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Jardine: Bad heart or cruel hands? Pathologists disagree

One forensic pathologist claims Craig Prescott ultimately died from hypertensive heart disease following an incident in the Stanislaus County Jail last April.

Another said, no, heart disease did not cause the 38-year-old former deputy's death. A lack of oxygen to the brain did.

You might wonder how these two doctors, presumably trained to do the same thing, came up with such contrasting conclusions. Is this common in the world of forensic pathology?

That Dr. Eugene Carpenter, under contract with the county coroner's office, would find a different cause of death than Dr. David Posey, hired by the Prescott family, isn't rare at all.

"It is not uncommon," said Dr. John Howard, president of the National Association of Medical Examiners. "An autopsy means 'to see for one's self,' and two different observers looking at different times will sometimes see different things."

So which is right?

Howard suggests Carpenter had the more ideal circumstances because he conducted the initial autopsy. He made the incisions and removed the body tissue and bones needed to make his determinations.

"Because of this," Howard said, "the body is altered. Thus, a second autopsy cannot see the body in the same condition as that seen at a first autopsy."

However, some second autopsies will reveal evidence not found in the first, he said. And sometimes, the doctors just disagree on what they've seen.

"Even if the exact same findings are observed by two different people, the interpretation of those findings may different based on each individual's training, experience and belief," Howard said.

Which explains why all across the country, and on a daily basis, forensic pathologists testify in murder, malpractice, civil and other cases only to be contradicted by another forensic pathologist who came to a different conclusion.

Conversely, scores of other cases never go to trial because a defendant's pathologist can't find enough contradictory evidence, and he pleads out.

"The thing to keep in mind is that medicine is not an absolute science," said Cyril Wecht, a nationally known forensic pathologist from Pennsylvania. "I cannot emphasize enough that differences of opinion among physicians are as common as anything."

When these physicians take the witness stand, they must testify under oath about the procedures and practices they use to make their determinations. A good attorney on either side can make them look bad, careless or incompetent, which doesn't bode well for their reputations and credibility as experts in future cases.

A notable example of this occurred during Scott Peterson's murder trial in 2004. Dr. Charles March, a gynecologist and fertility specialist testifying for the defense, fell apart when prosecutor David Harris shredded his testimony. He pleaded with Harris to "cut me some slack."

Peterson's attorney, Mark Geragos, wanted Wecht to testify for the defense in that same trial and Wecht declined.

"The medical examiner could not establish the cause of death," Wecht said. "Why bring me in and give the DA a chance to hammer away again?"

Dr. Michael Baden, a New York forensic pathologist, said pathologists hired by either side want by nature to believe the information coming from their employer is most accurate.

"They want to believe their colleagues are always correct," said Baden, a member of a panel of volunteers who investigate in-custody deaths throughout New York.

That can certainly affect their conclusions, he said. Consequently, an internal investigation might absolve deputies of responsibility for the in-custody death — which happened in the Prescott case.

But an investigation for a civil case can include a broader scope of interviews and perspectives, he said, with hospital personnel and others being brought into the mix.

"Then the civil case comes along and the jury awards millions to the victim's family," he said.

Last year, Merced County settled a similar in-custody death case for $650,000.

Posey has testified in scores of cases, performing autopsies for families such as the Prescotts, traveling from California to as far away as Germany to do so.

In some cases, his autopsy findings support the coroner's. In others, he's contradicted them. The Prescott case is one of the latter, with Posey clearly challenging Carpenter's autopsy findings.

One expert says heart disease killed Craig Prescott. The other says it wasn't.

Thus, it's a case that could be headed to civil court.

A dozen jurors whose knowledge of forensic pathology probably comes from watching "CSI" or "Bones" would be asked to decide which of these pathologists is right.

Jeff Jardine's column appears Sundays, Tuesdays and Thursdays in Local News. He can be reached at jjardine@modbee.com or 578-2383.

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