HAGÅTÑA (The Guam Daily Post) — There are some apparent issues regarding when the medical examiner’s office is notified of death cases, a matter that seemingly boils down to policy and staffing needs, as well as potential lapses in law, according to discussions Friday during a roundtable meeting among lawmakers, Chief Medical Examiner Dr. Jeffrey Nine and other officials.
Nine came onboard as the island’s chief medical examiner in November 2022, but has turned in his resignation and is scheduled to leave employment by April 29. He cited personal circumstances that required him to relocate to the continental U.S. with his family.
On Friday, Nine said he wants to maintain a relationship with the medical examiner’s office for coordination, as an acting chief medical examiner if needed, to direct a death investigator and other staff in the office, as well as act as a consultant on a regular basis.
The only part of forensic pathology that requires the physical presence of a medical examiner is the autopsy, according to Nine. Other work can be done by different personnel, he added.
“And that personnel has to be, at the minimum, a death investigator, because they are certified by an agency … to perform those roles. So, I envision being the acting chief, providing the daily services and consultation. I would be part of a team of medical examiners that would come and do the autopsies when they are required,” Nine said.
One issue that Nine said he hoped to address during his tenure was establishing policy with the Guam Police Department over what kinds of cases require a call to the medical examiner.
“The way that Guam has worked before I arrived and since I’ve been here, the notification of the medical examiner’s office is relying on the police department to call us. If we had a death investigator, then we could connect with the police department and say, ‘On these cases, we want you to call our death investigator.’ Currently, there’s been no kind of cross-communication policymaking with the police department on what cases they call the medical examiner on. It’s kind of up to them,” Nine said Friday.
“The problem is the police get called, but they don’t always call the medical examiner. I can’t really fault anybody for that because they had three years without a medical examiner, … So when you establish three years, 3-1/2 years of not having a medical examiner, the agency can go into a pattern that maybe is a bad habit. And I think to address those bad habits is to create policies, and we just haven’t had that in the short time that I’ve been here,” the doctor added.
Nine said the policy issue could be addressed even after he leaves the island, with a death investigator in place. He called on the government to get the proper personnel into the medical examiner’s office, which he said means a death investigator at the minimum.
There have been times when Nine felt his office should have been involved in a death case and was not, he said. Part of the problem lies with the way deaths are reported on Guam, he added.
The typical medical examiner’s office has a death investigator on call 24/7, according to Nine.
“Typically what happens, … someone in the community, whether it’s the police department, the paramedics, the emergency room, they know right away to pick up the phone and call the medical examiner. … That doesn’t happen on Guam. We don’t have that process,” Nine said.
More often than not, issues with death investigations are the result of “the poor reporting process” on Guam, Nine added, using the example of a suspicious death of a baby that occurs on Friday and isn’t reported by the receiving hospital until after the weekend.
“The hospital hasn’t notified the police, the hospital hasn’t notified the medical examiner’s office. Then, four days later, I get the medical reports and I say this looks kind of strange. The death investigation is shot at that point,” Nine said.
This lull in reporting, and subsequent issues with findings and investigations, also play into the “one or two” disagreements Nine said he has had with police on cases.
Worry
“I’m hesitant to say this on the record, but I worry that people in our community are getting away with murder,” Sen. Chris Barnett, chair of the legislative committee on public safety, said Friday.
Nine said that can be a problem in communities without a good death reporting system.
“And Guam is one of those communities,” Barnett responded quickly.
Nine said Guam is best compared to smaller rural communities in the continental U.S., which “always have their challenges when it comes to death investigations.”
The Guam medical examiner’s office reported nine deaths as “undetermined” in calendar year 2023.
One case involves a gunshot wound that Nine said represented a discrepancy between what he thought happened and what the scene investigation may or may not have indicated. The manner of death was between suicide and homicide, according to Nine.
“We just came to the conclusion that since it wasn’t really investigated properly to my desires, I called it undetermined for the manner. And same with these other cases. There’s one or two infant deaths, … if the infant death happens on a certain day and I don’t get involved until three or four days later, you can’t go back and re-create that scene to properly determine the manner of death,” Nine said.
Section 81107 of Title 10 in Guam law requires prompt notification of the medical examiner’s office of deaths that may be subject to investigation, which include violent deaths and deaths with suspicious circumstances.
“I think we can definitely make it better, this language. And I think we should immediately,” Speaker Therese Terlaje said Friday.
Attorney General Douglas Moylan, who also attended Friday’s roundtable, said he has not observed any conflict among the Guam Police Department, the medical examiner’s office and his prosecutors, but he did note some legal changes that could be worked on with senators.
Nine also commented that he and law enforcement have cooperated well and want to reach the right solution.
“The problem with Guam is (it’s) a small community, to do this properly, you look at what is the dream, what is the model for a death investigation agency. The model is you have enough personnel for every time somebody dies on Guam, they call the medical examiner’s office and the … death investigator takes the information and we can get in on the front end of it. That’s not the model on Guam,” Nine said.
That model would require at least four death investigators on call 24/7, each at $100,000 annual salary, according to Nine. That would create an “airtight” death investigation system on Guam, he added.
“But is that fiscally responsible, to invest 1-1/2 to 2 million dollars in a death investigation system where you have single digit homicides every year? I think the public might push back on that a little bit,” Nine said.
Jeffrey Nine
