Note: This article originally ran on June 4, 1989 as part of the AJC’s award-winning “Suffer the Children” series.
In Georgia, you can get away with murder if your victim is your child.
Crass as it may sound, if you strangle or smother your infant with a pillow, tell your local coroner the child has recently had a cold, and act distraught, coroners in many Georgia counties will bypass an autopsy and mark the death certificate as pneumonia or sudden infant death syndrome, medical experts say.
"Georgia still has one of the most archaic death investigation systems in the nation," said Dr. Joseph L. Burton, medical examiner of five metropolitan Atlanta counties and a child abuse expert.
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Revamping the state's coroner system would be a first step toward understanding why such children die in Georgia and perhaps preventing some of those deaths, say some child welfare experts and medical examiners. Specifically, they say, the state's elected coroners should be replaced with a medical examiner's system of trained forensic pathologists.
"If we had a really good medical examiner's system in this state, we could probably tell something different about these questionable cases," said Gerald V. Gouge, chief of the state Child Protective Services Unit. "It's always surprised me that we don't get more deaths that are caused by abuse or neglect."
Outside metro Atlanta, the majority of Georgia's counties rely on elected coroners to determine whether the cause of death is natural, an accident, a homicide, suicide or undetermined. To be a coroner, candidates need only have a high school education, be at least 25 years old and have no felony convictions.
"There have been service station attendants, people who are legally blind, people who will not touch a dead body who have been coroners in Georgia," said Dr. Burton, one of a handful of the state's forensic pathologists, specialists trained in the legal and scientific investigation of deaths. "Yet these people technically have the power to put on that death certificate a cause of death and a manner of death. And they have the power to ask that an autopsy get done or not get done."
According to Dr. Burton, the coroner of one central Georgia county signed off 95 percent of all deaths as heart attacks. The rate is generally 40 percent to 45 percent. In another county, the white coroner routinely attributed the deaths of black babies to neglect, he said.
In the deaths of most children, it is imperative to conduct an autopsy to determine the cause, experts say. Unlike adults, most children don't die of disease or readily apparent natural causes. Yet according to records kept by the Department of Human Resources, of the 1,601 Georgia children under 7 who died in 1987, only 37 percent were autopsied.
A report last year by the statewide Council on Maternal and Infant Health found that "a majority of postneonatal deaths outside urban areas in our state are not autopsied. There is no autopsy system, nor rules and regulations for the performance of death scene investigations, and no required qualifications for those performing autopsies."
One reason coroners skip autopsies is to spare the family. "The death of a child is very traumatic to the family," Dr. Burton said. "The people involved with the investigation - whether law enforcement or coroners - tend to try to find an excuse not to do the autopsy."
Another reason is politics. Small-town coroners are susceptible to the wishes of their constituents. According to Dr. Burton, state senators and "people higher than that" have often asked him to waive an autopsy and spare the family.
"A great number of the coroners own funeral homes locally," Dr. Burton said. "If you're in a small Georgia town, and you own the funeral home, and you're the coroner and you've buried everybody in that county for 20 or 30 years, politics are thick."
That type of political pressure, he said, could be responsible for an unknown number of mislabeled children's deaths.
In some cases, Georgia children whose deaths are blamed on natural or accidental causes in fact may have been murdered.
"I think the biggest problem is that children are so easily killed without leaving any sign," said Dr. J. Byron Dawson, director of the State Crime Lab in Atlanta. "Just cover their mouths with your hand, put a plastic bag over their heads, no problem."
Children can be easily strangled, suffocated, poisoned or even drowned in a bathtub with little or no detection, say forensic pathologists. Even an autopsy may not reveal the cause of death, making death scene investigations particularly crucial to any questionable death of a child.
"You can have the same autopsy findings, but based on the circumstances, one can be labeled natural and another an accident," said Dr. Joseph H. Davis, Dade County medical examiner in Miami.
Illinois and Minnesota are among the states that have recently enacted laws outlining protocols for investigating all questionable children's deaths, including a thorough death scene investigation and autopsy.
Under the Georgia Post-Mortem Act, a coroner must contact his local medical examiner whenever the cause of a death is in question. It is then up to the medical examiner - usually a local physician with little training in pathology - to decide whether an autopsy is warranted.
But in Georgia, the question of a child's death often stops with the coroner.
In cases where coroners don't seek the advice of a physician, they clearly "are not abiding by the law," Dr. Burton said. "Seventy-five percent don't abide by the letter of the law."
Thomas L. King, president of the Georgia Coroners Association and coroner for Columbia County, disagreed. Mr. King, who operates a funeral home, said he did not know why so few children in Georgia were autopsied. But he said, "Most of us do what we're supposed to do. I'd say 95 percent of the coroners do what they're sworn to do. But you do have some bad apples. And it makes a name for the rest of us."
He said the deaths of children increasingly are being recognized as tricky situations for coroners. Last year, half of the coroners' 16 hours of required training was devoted to the detection of child abuse homicides, Mr. King said.
A major stumbling block is a shortage of pathologists willing to do autopsies, he said.
Nationally, there are about 500 forensic pathologists such as Dr. Burton, and in Georgia there are fewer than 10, Dr. Dawson said.
The state pays only $450 per autopsy for a coroner's case, and it is not worth most pathologists' time, said Mr. King. As a result, most counties refer autopsies to the State Crime Lab, which currently has no forensic pathologist. Among those who perform the procedure are a chemist - Dr. Dawson - and a biochemist.
"Georgia is the only state in the country and the only jurisdiction in the Western world that allows non-physicians to do autopsies," said Dr. William R. Anderson, an associate county medical examiner in Naples, Fla., who formerly worked as a pathologist in Georgia.
Dr. Dawson agrees that the Georgia coroners system may be in need of a statewide facelift.
"You're probably looking at the vestiges of a system that's about to change," he said. "Pay attention to what's going on in Georgia in the next six months. We're going to embark on a new era of death investigations in Georgia, which I think will eventually wind up with regional medical examiners scattered around the state. It will be a tremendously slow, expensive undertaking. But we've got to change [because of] the sheer volume, and it's time this system moved forward."
According to Dr. Dawson, these regional medical examiners would be trained in pathology and capable of doing their own autopsies. Such a system is already in place in most states.
The coroners may be reticent to embrace the change, however, and they are not without political influence in the Legislature. "I would have a problem with the regional system," Mr. King recently said. "Because of the expense of it. It would cost the taxpayers."
