A former EMT/paramedic Bruce Goldfarb is an award-winning journalist whose work has appeared on All Things Considered, the Washington Post, USA Today, American Health, Baltimore magazine, and many other print and online publications. Goldfarb was executive assistant to the Chief Medical Examiner for the State of Maryland from 2012 to 2022. In that role, he was public information officer for the OCME and curator of the Nutshell Studies of Unexplained Death. His first book, 18 TINY DEATHS, was released in 2020 and outlines the extraordinary story of Frances Glessner Lee, an independently wealthy matriarch who revolutionized the field of forensic death investigation and who is well known for her crime scene dioramas recreated in minute detail. Goldfarb's second book, OCME, Life in America's Top Forensic Medical Center, details the precarious state of forensic death investigation, which in many parts of the country is failing to provide essential public health services to the public.
Originally aired on: Nov 16, 2023
A former EMT/paramedic Bruce Goldfarb is an award-winning journalist whose work has appeared on All Things Considered, the Washington Post, USA Today, American Health, Baltimore magazine, and many other print and online publications. Goldfarb was executive assistant to the Chief Medical Examiner for the State of Maryland from 2012 to 2022. In that role, he was public information officer for the OCME and curator of the Nutshell Studies of Unexplained Death. His first book, 18 TINY DEATHS, was released in 2020 and outlines the extraordinary story of Frances Glessner Lee, an independently wealthy matriarch who revolutionized the field of forensic death investigation and who is well known for her crime scene dioramas recreated in minute detail. Goldfarb's second book, OCME, Life in America's Top Forensic Medical Center, details the precarious state of forensic death investigation, which in many parts of the country is failing to provide essential public health services to the public.
Originally aired on: Nov 16, 2023
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Speaker
Hello, everyone, and welcome. This is episode 92 of forensics talks. I want to wish you a happy Thursday and I hope that everybody is doing really, really well
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today. Our guest is Bruce Goldfarb,
00;00;42;12 - 00;00;46;00
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So, he is a former EMT and paramedic.
00;00;46;00 - 00;00;57;15
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he's an award-winning journalist whose work appeared on All Things Considered, The Washington Post, USA Today, American Health, Baltimore magazine, and many other print and online publications.
00;00;57;17 - 00;01;21;16
Speaker
Bruce was the executive assistant to the chief medical examiner for the State of Maryland from 2012 to 2022. And in that role, he was public information officer for the O.C. M.E. and curator. For the nutshell, studies of unexplained death. And the nutshell studies are something that I'm going to be talking about. But his first book, 18 Tiny Deaths, was released in 2020, and I've got it right here.
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We're going to be talking about that. And if you don't know who
00;01;25;22 - 00;01;43;02
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Frances Klausner Lee is, she was a very important icon in the formation of a lot of forensic science early on. And she revolutionized the field of forensic death investigation. So, we're going to be talking about his first book for sure and his second book, which is on CME right here.
00;01;43;02 - 00;01;45;20
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It's Life in America's Top Forensic Medical Center.
00;01;45;20 - 00;01;49;22
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It details the precarious state of forensic death investigation
00;01;49;22 - 00;01;58;01
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in many parts of the country, which is failing to provide essential public health services to the public. Now, interesting story.
00;01;58;01 - 00;02;01;11
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Many of you know that I was in Romania about a month ago.
00;02;01;11 - 00;02;05;27
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And Dr. Perper, thank you very much. Great conference. And the people there were excellent.
00;02;05;27 - 00;02;27;17
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But as I was there, there was a virtual presentation from Bruce, and I actually had his book beforehand. And as he was presenting, it didn't register right away who was actually speaking, but it did click in later. I realize, hey, that's the guy who wrote the book. So, I had it here. And subsequent to that, we have him here as a guest.
00;02;27;17 - 00;02;29;15
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So let me bring him on in here.
00;02;29;15 - 00;02;31;00
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Hey, Bruce, how are you?
00;02;31;00 - 00;02;32;09
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Hey, Eugene. How are you?
00;02;32;09 - 00;02;50;12
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Not too bad now, just for everyone to know. So, Bruce got caught up and he's kind of stuck. So, he's doing the interview or the discussion here from his vehicle, so. Bruce. Yeah. Thanks. I appreciate you still making it happen, even though you're kind of stuck there.
00;02;50;15 - 00;02;57;24
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I apologize. I'm in Washington. I'm stuck on the road and unable to get back in time. So, we do what we can.
00;02;57;24 - 00;03;00;10
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we'll do what we can, and we'll try to make it work.
00;03;00;10 - 00;03;11;12
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So, one of the things I was going to ask you, Bruce, is you have this interesting background where, you know, you were an EMT. And so that sort of tells me that you had an interest in one particular area.
00;03;11;14 - 00;03;32;26
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But you also have an interest in writing, like a journalist writing article. And of course, you know, you've authored a couple of books here as well. So where were you from a young age or something interested in medicine or you or were you more interested in writing stories? Like how did you what was your path like getting to where you were?
00;03;33;09 - 00;04;06;14
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Our path was pretty circuitous. And, you know, I've always had an interest in, I guess, storytelling. I never really considered myself a writer and was sort of a hobby and something that I was doing on the side and after high school, for lack of any better idea, I went to EMT school. I thought it was interesting. The emergency had been on TV and Gage DeSoto and that whole thing sounded quite interesting.
00;04;06;14 - 00;04;21;28
Speaker
So, I did that, and the writing just took up more and more of my time and discovered that I could make money at it. And there you go. I think it was just the path of least resistance.
00;04;21;28 - 00;04;28;28
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And on the EMT side, you know, you know, helping or sort of being like a paramedic and that sort of thing.
00;04;29;02 - 00;04;36;22
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What was your interest there? Was that something that sort of just caught you by surprise, or was it something that was in your mind from a young age?
00;04;37;13 - 00;04;58;15
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Well, it had been on television, the TV show that was part of it. It was at the time it was brand new. At the end of the 1970s, there was a lot of federal programs, federal funds to develop these emergency medical services systems. There was a lot of activity, a lot of training and things, a lot of development that was going on at the time.
00;04;58;17 - 00;05;22;09
Speaker
And so, you know, I went to I worked as an EMT and then I went for the advanced training to be a paramedic. I was in Memphis at the time and discovered that there weren't a lot of career opportunities. And so, a lot of paramedics were going to nursing school to get the R.N. Then you could work in an emergency department and teach and do other things.
00;05;22;09 - 00;05;49;17
Speaker
So I did that and I did nursing school, almost finished, really did not want to be a nurse and so I quit in my last semester, and that's when I learned about this program here in Baltimore at the University of Maryland, an emergency health services, a program for to train paramedic managers. And so, I did that, and that's where I got my undergraduate degree.
00;05;49;19 - 00;06;18;11
Speaker
But meanwhile, I've been getting clips and doing things, and I did a piece for National Public Radio and The Washington Post, and it just sort of emerged on its own. And it was, you know, you get the choice of being woken up all night and having people barf on you. Or you can sit in comfort of an office and write about it.
00;06;18;11 - 00;06;21;06
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So, I decided I'd rather write about it than actually do it.
00;06;21;06 - 00;06;24;19
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Right. Right. And so does that mean
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was your writing or were your articles sort of focused in one particular area, or were you writing about all kinds of different things?
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I started out a lot of medicine. I discovered that there was a market for people who were able to put together a coherent sentence and understood medical terminology. My first freelance articles were in paramedic journals, magazines, and I branched out to do general features and profiles and business stories and other things bit by bit, and as the opportunities arose.
00;07;00;14 - 00;07;07;22
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But I started out in my area of expertise, which has served me very, very a long
00;07;07;22 - 00;07;20;29
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And so, when, when did you first start with your first book, The 18 Tiny Deaths? When did the idea come to you that, hey, I'm going to I'm going to put together this book? And I mean, obviously it caught some interest for you.
00;07;20;29 - 00;07;24;05
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What was the spark that initiated that whole adventure?
00;07;24;05 - 00;07;52;07
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while. When I was at the medical examiner's office, I had the opportunity to spend time with the nutshell studies and learn about them more thoroughly and being able to look inside the cabinets and have visitors come look at them. And I met members of Lee's family, and the one person in particular was William Tyer, who is the curator and the director of the glitzier house in Chicago.
00;07;52;09 - 00;08;21;23
Speaker
And visitors to the nuptials would ask the same questions over and over. What was she like as a person? Why did she get started in forensic medicine? And Bill and I commiserated about the misinformation that there was about Francis Lester Lee in popular culture, that she was forbidden to go to college, that, you know, her parents disapproved of her work.
00;08;21;23 - 00;08;44;27
Speaker
And, you know, we said, you know, it's a shame that nobody has written a biography of Francis because really and, you know, somebody ought to do that one day. And, you know, it became pretty obvious, you know, there was a need for it because it hadn't been done. And there was a chapter in forensic science in forensic medicine history that was missing.
00;08;44;29 - 00;08;50;10
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And I just had the opportunity to be the person to do that.
00;08;50;10 - 00;09;08;05
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Yeah, it was really interesting. I didn't realize I mean, I've always I knew who Francis KLUSENER Lee was because a lot of the of the work that I'm doing on, you know, 3-D modeling and 3-D forensics and that sort of thing involves the visual aspect of, you know, presenting crime scenes and things like that.
00;09;08;05 - 00;09;32;19
Speaker
And so I ran across this in an article once, and, you know, talking about her dioramas, she's got these little miniatures, like almost like dollhouse miniatures that were extremely detailed, but that the idea or the notion of bringing the crime scene to investigators or to a jury, you know, so that they can look at it sort of objectively on a different scale, let's say, is really, really interesting.
00;09;32;26 - 00;10;04;03
Speaker
So, but what I didn't know and from I'm learning from, you know, reading the book here is the impact that she had. And also, the network of people that she was involved with. That's pretty amazing. And for those that don't know, this is a very, very wealthy woman family was very, very wealthy. And so, yeah, she I don't know if it's just she happened to be at the right place at the right time, but I think it would you say it had more to do, maybe with her connections.
00;10;04;09 - 00;10;05;06
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More than anything.
00;10;05;06 - 00;10;30;05
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I think it was being at the right place at the right time and also having a very, very sharp intellect, very highly educated and needing to have something meaty to do with it. And it was an intellectual challenge. And also, I think that she about above all, did it because nobody else was, it was a need that had to be met.
00;10;30;05 - 00;10;31;13
Speaker
And so, she did it
00;10;31;24 - 00;10;54;11
Speaker
I was going to ask you about the in the book. There's like a few little things that I made some notes on. So, one of them had to do with her being at a world fair. And I thought, is it, is it to me? I hopefully I get my facts straight. But did she meet Alfons Burton, who was, I guess, responsible for, you know, recording the piano?
00;10;54;13 - 00;10;55;24
Speaker
Yeah, yeah,
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Speaker
I tried to find a connection. I so tried. I know that she was there, her brother was there. George Burgess McGrath Were there, was there a battalion was there. I, I couldn't, there wasn't like a notation and a journal or an eye, a diary or anything like that that could actually connect them.
00;11;17;00 - 00;11;47;22
Speaker
However, Francis, his brother George, was a very avid photographer and virtually did have his camera apparatus. And I find it hard to imagine that at one time or another that they wouldn't have been there looking at it just it's obvious that they would have, but I couldn't document that they were all there, as was H.H. Holmes, America's first known serial killer.
00;11;47;22 - 00;11;52;29
Speaker
I should mention this to the two books kind of go hand in hand, because although you're talking about
00;11;52;29 - 00;12;09;03
Speaker
Francis Glacier, Lee's sort of story about she got going, you really outline the inception of the medical examiner system and the transition in some places from the coroner system to the medical examiner system. And then that's really followed on by Okami.
00;12;09;09 - 00;12;18;29
Speaker
So, what can you tell me about, you know, the coroner system? You know, back, back in the day when Francis KLUSENER Lee was first around?
00;12;19;18 - 00;12;48;13
Speaker
Well, the coroner system still around about half the United States is on the coroner system. It was the system that was used since the Americans were colonized by the Europeans. It dates from the Middle Ages. It's medieval English, common law. And the coroner would investigate sudden and unexpected deaths most often by calling a coroner's inquest. It's not terribly reliable.
00;12;48;13 - 00;13;23;11
Speaker
It's basically crowdsourcing death investigation. You know, some could argue that, you know, ten or 12 people using common sense, maybe it's better than nothing at all, but it really isn't quite the same as a scientific medical model, evidence-based death investigation. And at the time that Francis Glassner really got involved in the field, medical examiners only existed in three places in the entire United States, and that was Boston in 1877, New York City and Newark, New Jersey.
00;13;23;11 - 00;13;53;14
Speaker
That was it. And so, there was a huge need for medical examiners, and she undertook it to establish a program to train them and to she lobbied to change state laws, to abolish the coroner system and to enact medical examiners systems and to train the police so that they are scientifically trained in forensic death investigation. And she undertook all this by herself.
00;13;53;14 - 00;14;12;09
Speaker
There was a gentleman in the book, and I didn't realize his importance until I read it, which is her brother's friend. And they were colleagues at Harvard. And what can you tell me about George or Dr. George Burgess? McGrath and the impact. MCGRATH Yeah,
00;14;12;09 - 00;14;41;07
Speaker
George McGrath is really an underappreciated person in American forensic science. He Boston had the first medical examiner's office in 1877 and McGrath was appointed medical examiner. He was the second person to hold that job in Boston in 1907. He was the first person who'd been trained as a pathologist and medical school. And so, he was the first pathologist to serve as a medical examiner.
00;14;41;09 - 00;15;16;06
Speaker
And by definition, he was America's first forensic pathologist. And when he took the job, he realized that he didn't have the background or training or experience to do that, which was the field was then called legal medicine. And so, he undertook basically a fellowship training program and went to Europe, to London and Edinburgh and Paris and the leading centers of medicine in Europe and learned about legal matters and the scientific principles of death investigation, and then brought that back to America.
00;15;16;06 - 00;15;20;20
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And he really introduced that approach in the United States.
00;15;20;20 - 00;15;29;01
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And he was really instrumental in lobbying and trying to get people to change right from the from the coroner system or to a medical examiner system.
00;15;29;01 - 00;15;56;17
Speaker
He absolutely was there. There are the coroner system leaves a lot to be desired. It's a political position. They don't have any medical or scientific training. And so, there's a lot of opportunity for corruption and incompetence, indifference. And so, yeah, it's the way, you know, a medical examiner is basically it's a field of medical practice.
00;15;56;20 - 00;16;12;20
Speaker
And so, you know, you have a doctor with a special specialized training and qualifications to diagnose the cause and manner of death versus a politician with no training at all. It's pretty clear that one is better than the other.
00;16;12;20 - 00;16;28;07
Speaker
Yeah, I was I was surprised because. So, Francis Gloster, Lee is putting in like she's funding a ton of this stuff for like a I guess what it would be called a legal medicine course or something like that at, at Harvard.
00;16;28;17 - 00;16;37;05
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an entire department with a laboratory and a library and fellowship training. And she created a clinical field of practice.
00;16;37;05 - 00;16;46;26
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She basically made an offer they couldn't refuse. And even for that time, I forgot what the total amount of money was. But it was a ridiculous amount of money. And she didn't. She put them in their will.
00;16;46;26 - 00;16;50;23
Speaker
Like even when she passed away, she was going to give them even more money.
00;16;51;10 - 00;17;12;08
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I don't want to give away spoilers to the book, but she did tease them along, should she? The initial gift was about $3.4 million, and there was the promise of much, much, much more forbidding and they certainly did use each other to them for their own purposes.
00;17;12;15 - 00;17;21;08
Speaker
So, I mean, Francis clearly was a very intelligent woman. She was very, very detailed and stuff like that. So, what can you tell us about
00;17;21;08 - 00;17;29;25
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how she sorts of or where the idea came from to do these dioramas, to do these nutshell studies and what it meant
00;17;29;25 - 00;17;34;16
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there are three aspects to improve forensic medicine.
00;17;34;22 - 00;18;04;04
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You needed to have the laws that authorized medical examiners. You needed to have doctors who were trained. But the biggest and most important piece was the scene itself. You need to train the police because they are the first responders. They're at the scene of every sudden and unexpected death. Sometimes they're the only people who are at the scene there and honestly, back in the day, the police were not exactly the best and the brightest.
00;18;04;06 - 00;18;39;09
Speaker
A lot of them were illiterate. They didn't have high school educations. And so, they would do things clumsily because they didn't know any better and they would walk through blood, move the body, tamper with evidence, handle things. And so, she undertook this to she and the fellow who was the chairman of the Department of Legal Medicine at Harvard, Alan Morris, got the idea of beginning a training program for police officers to train them in forensic science.
00;18;39;11 - 00;19;09;11
Speaker
And they came up with a weeklong program was what they devised. And they had the curriculum. They'd observe an autopsy. They would learn about sharp force injuries and blunt force injuries. But how do you teach somebody to observe a crime scene and look for evidence other than taking them to a crime scene and looking for evidence, which you can't do for a variety of reasons, and they talked through these things.
00;19;09;11 - 00;19;37;10
Speaker
You really couldn't do it by with photographs. You couldn't do it by still moving pictures. And it was sort of an obvious, ingenious solution was to create three dimensional objects and, you know, models and miniatures were much more of a thing way back then. And so, she had that skill set of the domestic arts, the sewing and knitting and model making and miniatures.
00;19;37;10 - 00;19;55;00
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And so, it was just having once again, being the person with that, the being in the right place and have that solution for an innovative and innovative solution for a problem which is still useful today.
00;19;55;00 - 00;20;08;27
Speaker
I'd like to move into, you know, started your role at the CME but there's a relationship with between the nutshell studies they were they were housed at the OMB were all of them there or like how did they come into
00;20;08;27 - 00;20;10;05
Speaker
the possession there
00;20;10;05 - 00;20;26;17
Speaker
They are all 18 of them that exist are at the office of the Chief Medical examiner in Baltimore. When Francis Close nearly died in 1962, by then, her relationship with Harvard had soured.
00;20;26;19 - 00;20;55;08
Speaker
She was not keen on a department spoiler. She cut Harvard out of her will, didn't leave him a dime, and she made it quite clear that Harvard was not going to get to the nuptials. In any event, Harvard lost interest in forensic pathology, and they closed the Department of Legal Medicine. To this day, they don't have a forensic pathologist on the faculty at Harvard Medical School.
00;20;55;10 - 00;21;17;01
Speaker
And the fellow who was the chief medical examiner in Maryland, Russell Fisher, who had been one of the students of Maud's and went through the program and she knew him quite well. He was the chief here in Maryland. And he went to Harvard and said, we'll do the homicide seminar. And Harvard said, Great, you can have the dioramas take them down there.
00;21;17;08 - 00;21;24;11
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And so, they were brought down in 1967. And the homicide seminar has been held in Baltimore since 1968, ever since.
00;21;24;11 - 00;21;33;22
Speaker
Tell me about the introduction and your pathway into the okami. And I said it before, but you had like the perfect job for you, right?
00;21;33;22 - 00;21;56;01
Speaker
Because you're I mean, you're not a doctor, but, you know, you're an EMT, you've got you got training about the body and everything, but you're a journalist, you know, person who likes to communicate. And here you are in this public role where you have you know, you have all the insight and perspective on what's going on inside, but you're dealing with people all the time on the outside, and you have to respond to maybe news people or the public or whatever.
00;21;56;01 - 00;22;07;04
Speaker
So super cool job. And but how in the world was that? I mean, was that an existing job that nobody had or was this a new role that was made up and you were the first one in there?
00;22;07;04 - 00;22;37;03
Speaker
My understanding was that, I mean, the chief had a secretary before she actually was killed by a city bus. And so, the vacancy was there, but they had changed the job description a little bit. I in 2012, I was doing hyperlocal news service, an organization called Patch, owned by America Online and Huffington Post.
00;22;37;05 - 00;23;19;00
Speaker
And I was covering a community called Arbutus where I live. And there was a guy who was in my community who worked at the Army, and I knew that they had just built opened up this state-of-the-art forensic medical center. And I asked Mike Eagle to take us to if you'd arrange a tour for us. And they mentioned that they might mention that while we're visiting that they had this job opening as an assistant for the chief, working directly for him and the ideal candidate would be an EMT who had a journalism experience.
00;23;19;02 - 00;23;48;10
Speaker
And I said, Well, yeah, that's me. And they told me later that there was nobody else who was even close to it. It was just so obvious that it was made for me. And it was it was interesting in that, you know, over the course of all these things, when I was nursing school, I used to work in psychiatry years ago when I volunteered at a crisis center.
00;23;48;13 - 00;24;20;08
Speaker
And so, I had experience with the critical incident crisis and these sorts of things. And so, you know, it was he had me basically in charge of customer service. And a lot of the investigators when they're there are city people and you get in their face and they're going to get right in their face right back to you, which is not good when somebody is upset and complaining about the death of a loved one.
00;24;20;10 - 00;24;48;29
Speaker
And so, you know, I could come out and do my funeral director voice and be very soothing and, you know, talk them down and those sorts of things. And it was the job honestly took every bit of my experience in a variety of ways doing the I wrote letters to family members and, you know, really made an effort to not be cold and dispassionate and to express some hurt and understanding.
00;24;49;02 - 00;24;58;13
Speaker
And it was really just an extraordinary job and an absolute privilege to be able to do that. When I did, it just was tremendous
00;24;58;13 - 00;25;13;10
Speaker
Yeah. And it was interesting. You know, something you mentioned in the book was there wasn't really like a big orientation for you. It was kind of like you talked about, you know, you're at your desk and it is not like there was a six-month training program for know reserved for Bruce, right?
00;25;13;10 - 00;25;16;29
Speaker
It was like you're like, what do I do?
00;25;16;29 - 00;25;20;05
Speaker
Answer the phone. There you go. There is your desk. And so, the phone,
00;25;20;05 - 00;25;21;03
Speaker
that was it
00;25;21;03 - 00;25;44;08
Speaker
Well, it's pretty interesting. So in terms of the role that the medical examiners had, in fact, rated at the beginning of the book, you talk a little bit about, you know, the difference between, you know, what the police might be doing or what a prosecutor might be doing and what the role of the medical examiners.
00;25;44;08 - 00;25;49;29
Speaker
So, what can you tell us in your mind about the role and responsibility of the medical examiner?
00;25;49;29 - 00;26;01;02
Speaker
Well, honestly, I did not have that clear. And idea before I started. But as soon as I got in the environment, I got it immediately.
00;26;01;02 - 00;26;37;08
Speaker
I got it. This is a hospital and their doctors and immediately I understood the setup and the mission and what they're doing and their doctors’ day and night doses and the autopsies, the physical examination and the cause, the manner of death was the is the diagnosis. And so got it. And what I found interesting was that in forensic medicine, you don't have all these gadgets and things that other doctors have that help them through a diagnosis.
00;26;37;08 - 00;27;14;17
Speaker
You don't have the EKG and pulse oximetry and all of these machines telling you things in real time. You're left with what you can see and what you know and what you can deduce. And I discovered that the processes of forensic investigation are really analogous to investigative journalism. It's about checking facts, being persistent, discerning fact from opinion and, you know, summarizing things in a very concise way.
00;27;14;17 - 00;27;23;26
Speaker
And that's basically what they're doing. And I just found myself very like with like minded people there, they're really great people.
00;27;23;26 - 00;27;38;18
Speaker
And how did you find yourself handling, you know, the fact that, you know, you're dealing with sometimes very difficult cases and, of course, sometimes very gruesome things, you know, an autopsy is never a pleasant thing to be looking at it.
00;27;38;19 - 00;27;45;11
Speaker
It just become work to you and to everybody internally. Or were there still times where things were difficult for you?
00;27;45;11 - 00;28;07;17
Speaker
I mean, sure, there are times that are difficult to people that that that have been difficult. But the unpleasantness of the job, you get used to very, very quickly Everybody who is there to be a forensic investigator, for example, you have to have five years of major trauma experience.
00;28;07;17 - 00;28;31;04
Speaker
Most of the many of the investigators, they are EMTs and paramedics. And so, they've seen things in the field. And I saw things in the field. And so, all those icky moments, you know, those are those are all gone and way past with I, you know, picked up my first cadaver when I was, I guess, you know, 20, 21 years old and a young EMT.
00;28;31;07 - 00;29;01;26
Speaker
So, you know, once you get that out of your system and I do think of them as patients, they call them decedents. But, you know, it's very analogous to, say, a clinic or an emergency room where there's a flow of people coming in and out and they're going to X-ray and various things. And so, the environment was very familiar to me and very comfortable
00;29;02;11 - 00;29;21;15
Speaker
Okay. You know, in the book, you talk about sort of the transition of the U.S. Army from know this, it things going really well. And then all of a sudden, it's gone really bad. And I wanted to ask about I mean; you have a new they had they had upgraded the buildings over the years. They started in like a really, really bad situation.
00;29;21;21 - 00;29;41;04
Speaker
You know, they kind of gave them a building near where all the sewer stuff was or sort of a rough part of town. And then over the years, you know, you end up in this really high-tech facility. But what why did it work so well at the beginning? Like what were the factors that that contributed to a really successful operation?
00;29;41;04 - 00;29;53;14
Speaker
Because it sounds to me like the me there was it was a beacon, a really a model, a model enterprise. It just was something where people could really look up to
00;29;53;14 - 00;30;13;17
Speaker
it was it worked well because it was a smooth-running operation during its 80-year history from 1939 till 19 or to 2019, there were only four chiefs in the entire history or the organization.
00;30;13;17 - 00;30;41;25
Speaker
So, there was a sense of consistency and stability. You know, in some places it in some places when somebody say, well, we do it this way because that's the way we always do it, you know, is a questionable reason. But in this case, that's the correct one, because these are tried and true methods. This is the way we do it, because this is the way that avoids problems and so forth and so on.
00;30;42;00 - 00;31;09;10
Speaker
So, you know, it had a Dr. Russell Fisher who was the chief from 1949 till 1983, really had a lot to do with policies, procedures. He literally coauthored the textbook with Verner Spitz and the Medicolegal investigation of death. And so, you know, things were done if you asked me. And it ran like a like a smooth-running machine.
00;31;09;12 - 00;31;42;09
Speaker
The average cost to operate an accredited forensic medical center in the States is over $4 per taxpayer per year. And the U.S. Army was operating at a dollar and $0.97 per taxpayer per year. So, it was well below the average for the field. And so, it ran because they were extremely, very good doctors and had a system that ran smoothly.
00;31;42;12 - 00;32;13;29
Speaker
What happens when you double the caseload that's going to create problems and in time, this is what happened through the opioid epidemic beginning in 2013. And it just caused the cases to skyrocket, which leads to excessive case loads with the medical examiners, which leads to dissatisfaction. And then they leave and then the caseload increases for others.
00;32;13;29 - 00;32;20;02
Speaker
And you get into this vicious death spiral, which is what happened.
00;32;20;02 - 00;32;32;07
Speaker
Okay. And clearly the population growth of Baltimore, Maryland, that that was I'm assuming, a smaller contributor than everything else.
00;32;32;07 - 00;32;58;09
Speaker
Doctor Fowler said that the increase in caseload can't be accounted by the increase in population itself. He ran the numbers and I; I don't have them off the top of my head. I could look it up. There's, you know, population of Maryland increases something like 50,000 a year if you assume that the number of those people who die of number of those who need forensic investigations, it increases it modestly.
00;32;58;16 - 00;33;12;08
Speaker
But it's not going to cause medical examiners to have double the caseload that is acceptable by the National Association of Medical Examiners Standards for Accreditation.
00;33;12;08 - 00;33;16;06
Speaker
being at the medical examiner's office.
00;33;16;06 - 00;33;33;15
Speaker
I mean, you have insight into how people are dying. And so, was there an early indication of the whole opiate disaster and the different types of drugs that were coming through? I mean, you guys are assuming going to be the first people who see this sort of thing. Is that true?
00;33;33;15 - 00;33;57;07
Speaker
It there's a there's a pretty big noise to signal ratio in that the uptick in opiate deaths due to fentanyl really began to emerge at the end of 2013. And I mean, there's a lot there's an awful lot of I forget what it was.
00;33;57;07 - 00;34;23;09
Speaker
I think it was 1200 drug deaths, drug and alcohol deaths in 2000, 12 or thereabouts. And so, the number of fentanyl deaths that first year, I believe, was like 35. And so, it didn't really until you look for it, but it became much more apparent year after year after year when the numbers kept going up. Now, when I when people come through, I of course, you know, I'm up on the fifth floor.
00;34;23;09 - 00;34;50;24
Speaker
I don't see every case. But, you know, about two thirds of the cases that go through the medical examiner's office are natural causes anyway. So, I personally don't see an increase in one thing or another until the annual reports done and the numbers are compiled. And you look at it in retrospect, but obviously other people, the tox lab and other folks were keeping an eye on that sort of thing.
00;34;50;24 - 00;34;52;06
Speaker
And that's what they do.
00;34;52;06 - 00;35;07;17
Speaker
At what point did you know things were going to be seriously problematic? Like, you know, the story about, you know, the frog sitting in the water. And as it gets hotter and hotter, he doesn't jump out because he doesn't know it's getting hotter and hotter.
00;35;07;19 - 00;35;14;12
Speaker
Was it something like that or was it very evident to everyone there that, hey, we have a problem and it's just going to keep getting worse and worse?
00;35;14;12 - 00;35;40;26
Speaker
Honestly, when Dr. Fowler left, it was bad. It was bad. It was clear year after year the situation's getting worse. I mean, numbers don't lie. And there's the data. There’re the charts. We are running headlong towards a wall. The wall is directly ahead of us. We are going to hit that wall. And, you know, the wall is coming.
00;35;40;29 - 00;36;15;04
Speaker
And that's what happened. We hit the wall and I when the chief left, Dr. Fowler, and they were really unable to get a replacement that told me a lot that nobody really wants to take over. They did have they appointed Dr. Victor Wheaton and he served for a year. He wasn't able to fix it. He left in February of 20 to they'll be going on almost two years now.
00;36;15;04 - 00;36;35;26
Speaker
It's over a year and a half. They still have an acting chief. They have doubled the salary from what they're paying. Doctor Fowler. They still can't get somebody to take the job, so they don't have a permanent chief. I don't think they it is just it's a bad situation and I don't know what the outcome is going to be.
00;36;35;26 - 00;36;49;15
Speaker
Yeah, well, it's crazy. And why is it so difficult, I mean, to get funding like, you know, I mean, like you'd think that, you know, you need more doctors. You've got the, you know, the cases going up.
00;36;49;22 - 00;37;01;04
Speaker
People are dying. And you had you had like a crazy backlog of bodies that were sitting at the at the facility there. So why is it so difficult for people to fund?
00;37;01;04 - 00;37;37;17
Speaker
well, Dr. Fowler always said that dead people don't vote and living people don't want to spend money. But, you know, the medical examiner's office was always one of those things. It worked. It always worked. Cases were in and out within 24 hours. They did that for over 80 years, you know, just through that. And so, it isn't until very, very bad things happen when there's a crisis, when people go, oh, we have a crisis here, we'll throw some money at it.
00;37;37;19 - 00;38;09;11
Speaker
Let's hire somebody. You know, let's fire the chief and bring somebody in who can fix this. And then problems persist, and they fire that chief and, you know, rinse, repeat and go on and on and on. And that is what happens in major forensic medical centers throughout the country. It's not just Maryland, but this has been going on and in many large cities coast to coast, been having problems like this, backlogs, delays and shortages.
00;38;09;13 - 00;38;15;25
Speaker
And people are being fired and quitting and left and right.
00;38;15;25 - 00;38;30;10
Speaker
I mean, you talk about the when the backlog got really bad in order to fix it, they had to call in help and I just want you to talk a little bit about that. But why that I mean, it seems like it was just a temporary solution. No,
00;38;30;10 - 00;38;59;28
Speaker
It was a temporary solution. And truth be told, they helped marginally. I believe they sent in two forensic pathologists who and autopsy techs. There were two teams a few days. They helped a bit, but the lion's share of that backlog was cleared out by the Okemos doctors knocking themselves out and just undertaking it.
00;38;59;28 - 00;39;23;14
Speaker
We're going to do it. And they just did a just and a brutal number of cases per day to do it. I believe they had the backlog cleared up. It took 11 days to they had a backlog at the peak of 240 bodies, and they had that cleared up in 11 days while taking care of the cases that were still coming in the door.
00;39;23;14 - 00;40;01;00
Speaker
So that was just absolutely extraordinary. But the demand did help a bit. It really it was it was it was a psychological thing. It was literally, you know, throwing in the towel and having to basically admit that you're a disaster in order to get their help and to do that. And it was psychologically that really meant a lot because, you know, it's not too much to it's not overstating things to say that the U.S. it was a beacon and it was a gold standard that many people regarded as, if not the best, you know, one of the best.
00;40;01;02 - 00;40;12;01
Speaker
And to see it fall to such depths and to become literally a disaster was just heartbreaking.
00;40;12;01 - 00;40;23;26
Speaker
So, what happened in your case, you know, after you were there, you saw that, you know, you're going through very difficult times. You see this decline. At what point did you decide, you know, I need to move on?
00;40;23;26 - 00;40;45;08
Speaker
It was things were things started deteriorating. Once Dr. Fowler left, there was an exodus. People were leaving a lot. Several doctors left and then people in the IT department left. And you know, it was it was, and people were leaving it.
00;40;45;08 - 00;41;19;22
Speaker
The chief of investigation's left and it was the morale just it was awful. You know, I was I was the person who was getting the phone calls, the complaints from the public and family members when and obviously autopsy was delayed. And I, you know, had day after day after day for weeks and weeks speaking with irate family members who were upset and angry and crying and threatening more than once.
00;41;19;22 - 00;41;45;00
Speaker
I've had you know, I had people come down to threaten. They're going to punch me out and you know, that. And then COVID getting so isolated, it was just it I used to champing at the bit to get to the office. I would answer my phone all hours of the day. I couldn't wait to be at Yosemite and to do something.
00;41;45;07 - 00;41;52;12
Speaker
And when it gets to the point where you're dreading it, I mean, that's it. You're done. You know, it's that's time.
00;41;52;12 - 00;41;59;20
Speaker
Yeah. Do you still have close ties with some of the people there, or are you just sort of left behind you?
00;41;59;22 - 00;42;00;20
Speaker
Yeah.
00;42;00;20 - 00;42;12;28
Speaker
got together with a couple of guys. A couple of weeks ago and. Oh, yeah, we're still in touch with Facebook. I have many friends there who, you know, we're in touch all the time.
00;42;12;28 - 00;42;20;25
Speaker
I get texts from them. I have my sources. I know what's going on there, but I still have many, many friends that are sure
00;42;20;25 - 00;42;32;23
Speaker
Okay. I meant to ask you before, I didn't only back up for a second, but what would you say in your opinion was let's say one of the most important pieces of technology that was used at the U.S. Army?
00;42;32;23 - 00;42;47;15
Speaker
who are important. They did a lot of really innovative things. They had a full body, low dose X-ray machine, which was very cool. They're one of the few forensic medical centers to have that.
00;42;47;15 - 00;43;15;24
Speaker
They also had a CT machine, which and they were able to do amazing things with because you can look layer by layer and look just at the soft tissue or just at the bone. But the coolest thing that they were doing was Dr. Fowler and a couple of others were doing 3D printing skulls. They would take data from the city and feed it into a 3D printer so they could actually reproduce injuries.
00;43;15;27 - 00;43;36;01
Speaker
And that would be a visual tool that they could take into court. Who was actually accepted evidence in court and show a jury which are made up of laypeople. It's much easier for them to visualize, you know, a skull fracture. If you actually see the skull, then to interpret an x ray or a C, T or something like that.
00;43;36;01 - 00;44;08;22
Speaker
It's a little more abstract. But in terms of what is importance that the U.S. Army developed, it's the system, the system approach to forensic death investigation, the policies and procedures that they had hammered out over decades. And, you know, that was really the I hate to use the expression the Maryland way, but the way they did things was what the most important thing that they that they developed.
00;44;08;22 - 00;44;32;18
Speaker
And it is it’s a shame to see that being lost. Everything done was done by consensus. So, it's not like kind of TV shows where there's a medical examiner working by his or herself, but they do morning rounds every morning, so everybody gets to see what's going on. They examined the decedent and it's you know, a real collaborative environment.
00;44;33;07 - 00;44;44;03
Speaker
Did you have any close ties with, you know, universities or other medical examiner officers, or did you ever host people? They're like doing like little internships and things like that
00;44;44;12 - 00;45;12;14
Speaker
All the time. It was the training site. They did the fellowship program, six medical schools in the mid-Atlantic, but two in Maryland, Georgetown, G.W. Howard University Armed Forces University. There are a lot of people visiting from various places. You know, a lot of folks just wanted to come in and see how things were done, spend a day there, see how morning rounds and afternoon conference was done.
00;45;12;17 - 00;45;20;07
Speaker
But they did an awful lot of that. They took that that part of their mission very, very seriously.
00;45;20;15 - 00;45;23;16
Speaker
So, who is the chief medical officer at the moment?
00;45;24;21 - 00;45;40;14
Speaker
Stephanie Dean is the acting chief. She has been for a while. She's really very good. She's a wonderful person. I don't know what the plan is long term, but she's the chief right now.
00;45;40;14 - 00;45;43;27
Speaker
Okay. Well, let me ask you now post those CME.
00;45;43;27 - 00;45;46;25
Speaker
you are you do you have plans for writing?
00;45;46;25 - 00;45;51;14
Speaker
Do you have plans for books? Do you have what can you tell me about your plans at the moment?
00;45;51;14 - 00;46;08;25
Speaker
Yeah, I am. I'm working on the next thing, which is something I've been wanting to write about for years and years, about the events of January 13th, 1982, when Air Florida 90 crashed into the 14th Street Bridge.
00;46;08;27 - 00;46;39;08
Speaker
A lot of people remember that stunning video of the guys being rescued, the people being rescued from the water from a park Service helicopter. And most people don't know that just minutes after that airplane crash, the Deeks brand new state of the art subway system, the Metro had its first fatal derailment. So, the first responders had to handle two simultaneous disasters while the city was paralyzed by a historic blizzard.
00;46;39;11 - 00;46;44;05
Speaker
It's absolutely epic. And so, it's a lot of fun.
00;46;44;05 - 00;46;46;25
Speaker
Yeah, I'm sure that's going to keep you busy.
00;46;46;28 - 00;47;06;23
Speaker
I mean, you were you obviously did the presentation virtually at the Romanian conference, but do you get requested to do that sort of thing, like for other medical examiners or for other pathologist conferences and things? So, I think I mean, the story that you have to tell is kind of important and I've got to guess it's not it's got to be common throughout the United States.
00;47;06;23 - 00;47;31;24
Speaker
It is common throughout the United States. I have done a few. I really haven't been as aggressive. Is that the right word? Proactive in terms of marketing myself, I should be going to the name conference and the Association of Forensic Science and those sorts of things and doing more like Judy Melinek and a lot of other people.
00;47;31;24 - 00;47;55;11
Speaker
Do I should I have spoken at several conferences. The George Papa in Romania is very nice and has asked me to speak for a couple of years in a row. And thanks to you, I think I will be going to Bucharest next year. I'm looking forward to that and it would be great if we could hang out in Bucharest.
00;47;55;13 - 00;48;21;11
Speaker
But, you know, I absolutely agree that, you know, this is something that, you know, it's not limited to Maryland. And it's one of those things that, you know, most people the impression of forensic death investigation is based on these TV shows, and they think that they're infallible, that anytime somebody dies, there's this crew of well-trained professionals to come and they go to the scene and they come for evidence.
00;48;21;11 - 00;48;55;00
Speaker
And the fact that that doesn't happen, and the medical examiner's office is one of those things that most people will never have to deal with in their life, thankfully. And so most people don't. It's just not in their horizon. It's just not on the radar. And, you know, it's I, I do think it's a pressing issue nationwide and I'm absolutely all for more talking about it
00;48;55;26 - 00;49;10;15
Speaker
Well I. I certainly enjoyed your books and I'm just going to bring them up here on the screen. And for those who want to find out more, they can just go to Bruce Goldfarb dot com. I'm not sure if there's somebody somewhere else that they can go now you're on LinkedIn, too, I believe. Right. So
00;49;10;15 - 00;49;11;26
Speaker
I'm on LinkedIn.
00;49;11;27 - 00;49;29;19
Speaker
You can get me on Facebook. I'm on the Twitter X, whatever it's called. I think it's Bruce underlined. Goldfarb I'm on Instagram and my kids talk me into doing Tik Tok, so I'm all over the place.
00;49;29;19 - 00;49;40;25
Speaker
I'm all over. You've got Tik Tok, too. I got it pretty good, right? Yeah, I guess. I guess I got to do that too. I haven't quite done that one just yet. But look, Bruce, thank you so much for your time.
00;49;40;25 - 00;49;55;17
Speaker
I hope we do. I hope I see you in in Romania next year. It'd be great to hang out and talk some more. I hope you. I hope you do get out. I hope you get out and do more of these kinds of things, because I think there are lessons to be learned in a lot of the stories that you tell.
00;49;55;17 - 00;50;19;07
Speaker
And you know, for the people in the audience that are, you know, either forensic pathologists or working in that area, if you just even have an interest in early forensic science, and especially on the medical side, I mean, both of these books are a really great sort of coverage of the history. And then, you know, something that is more up to date in more recent times.
00;50;19;07 - 00;50;28;04
Speaker
So, look, thanks. Thanks for everything, Bruce. Great, great writing. I love your writing style. Really easy to read, pleasant read. And yeah, keep up the great work. I hope we can keep in touch.
00;50;28;04 - 00;50;30;10
Speaker
Thanks so much, Eugene. It's been a lot of fun.
00;50;30;10 - 00;50;31;15
Speaker
Thank you for having me.
00;50;31;15 - 00;50;39;11
Speaker
So, we're going to leave it at that. Thank you very much. I wish you all a very, very happy Thursday and hope to see you all soon. Take care. Bye.