Since the early 1970s, death investigations in Lexington County
have had the combined advantages of a coroner system and a
medical examiner service.
Dr. Guy Calvert, the founding director of Lexington Medical Center’s laboratories,
offered his forensic pathology expertise to Coroner Harry Harman in 1974,
during Coroner Harman’s first term in office. Dr. Calvert and Coroner Harman
worked closely in a wide variety of death investigations, establishing the
pattern of law enforcement advantages of a coroner system with the forensic
medicine expertise of a medical examiner system. As the Lexington community and
the LMC pathology group have grown, the advantages of this combined service
have become an important part of the hospital’s quality assurance program.
Pathology Associates of Lexington, P.A., the 10-member pathology group
at LMC, has played a critical role in the full spectrum of death investigations
and has served as expert witnesses in numerous homicide and accidental death
cases. Through these investigations, the group has played an increasing role in
LMC’s medical staff quality assurance program. LMC’s pathologists investigate
all manners of death to the full extent of inpatient medical autopsy studies
and submit complete reports to LMC physicians involved in the care of patients
within the coroner’s investigation.
Possibly uniquely in the United States, annual QA reports to the medical staff
indentify opportunities to improve care. Thorough investigations of infant
deaths have led to a significant decrease in the number of accidental infant
deaths (SIDS) in Lexington County, and a significant decrease in the number
of sudden, unexpected cardiac deaths. Observations of sudden cardiac death in
the coroner system led directly to LMC offering 24/7 STAT AMI profiling in
1994, which has significantly decreased the number of cardiac deaths after
discharge from a community medical center or ER visit. LMC was the first
hospital in the Midlands to offer this service. Similar results of death
investigations have prompted the urgency of physician office referrals of patients
presenting with acute coronary symptoms directly to a CMC or LMC’s ER.
By using coroner autopsy findings as a medical staff quality assurance process,
we have identified the absence of a personal physician as the single greatest
risk factor; refusal to seek medical care is the second most important risk factor.
Other survival benefits resulting from the coroner/medical examiner interface
include improvements in EMS intubation of critically ill infants, the evaluation
of prosthetic cardiac valve dysfunction and treatment of excess anticoagulant