Inside Track: Focused beyond the tragedy
Stephen Cohle’s interest in forensic pathology led him to accept the job of Kent County deputy medical examiner in 1982.
Dr. Stephen D. Cohle’s work day often entails things people don’t want to contemplate.
As chief medical examiner of Kent County, he has performed several thousand autopsies and has overall responsibility for the investigation of all deaths that are sudden, unexpected, violent, suspicious or unnatural. He has appeared in court to testify several hundred times.
The department is still working on its 2014 annual report, but according to the Kent County Medical Examiner Office’s 2013 annual report, there were 5,468 deaths that year. The M.E.’s office was contacted regarding 1,518 of them, which ultimately required 296 autopsies.
Cohle confirms he has often been asked “The Question” by friends and relatives: How can you do a job that entails so much tragedy?
“I focus on the problem-solving aspect,” he explains. “You accept that it’s a tragedy but you have to objectively focus on the answers wanted by the family and society.”
The goal of an autopsy is to determine how the individual died and what led to the death. Sometimes, the information can prove invaluable to the family of the deceased.
Undiagnosed heart disease, for example, is a common cause of sudden death, and in some cases, it is found to be an inherited disease. Medical examiners then are able to alert family members they are at risk, said Cohle.
STEPHEN D. COHLE, M.D.
Cohle is a native of Carthage, Mo. His father was an M.D. who specialized in internal medicine and was a role model for his son. In 1972, Cohle graduated magna cum laude from William Jewell College in Liberty, Mo., where he studied chemistry and biology. About halfway through his years there, he landed a summer job in a local hospital as an orderly and ambulance driver. He enjoyed it so much, he decided to go for a pre-med degree — but later, his application to a medical school was turned down.
At that point, Cohle became one of millions of young American men who suddenly were profoundly impacted by a number. His was 46.
In late 1969, the Vietnam War was raging and the U.S. government was in need of draftees to serve in the Army. The government decided to eliminate student deferments and, on live television, drew capsules out of a drum. There were 366 capsules, one for each day of the year plus one for the extra day in Leap Year. The order in which a young man’s birthday came up was his draft number; it was generally understood that numbers one through 120 or so would be drafted — “I was going,” Cohle said.
He quickly decided to enlist in the National Guard, which would take him away from his pursuit of a graduate degree for just one year of active duty, whereas being drafted into the Army was a two-year commitment.
His goal was to earn a Ph.D. in anatomy, but when he reapplied to medical schools, he was accepted by two. He enrolled at the University of Missouri in 1973 and completed his medical degree in 1977. He decided to specialize in pathology to utilize his interest in anatomy.
Before he began his residency at Baylor College of Medicine in Houston, Cohle worked for several weeks in the Dallas County M.E.’s office, going to death scenes with the investigators at all hours. During his four-year residency, he and another student shared a weekend moonlighting job at another county M.E.’s office.
“Those cases were incredible,” says Cohle, and led him to specialize in forensic pathology. “Forensic” pertains to legal proceedings.
“In forensic pathology, we see the unusual cases. The usual cases don’t come to us.”
In 1982, Cohle was offered a job as deputy medical examiner in Kent County. He liked what he saw when he came to interview.
“I wanted a well-established medical examiner system,” he said, although he was not looking for the top job. “I just wanted to be a worker bee,” said Cohle.
He figured he might stay in Grand Rapids a few years before moving up the career ladder in a larger market such as Detroit or Chicago, but, he said, “The community was unexpectedly receptive and supportive, and there were fascinating cases to work on. I didn’t expect to be here 33 years later, but here I am,” he said.
In 2002, his boss, Dr. Douglas Mack, retired after 25 years as Kent County’s chief medical examiner. Another doctor replaced Mack but soon resigned and was replaced by Cohle.
For decades, Cohle occasionally has been called upon by other counties to take challenging cases because there are relatively few forensic pathologists in Michigan. In Kent County, there are only two: Cohle and his deputy chief medical examiner, Dr. David Start. Most counties don’t have a forensic pathologist “because there are not enough cases to make a living. Kent County is an exception,” he said.
Only two individuals out of seven or eight who work for the Kent County Medical Examiner Office are employed by the county. Most are medical professionals who work as death-scene investigators on an on-call contract basis. Kent County has budgeted almost $1.3 million for the office this year, and contracts for its M.E. services from Spectrum Health. Cohle is a member and shareholder of a physicians’ group under contract to Spectrum called Michigan Pathology Specialists.
Mack was not a pathologist; he was a public health physician. Back then, said Cohle, in many small counties the chief medical examiner was also the county public health officer.
Most people, said Cohle with a slight tinge of exasperation, “don’t know the difference between a medical examiner and a coroner,” and that sometimes includes the news media.
“Here’s the deal,” he said. “In Michigan there is no such thing as a coroner. Coroners were eliminated from the state law in 1973. They were replaced by medical examiners.”
Coroners are elected, and in most states, “they can have any kind of background” — they do not have to be a medical professional, according to Cohle. In Indiana, which has coroners, “you have to be 18 and have a driver’s license in order to run for office,” he said. In most states with coroners, a pathologist must be hired to conduct the autopsies.
Being elected can involve an element of politics. For instance, a politically connected individual might pressure the coroner to rule the death of a relative an accident rather than suicide.
“I feel we (in Michigan) are independent of the political end of the spectrum,” said Cohle.
In Michigan, medical examiners must be licensed physicians and are appointed by the county board. However, they are not required to be forensic pathologists “and they don’t have to have any death investigation training,” said Cohle.
In some of the state’s rural counties, the M.E. might be a general practitioner and may make mistakes in a death investigation, not knowing what to document and not always being aware when they need to ask for an autopsy.
And things keep changing. In Kent County, there is a “huge uptick” in cases of death by drug overdose, Cohle told the Kent County Board of Commissioners in June. He said there were 55 accidental overdose deaths in 2014, but this year that number was 24 in just the first quarter. Last year’s first quarter had 13.
The No. 1 overdose killer is heroin, followed by painkillers and cocaine. Cohle said there also is “a plethora of designer drugs” with dangerous consequences. The problem is the challenge facing toxicity labs to keep up with new drugs.
Like the need for police and firemen, human nature guarantees there will always be work for the medical examiner.