The difference between a policy and a law in state government is that the former can be ignored or altered, depending on who is in charge, and the latter carries the weight of the Legislature and the governor’s signature.

Lawmakers are looking to pass legislation aimed at ensuring autopsies involving children under the age of 2 receive the most professional scrutiny possible. To some people, this might sound callous, given how tragic and terribly emotional the deaths of young children are for parents and families. But instances of suspicious or unexplained deaths of infants require the highest degree of certainty possible. That means bringing in the chief medical examiner to review the autopsy and any related evidence after such a death.

The issue is being driven, in part, by parents and lawmakers who have seen cases in which an associate state medical examiner either failed to determine a cause of death or concluded initially an infant’s death was homicide, but later changed the ruling to undetermined. In one high-profile case, a nanny was charged and found guilty of homicide of a child in her care in Cambridge who had just turned 1. 

The nanny was sent to prison, but the associate medical examiner who did the autopsy later revised her opinion to an “undetermined” cause of death after pretrial conversations with medical experts on the nanny’s defense team who offered other explanations for the toddler’s death. After that medical examiner decided on her own to change her ruling, prosecutors dropped charges against the nanny, who was released after two years in prison and returned to her native Ireland.

Dr. Mindy Hull, the chief medical examiner, told two lawmakers a few months before the pandemic hit that “she didn’t think this should be part of her responsibility” to be the ultimate sign-off on such autopsies, according to State House News Service.

But Rep. Marjorie Decker, D-Cambridge, who filed the bill with Sen. Cindy Friedman, D-Arlington, and Rep. Sheila Harrington, R-Groton, said Monday the number of cases involving children under age 2 are very small and she believed the chief medical examiner must be the ultimate authority.

“Absolutely, the chief medical examiner’s office has the bandwidth to do this, and the fact that the highest-paid public servant in the state of Massachusetts did not want the responsibility to do this means that, because the administration won’t move forward with this, we are moving forward with this as a bill,” Decker told the news service.

The Office of the Chief Medical Examiner did implement a new policy in 2020 that requires any medical examiner who conducts an autopsy in a case with a child that young to present the findings to a group of peers, including either the chief or deputy chief for feedback before signing the death certificate, the news service reported. The chief is not explicitly required to grant approval on every finding. If an examiner wanted to amend a death certificate, he or she would have to go through a similar process.

That policy is good as far as it goes to ensure one of the higher-ups reviews an underling’s findings. But this is where a policy – which is subject to change by those who set the policy – differs from legislation. 

Decker, Friedman and Harrington want the final review and sign-off squarely in the hands of the head of the Office of the Chief Medical Examiner. As Decker pointed out, cases involving autopsies on infants are, thankfully, fairly rare, so this responsibility shouldn’t be seen as an onerous task on the person at the top – in this case, a chief medical examiner whose gross salary in 2020 was more than $395,000, according to state payroll records.

“This is a small ask for a very important issue, and I think it will especially help those that find themselves in this terrible situation as parents,” Friedman told the news service.

We agree, and believe the Legislature should pass this bill (H 2261/S 1439) and the governor should sign it into law. That, too, is a “small ask” to ensure the right thing is done for grieving families.

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