The Illusive Autopsy Report

Is the autopsy report public record? That was a question I had at the beginning of this project, but didn’t research that intensively. Here’s a little more of the low down:

Autopsy reports are generally public records. There are exceptions for (1) deaths from natural causes not referred to the coroner and (2) reports pertaining to criminal litigation, and others as directed by court order or subpoena.

California law bars the copying of photographs taken for the coroner at the death scene. They are available for use only in a criminal action or proceeding that relates to the deceased, or as a court permits. So getting the photographs that accompanied Patty Vance’s medical examiner’s report is out of the question. I can’t say if photographs exist. They should. And probably it’s for the best that I don’t see them.

Most states exempt from disclosure law enforcement investigatory records. And often the autopsy report is considered one of these records. Just as it is considered a medical record in some states, which precludes it from being public information and is governed by privacy laws.

Whether a particular document can be withheld under this exemption in a particular state will depend on the circumstances. In addition, the scope of the investigatory records exception varies among the states. Some of the variations include whether the exemption:

1. is limited to active investigations or prosecutions (such as in Louisiana, La. Rev. Stat. Ann. § 44:19);

2. gives law enforcement agencies discretion to release investigatory records (such as in Mississippi, Miss. Code § 25-61-12) or entirely prohibits their disclosure (such as in Vermont, 1 Vt. Stat. § 317); or

3. restricts access only when certain factors exist, such as when disclosure would (a) interfere with enforcement proceedings; (b) constitute an unwarranted invasion of a suspect’s, defendant’s, victim’s, or witness’s personal privacy; (c) deprive someone of a fair trial; (d) disclose a confidential source or investigative technique; or (e) endanger the life or physical safety of law enforcement personnel (for examples, see laws in Alaska, Idaho, Illinois, and Kansas (Alaska Stat. § 40.25.120, Idaho Code §§ 9-340B(1) and 9-335, 5 ILCS 140 § 7(1), and KSA § 45-221(a)).

Some states also have statutes prohibiting disclosure of a record when disclosure would invade a person’s privacy. For example, Hawaii, Illinois, and Kansas prohibit disclosure of records that would constitute a clearly unwarranted invasion of personal privacy, and Kentucky law requires a court order before disclosing a record that would constitute a clearly unwarranted invasion of personal privacy (Haw. Rev. Stat. § 92F-13(3), 5 ILCS 140 § 7 (1)(b), KSA § 45-221(a), and Ky. Rev. Stat. § 61.878(1)(a)).

Other provisions may be relevant to whether these records can be disclosed in some states. For example, Washington prohibits disclosing information revealing a victim’s identity, without the victim’s authorization, if it would endanger a person’s life, safety, or property, and Florida prohibits disclosure of information containing a person’s confession until completion of the person’s criminal case (RCW § 42.56.240 and Fl. Stat. § 119.07).

Are autopsy reports available to the public? The cause and manner of death is a matter of public record and can be released, unless release of such information will hinder or harm an ongoing criminal investigation [Iowa Code 22.7(41)]. The remainder of the information contained within an autopsy report is confidential and treated as a medical record.

Obtaining California Autopsy Reports. … The pathologist then prepares a written autopsy report. An autopsy report is public record in California unless it is deemed to be confidential under public-records exemptions because it is being used in a pending criminal case.

What’s in a coroner’s report vs. autopsy report?

A coroner’s report is the report produced further to an investigation by a coroner identifying the deceased person, the date and place of death, and the causes and circumstances of death.

A coroner’s report is the report produced further to an investigation by a coroner identifying the deceased person, the date and place of death, and the causes and circumstances of death. In some cases, the report may also contain recommendations aimed at preventing similar deaths. This document is public and available to anyone who requests it.

Autopsy reports are appended to the coroner’s report. Other appended documents include the toxicology report, the medical record and the police report. Coroners use these documents to produce their reports. Access to these appendices is restricted and is allowed only if applicants can show that the requested document will be used to uphold their rights.

An Overview of Death Investigation

At all death scenes there are two scenes: location(s) of the incident and the body itself. If a crime is suspected, the incident will belong to the investigating law enforcement agency; and the body, together with all items on or about it, will belong to the medical examiner’s office. The agencies will work independently of each other with overlapping goals. The death investigator has certain responsibilities and a duty to pursue those responsibilities. The body is exclusively under the custody and control of the death investigator. Until they arrive on scene, no other person can touch, move, or remove the body or those items on or about it. The assessment includes complete photography, documenting wounds and injuries, or lack thereof, rigor and livor mortis, body position and relationship to the scene, and condition of the body due to postmortem interval and environment. If the body has been moved, possibly to a remote area, there will be another crime scene at the place the death actually occurred.

Medical records are a very important component of a death investigation and may be referred to in the autopsy report. In addition to medical history, these records may include mental health history, prescription and medication history, family history, and social history. It is important for the medical history to be shared with the forensic pathologist at the time of autopsy or as soon thereafter as possible. What might be seen as a fall and head injury at autopsy may instead be a spontaneous bleed with previous history and consequential falls.

Autopsies are valuable and are a component of a complete investigation, if one is performed. All violent, suspicious, unnatural, and unattended deaths are investigated (these account for a small percentage of reported deaths). A preliminary investigation, statute, and protocol will dictate if an autopsy is performed. The authorization of the autopsy depends on the circumstances of the death and the protocol of the medical examiner’s office. The autopsy consists of the gross external examination (detailed examination and documentation of the body), gross internal examination (detailed examination and documentation of the organs and internal body structure), toxicology tests, and microscopic examinations. The external examination is head to toe and includes measurements of all wounds, scars, marks, tattoos, and condition of the body and structure.

The internal examination is what is often thought of when “autopsy” is mentioned. This surgical procedure includes the in situ examination of the organs, removal of them with weights, and complete external/internal examination of the organs. This examination also includes the assessment of bullet trajectory, wound tracts, ligature markings, etc. One area of specific forensic pathologist training is wound (all injuries and trauma) examination. Specimens of each organ are collected for microscopic examination, part of the anatomical and clinical certifications preceding a pathologist’s forensic certification. At the conclusion of the autopsy the functions of the forensic pathologist and death investigator temporarily separate into two different tasks. The death investigator will submit his report, detailing the findings of his scene investigation, evidence review, and medical records review. The forensic pathologist will review the death investigator’s report and case file to finalize his autopsy report and certify the Cause and Manner of Death.

Autopsy reports are not casual or interesting reading material. They are very informative when reviewed with all concurrent investigative reports and evidence. All autopsy reports follow a general format as approved by the National Association of Medical Examiners (thename.org). Although they may differ in appearance, the general content format consists of: Diagnoses, Toxicology, Opinion, Circumstances of Death, Identification of the Decedent, General Description of Clothing and Personal Effects, Evidence of Medical Intervention, External Examination, External Evidence of Injury, Internal Examination, Samples Obtained – Evidence, Histology and Toxicology, and Microscopic Examination. When the autopsy report is reviewed by the lay person their focus is on the first four items, as these are the summary of the remaining medical details of the report. It is important to review the report and all of the information contained therein for the complete picture. It is also important to understand what is in an autopsy report before we can begin to decipher all the latent and patent information it contains.

Circumstances of Death

This section consists of one to two paragraphs briefly describing the perimortem circumstances as known at the time of autopsy. Autopsies are often performed within 24–48 hours of discovering the body, with the full medicolegal and law enforcement investigation ongoing, medical records have likely not yet been received or reviewed. This narrative is important because it summarizes initial investigative findings and hearsay reports of witnesses, it also includes evidence found at the scene, such as: projectiles, syringes, paraphernalia, disarray of the scene, vomitous, etc.

Death certificates and autopsy reports contain personal identifying information and clinical information protected under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. These documents are used, for example, by the families of the deceased for settling estates, bereavement and closure, and genetic counseling of relatives. Insurance companies, public health and law enforcement officials, and the legal community also have legitimate claims to this information. Critical ethical questions have not yet been settled about whether and when this information should be public and under which circumstances making this kind of information public incurs benefits, harms, or both. Additional considerations include which organizations—the media, academic institutions, or government agencies, for example—are best suited to interpret these questions and respond to them.

Legally, ethically, and clinically relevant, however, is that MEs and coroners are not “covered entities” under HIPAA. To be clear, all MEs are forensic pathologists in appointed positions, while coroners are elected officials. State-to-state variations abound: sixteen states do not have laws requiring coroners to have specific training requirements, and four states require them to be physicians though not necessarily pathologists [7].

AMA Journal of Ethics:

For example, in some states (e.g., Kentucky [11]), if a death is determined to be a coroner’s case, an ME or coroner has the authority to order an autopsy without obtaining consent from the deceased person’s survivors and to release information about the cause and manner of that person’s death to the public. Is this ethically appropriate, particularly considering the legal, ethical, and professional standards that typically apply to patients’ rights to have their PHI protected? Which protections should be afforded to the deceased and to a deceased person’s loved ones? How much value should be attributed to survivors’ distress?

O, BROTHER WHERE ART THOU?

After four years of waiting, Patty’s brother finally accepted my friend request. I think it’s her brother. His birth date seems right. I’m so grateful. Somehow his accepting translates in my mind to at least he doesn’t hate me. Or hopefully that means he’s not pissed at me. All he may know about me is that I wanted to step in and buy a grave stone for Patty because she didn’t have one. I’m assuming he’s the owner of the plot. He might have heard via the grapevine — meaning Holy Cross cemetery — because he bought and placed a stone finally.

Sadly, I haven’t been able to visit it. But it’s going to be the first thing on my agenda when I go back to visit California. That and talking to Detective C at the Hall of Justice. I don’t think he’d refuse to meet with me. But that is the fear. That speech I’ve rehearsed in my head a hundred times about how the police are basically in the citizen’s employ is destined to stay in my head. I’m too much of a coward to confront law enforcement.

While watching “Blue Bloods” last night, the daughter of the Police Commissioner, Niki Reagan, said that “you’re either on one side of the law or the other.” She didn’t mention how you could change sides. I’ve found myself shuffling off my in-your-face attitude that worked for me in my youth. Now I’m all deference and gratitude. I used to lump them together, now I realize there are just bad eggs in the bunch. I’ve been lucky that I haven’t rubbed up against any of those. 

I wrote a note to her brother asking him to confirm that it is or is not him. Maybe that’ll take another four years. Who knows. Still, I was hovering for a full day after I found out he’d accepted my friend request. I don’t even know what I’d ask him first. How did things turn out for her son? How were the last four years of Patty’s life during the time we were estranged? Clearly some of those years were not so great. I could say the same for myself. Did she push away her family like she pushed me away? Is there any fucking chance that her case is going to be solved? Maybe he has some inside knowledge, some hopeful tidbit since he is a police officer himself. Not only that, but a friend of Detective C. Or maybe he knows just as little as I do. I really just want to talk to him. 

15 Minute Rule

It’s been almost a year since I started volunteering for Street Safe, an outreach program for women living or working on the streets of Albuquerque. Two months into the gig in the middle of summer the Executive Director (ED) gave a presentation at the Santa Ana Star Casino about trafficking on the reservations. After the day was done I followed her around the casino.

We made a few loops around the gaming floor then sat on a ledge in front of a faux waterfall. It felt strangely peaceful. The ED pointed out suspected traffickers weaving between the slot machines all while she sipped on a chocolate milkshake. This was all in a day’s work to her. I, on the other hand, struggled to adopt her nonchalance, trying to appear as if I wasn’t staring. I badgered her about how she handled her job. Specifically, I wanted to know how to avoid getting attached to the women.

“When I was a medic, we had a 15-minute rule. Patch them up, and send them back out into the world. That’s all you can do.”

We are out in the heart of the war zone on Friday nights for two hours. It feels like longer some nights. Just two weeks ago I parked a half block away, encountering a trio hunched against the wall. One girl was using her hoodie to cover the crook of her arm while she shot up. I reined in the fixer in me and walked past. I recited the 15-minute rule to myself.

Then I tried to sort out why this bothered me so much. Here is one reason: There should be clean, safe, convenient, supervised rooms for girls like her. If Vancouver can do it, why not Albuquerque? Options for rehab — if a woman chooses to get help — even better.


B Side




Back in 1975 the civic center district of San Francisco was not the sparkling center of all things government and high culture it is now. The Plaza, with its chugging rows of fountains and pools gleaming with pennies, was a rectangle of turf littered with candy wrappers and take-out cups. With a keen eye, the odd hypodermic leapt out. The homeless camped out but were called hippies. It’s cleaned up in forty some years. The malingerers got shunted up to Larkin Street back in the nineties. Now it’s a picture of contrasts. On one side of the street a psychedelic dragon shod in sneakers guards the door to the Asian Art Museum. On the other, a row of tents hugs the wall of an abandoned building. I visited a couple years ago. It gave me whiplash walking past.

To ditch or not to ditch? That was always the question of the day for Patty and me. One day we were slumped against the gate on the Bay Street side of our junior high, sucking down a cigarette. My arguments against cutting school were half-hearted. 

“I don’t want to flunk eighth grade. But sitting in a hard chair all day? Ugh. What’s playing at the movies?”

Nevermind either way we’d be sitting in a hard chair all day. The real world was the superior education. Jack Kerouac said that. If I proposed the movies, Patty would smirk, code for “I’m in.” We were escapists of the first order. So it wasn’t technically the real world. A triple feature was the ultimate. If we had a dime bag of dirt weed, even better. 

A block from the rotunda of city hall sat a row of movie theaters clumped together on the south side of Market Street. We called it the movie district. X or XXX films were shaking their money makers with titles like Behind the Green Door and Deep Throat, but a few hold outs like the Strand and UA offered up PG fare. We’d panhandle four blocks north on Geary Street in the theater district then lug our coins back to the movie district. We were beneficiaries of the trickle down effect years before Reaganomics entered the vernacular. 

If we weren’t broke, we’d hop the 19 Polk and get dropped at the city center, choked with electric buses and trolleys (now considered “vintage”). Pedestrians rushed along the sidewalks. A few meandered. The crowd was buttoned up or buttoned down. Suits and ties. Or mini-skirts and love beads. A few holdouts from the 60s still roamed the downtown streets, plug eyed, but happy.

We lucked out this one day. Sparkle was playing on a double bill. It followed a girl group, Sister and the Sisters in 1958 Harlem. The plot braided three stories, but it was Sister we followed. We tracked her every move, the glimmer of the screen lighting up our faces, our fingers and shoes sticky with confection. We sat mezmerized, tensing our shoulders as Sister was lured in by the brutish Satin. We emerged from the theater, blinking in the sunlight. We were tired and sore.

“Sister sure was pretty.” I raised my voice over the buzz of traffic. 

“Yeah, she’s sexy. Why are we so flat-chested?” Patty pressed her palms against her breasts. 

“It doesn’t matter. Even when we grow some, we can never be like her.”

“Speak for yourself.” Patty hiked up her yolk-sized bumps of cleavage.

She looked disappointed.

This was San Francisco in the 70s. You could stroll the streets, flowers painted on your bare chest and not turn a head. Still, I was paranoid. I didn’t want anyone staring at us. When I scanned the crowd, no one was, proving my point that we were nothing special.

We hiked three blocks to the bus stop gabbing about Sister and her style. Neither of us could pull off a white gardenia behind the ear. The girl group eluded to The Supremes, but the parallels between Billie Holiday and Sister smacked you between the eyes. 

As soon as I got allowance money together we descended on Tower Records in North Beach, a mega-store one block from North Beach. From the parking lot we smelled fish, poking our noses in the air like alley cats. The odor wafted from the docks at Fisherman’s Wharf — the vats of steaming crabs and brackish water. I bought the album Sparkle with change to spare. Aretha Franklin glowed on the cover, wrapped in white and encircled by a metallic silver frame. She looked dignified, as if her image could be minted onto a coin. We fought over who’d hold the album on the bus ride, each of us tugging at a corner of it. 

At Patty’s house, we leaned out her window smoking, listening to the songs. We spead out on her double bed — our raft. We borrowed two white slips from her mother. Patty stashed a pair of her elbow length gloves behind her training bras in a drawer. During the A side of the album she was Sister. I was Sister on the B side. We gestured the moves we remembered from the movie, fishtailing our arms and wagging our hips.“I Get High,” Sister Williams’s lament about her descent into heroin addiction made me shutter. The line “woke up this morning, looking back over the darkness of my life” nailed my very own mornings. It was a rarity to wake up without a cloud bank bearing down on me. 

“I don’t see why I can’t be Sister all the time. You can be Dolores.” Patty refused to give up the gloves.

We both stared down at the record player needle stalled at the end of A side.

“It’s my album.” I tugged at the gloves.

Her face arranged itself into an expression of mock hurt. I relented. The hypnotic beauty was too hard for me to pull off anyway. Besides, I resembled Dolores more, the shy, self righteous sister. I was a B side. I was the inferior one. Not in a bad way. Just in the way that everyone can’t always be hit material. 

Sister’s funeral half way through the film never came up in conversation between Patty and me. We didn’t question our fixation on her. Today we might discuss her as a popular culture trope, the self-destructive woman. We might point out we weren’t alone in being seduced by it. We’ll never have that talk.

Now I see that over-the-top worship as a sign, albeit a flickering one. It wasn’t long before we slid into self destructive behavior ourselves. Not together, but each of us on opposite ends of the city. We yearned so desperately for happiness we tried to slam it into our arms. Needless to say we didn’t find it. I nodded off during a Chemistry exam my junior year capping off a less than stellar semester. I dropped out the next day. Patty was dead a year later.

I accepted that I’d never turn heads the way Sister did. But we had one thing in common. When it came to men I was every bit like Sister. I understood getting your signals crossed. Just like Sister, I didn’t know love from cruelty. 


Going Deep


To say something goes deep or runs deep, you mean that it is very serious or strong and is hard to change. As in “his anger and anguish clearly went deep.” The phrase “go deep” has been cropping up in my writing circles. In this case it means something different. It means to plumb the depths of your emotions. It is the trumpet call to explain more fully — in feelings — why I’d want to pursue getting Patty’s cold case solved, let alone write about the experience. “We don’t understand why you’re doing this,” is a close paraphrase of what people say. Or “are you guilty about something?” 

I told the instructor of one group that only law enforcement understood. That wasn’t completely true. My cousin, an artist, has never asked me to provide a motive. I asked that same instructor if she had some motive in mind already, practically begging her to tell me what readers expected me to say that I hadn’t already. She expressed an understanding of how close I was to Patty, that our tight friendship was motive enough. And yet. The subtext during our next conversation was “go deeper.” It’s true more than a month had gone by since we last spoke about it, but that was long enough apparently for the question to arise once again. “It’s still not clear,” she said.

If I claim it is just my doing a good deed, it is not satisfying. I wonder how much of our culture of oversharing is responsible for the expectation that if you’re writing about your life, you are expected to turn yourself inside out? 

The instructor had just finished reading Lidia Yuknavitch’s The Chronology of Water, and agreed that she had gone deep. We are all not as brave as that. 

If I claim I am a fixer, a rescuer, it is not satisfying. I am trying to come up with a take on it that resonates with today’s reader. Are we not a psychologizing people? It is one thing to admit that maybe I was attracted to other teens because I believed I could rescue them back when I was too young to give the behavior a name. But to attribute my trying to get someone to look at Patty’s cold case to fixing is a stretch.

Every writer that is chronicling the true details of his or her life has to decide to what include and what to omit. It is not as though I am consciously skirting an admission, only thinking about what I owe the reader and what I owe myself. 

Whose Story Is It Anyway?

During a conversation with a person critiquing the chapters I’ve written so far, the subject of whether or not the Vance family supports my efforts to get Patty’s story out came up.

I didn’t start to write this story in order to reopen old wounds for the family. As far as I know her two brothers and her son are the only immediate family still around. The last thing I’d want to do is add to the trauma they’ve already suffered. I recently discovered there is a niece of Patty’s, her brother John’s daughter. My intent is not to bring up any uneasy feelings for her either.

Anyone who cared about Patty would want attention drawn to her case. I have to say that I doubt much attention is a result of my blogging about a book I hope to write. The dream is that the book itself might lead to someone coming forward — a witness to the crime — not that the book leads to any sort of embarrassment or shame about Patty and her life choices. Yet there are pieces of her story I thought needed to come out because perhaps they might trigger someone to remember her, or to recall that they witnessed her tragic murder. 

I was recently speaking to a writer friend of mine and she asked about the details of the case. She kept coming back to the fact that there MUST have been witnesses. The chances that no one was around in that generally busy neighborhood in San Francisco at that time of night are minuscule was the way I interpreted her point. Perhaps I’m not being realistic, but I’m anticipating that there will be a larger audience for my book than there is currently for my blog. If word can get out, maybe there will be some movement on the case.

Part of why I feel this is my story as well as Patty’s story is that I’m using this opportunity partly to crack open what exactly happened to us and between us. I was one bad decision away from leading the same sort of lifestyle she led. Yet I didn’t. There was more than one occasion when I considered what it would be like to make the “easy money” involved in sex work. Just like the gambler who never talks about his losses, it seems no one I’ve known involved in the business wants to talk about the downfalls. The conversations are always about how difficult it is to turn down the windfall that comes from selling sex, or partaking in the presumably less risky off shoots of sex work — dancing and porn. 

My thoughts were often about the pitfalls. The same impulse that made me shy away from taking up hard drugs kept me from chasing the easy money. I pictured the worse case scenarios and could never make the plunge. If I fast forwarded my life on drugs, I’d imagine myself homeless, or left with only half an arm. I thought if I injected intravenous drugs it would inevitably lead to infection and amputation. If I spun out a reel of my life as a prostitute, there was always a scene in which I was beaten and raped. I was just too damn scared to venture down either of those paths.

There is much talk about how women are forced to prostitute themselves for economic reasons. I can’t help think that there were other options for Patty. But I also know that this was likely her mindset. Sure, she wasn’t living in a developing country having to feed a brood of children. But she was a young mother who struggled with drug addiction in a town that was somewhat expensive even back in the 70s. Likely such was her skill set that she didn’t feel she had a ton of options. All this is a long-winded way of saying that she probably felt desperate, that the drugs got the better of her and she wronged people she would never have wronged. I don’t judge her and am hoping others won’t either. She was a good person who got caught up somehow in behavior that likely ended up sealing her fate.

This book is partly about the meaning of friendship, of forgiveness, of compassion. Also what betrayal meant to our relationship. Is writing this book and blog I’m committing the ultimate betrayal? I hope not. I hope I’m not in denial about my motives. I’d like to think my motives are pure. My apologies to her family if that’s not the way they see it. 

Medical Examiner’s Report

I was floored when this week I got an email from the Albuquerque Medical Examiner’s office saying that they’re going to review Patty Vance’s autopsy report. I submitted it along with a request that someone in their office might summarize it for me back in October. I was being patient mostly because they’re doing it as a courtesy, and I know that you can’t get law enforcement response times of this sort in a speedy fashion.