abusing a child, you ruin them. If the charge is justified by a thorough medical examination, it should be made. But it’s a charge that should not be made lightly.

“We’re not talking about mass incompetence. But one person wrongly accused is one too many.”

Semel said she believes Chadwick, who is perhaps the county’s most prominent child abuse expert, “calls the shots in these cases more than the pathologists do.”

“He’s a pediatrician,” she said. “That doesn’t mean he doesn’t know a lot about child abuse. He does. But he doesn’t know about autopsies.”

Stark, the county coroner, acknowledged that Chadwick presses aggressively for autopsy findings that can lead to child abuse or murder prosecutions. But Stark said neither he nor the pathologists allow themselves to be manipulated.

“Sure, I’ve said, ‘Dave, you’ve got tunnel vision; you think every kid’s a battered child,’ ” Stark said. “We’ve had some very interesting discussions. But I tell him ‘Yes, this kid’s battered, but maybe this person that abused this child is going to go free.’ Once in a while, that’s going to happen. Sometimes the injuries can be a cumulative thing so subtle that you can’t properly document it.

“Heaven forbid we should have a parent sit in that chair in court and be wrongly accused. I don’t think that’s happened.”

Stark, who is considering changes in his office structure because of widespread criticism about the quality of autopsies, said he is not about to sever his ties with Children’s Hospital. He added that the hospital’s new director of pathology, Dr. Henry Krause, may soon be doing coroner’s autopsies.

“Is it unnatural for myself and Dr. Chadwick to have this relationship? I don’t think so,” Stark said. “Who knows more about injuries in children and what causes their death than those pediatricians and pediatric pathologists at Children’s Hospital?”

Deputy Dist. Atty. Jay Coulter, who prosecutes many of the county’s child abuse cases, said he considers himself a “friend and compatriot” of Chadwick and said he has “nothing but complete trust in the honesty and integrity” of the Children’s Hospital pathologists. Coulter said he thinks charges of a conflict of interest are unfair.

“It’s like we’re saying we’re not going to let detectives investigate crimes because the San Diego Police Department has close ties with the district attorney’s office,” Coulter said. “Of course we do. The point is, you don’t get pediatric pathologists wandering around the streets looking for work.”

Coulter said he has seen Children’s Hospital pathologists differ with the opinion of deceased patients’ attending physicians.

“I have seen them disagree quite violently,” Coulter said. “I’ve seen a doctor from Children’s say ‘That injury could not have resulted from (an accidental) fall,’ ” he said. “And I’ve heard the autopsy surgeon say, ‘B.S.’ and they get into one heck of a heated discussion. I certainly do not feel that anyone is selling out their medical ethics in these cases.”

Chadwick characterizes Thompson’s charges against him as “absurd,” contending that the Carlsbad attorney is trying to create a climate that will favor him in the Phinney case and in the future.

“I think he has a hope that by this kind of tactic he will discourage physicians from taking an active and interested role in these kinds of cases and that will make his job easier,” Chadwick said.

Chadwick said his vast expertise in child abuse is a valuable asset to the coroner’s office. And he said he would have little to gain by pressing for prosecution in cases that are not strong enough to warrant it.

“You have to remember that all of us are interested in being credible, in being correct and being able to prove our correctness,” he said. “If we begin to fudge, if we begin to provide opinions not supported by the evidence involved, we simply harm ourselves. We have too much to lose.”

Coulter, the prosecutor, said the public is better served by Chadwick’s zealousness than it would be by a docile pediatric community.

“I’d rather be in a community where doctors are going to pound on my door and say ‘Dammit, get up and prosecute this sucker,’ rather than what might exist in other communities where a case turns up and the prosecutor goes from doctor to doctor and they all say, ‘Gee, I’d like to help but I’m real busy’ or ‘The facts in this case aren’t clear.’ There are some communities where no child abuse exists, because doctors won’t testify and the cases cannot be put together.”

Times staff writer Marilee Enge contributed to this story.