L.A. Coroner Alters Policy on Corneas

The Los Angeles County coroner’s office, responding to reports of ethical breaches and procedural lapses, announced Monday that it will no longer routinely permit a local eye bank to harvest corneas without the permission or knowledge of surviving family members.

“The department as a whole will now take a proactive approach in making contact with families, to ensure that they’re aware of any corneal removals,” said Coroner Director Anthony T. Hernandez. “Basically, that’s the bottom line.”

The coroner’s about-face came one day after The Times revealed that the Doheny Eye & Tissue Transplant Bank has paid substantial sums to the morgue in exchange for thousands of corneas, removed without family consent under a little-known state law.

The 14-year-old statute permits the removal of corneas if no known objections exist from next of kin. But coroners are not required to ask, a loophole that critics say has been used to an unmatched degree in Los Angeles County--to the financial advantage of the coroner’s office and Doheny and its management firm, Tissue Banks International.

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During the last two years, Doheny has paid the coroner’s office between $215 and $335 for a set of corneas. The eye bank resells them to transplant institutions for a “processing fee” of $3,400 to cover acquisition, testing, storage and distribution of the corneas. Tissue Banks International takes a cut of the money.

During a lively news conference, Hernandez said that beginning today, coroner field investigators will be required to ask families whether they object to corneal removals, which are performed by Doheny’s technicians.

Hernandez said that if family members cannot be found within 12 hours after an individual’s death, his office will remove the corneas under the law because the dome-like tissue covering the eye’s colored iris perishes quickly.

Humanitarian concerns, he said, dictate that his office do all it can in the future--as it has in the past--to provide an ample supply of transplant corneas for patients with impaired sight.

“If we were funneling corneas over for profit alone or because we were getting something out of it, then I would say that would be a horrendous ethical violation,” Hernandez said. “But that’s not the way we operate. That’s not what we’re in it for. We only do it to make sure that people get what they need so they can have a better quality of life.”

Hernandez said he expects “an initial drop-off” in cornea removals because of families’ objections but predicted that “it will probably get back to where it was.”

At least half of Doheny’s corneas--more than 1,000 a year--are obtained from the county morgue under the so-called Coroners Law. Officials for Doheny and Tissue Banks International did not return repeated telephone calls for comment Monday.

County Supervisor Zev Yaroslavsky said he is pleased with the policy change, but he added that coroner officials “are going to have some answering to do to the board and to the public.”

The board, of which Yaroslavsky is now chairman, had approved a series of contracts giving Doheny exclusive rights to remove tissue from the coroner’s office in exchange for reimbursing the county for costs associated with the procedure.

But Yaroslavsky said he remembers nothing in the paperwork presented to the supervisors disclosing the extensive use of the law or the full financial details of the arrangement that were revealed in The Times.

Among other things, The Times found that: Employees of the coroner’s office and Doheny say they were discouraged from seeking family permission so corneas could be harvested under the state law; eye bank technicians were warned in a letter from Tissue Bank’s president that layoffs were possible if productivity wasn’t increased; and there have been extremely close personnel ties between the eye bank and the morgue.

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Yaroslavsky said, “I guarantee you” that such behind-the-scenes machinations were not included in the contract reviewed by the board.

“It doesn’t say anything about 1,400% markups, about family members being hired, the pressure to produce corneas and suggestions not to talk to family members,” Yaroslavsky said. “You begin to wonder whether this is being driven by financial considerations or humanitarian considerations.”

Meanwhile, more family members have come forward with accounts of their own, accusing the coroner’s office and Doheny of improperly profiting from the deaths of loved ones.

One of them is Kandy Wendell, a Glendale city employee, whose 23-year-old daughter, Heather King, died in her bathtub in July during an epileptic episode.

“The marriage between the L.A. County morgue and the tissue bank is disgusting and offensive,” she said.

Wendell said she did not realize until reading The Times’ story Sunday that the coroner’s office had taken her daughter’s corneas under the state law--and without her permission. She said she was “absolutely available” for anyone to call.

“If they did make money,” she said of the coroner’s office and the tissue bank, “it’s like blood money.”

As for the coroner’s new policy, Wendell said she’s skeptical.

“Well, I’d have to wonder why all of a sudden they’re going to show us that courtesy when our feelings were never taken into consideration before. . . . They must think that somehow they’re going to be in trouble and this is going to placate everybody.”