The head of the medical examiner's office that performed the first autopsy on Michael Brown supports a state law change that would require autopsies for anyone who dies while in custody, including those who are executed.
Dr. Mary Case is the chief medical examiner for St. Louis County. She also is a pathology director at St. Louis University School of Medicine, where she is co-director of the division of forensic pathology. Her office autopsied Brown, the black teenager who was shot and killed by a white officer in Ferguson on Aug. 9, sparking weeks of unrest.
"If it were in my county where they were having an execution, I would demand" an autopsy after the execution, she said.
Case said a post-execution autopsy would help resolve claims of brutality or botched executions. "That's why they need to be autopsied," she said. "It protects everyone's interests."
Missouri is one of the few states that does not perform autopsies after executions, she said.
She said she has asked why they aren't performed in Missouri, and the answer she gets is: "Oh, we know why they're dead."
But, she countered, "I don't think that's a very good answer. If somebody's dying and they are in the custody of the law, those people need to be examined. That's kind of a primary principal in forensic pathology and medical examiner work. Because these are the (cases in which) people may raise issues.
"So we want to have the answers. And if you don't autopsy, then you won't have those types of answers," she said.
Dr. Gregory G. Davis, president of the National Association of Medical Examiners (NAME), said his organization probably wouldn't vigorously support or oppose Missouri legislation requiring autopsies for people who die while in custody, or after being executed.
He said medical examiners should - and do, in all states as far as he knows - have the discretion to perform autopsies in those situations.
Davis said early in his career, he was taught that autopsies always should be conducted in such situations. But he said experience has taught him and other medical examiners to rethink that philosophy.
"If they die in an infirmary of leukemia, or lymphoma, and the family's not (questioning that), then I don't perform autopsies," he said. "I prefer the latitude to decide on a case-by-case basis."
Both Missouri Senators Mike Kehoe, who serves on the Joint Committee on Corrections, and Bob Dixon, who chairs the Senate Judiciary and Civil and Criminal Jurisprudence Committee, believe in giving medical examiners the authority - but not requiring them - to conduct autopsies in such instances.
Missouri law requires the Department of Corrections (DOC) to have autopsies performed when offenders die "under violent or suspicious circumstances or apparent suicide to ascertain as nearly as possible to cause of death."
The department and the governor's office declined to say whether they would support a state law change.
The Senate Research office couldn't find an instance of such a law being proposed in Missouri. In 2001, an unsuccessful bill sought to require DOC to post inmate autopsies on its website and provide a copy to any member of the Legislature upon request.
Alex Friedmann, associate director of the Human Rights Defense Center, said his group supports the requirement for autopsies for anyone who dies in custody, including those who are executed.
"I think any time the state takes the responsibility for holding a person and that person dies, then the public has the right to know the circumstances under which that person died while in custody," he said. "There should be no question about that whatsoever."
He said autopsies can determine many things. "It shows the condition in which a person lived just prior to their death, whether they were brutalized, had bruises on their body, suicide attempts, perhaps displayed from cuts on the wrist," he said. "It shows the number of times prison officials tried to introduce the needles in lethal injections."
Many times, he said, prisoners have collapsed veins from years of drug use and prison officials have to stick them repeatedly to find a usable vein. Other times, the needle goes through the vein, and the lethal drugs are injected into the muscle, which slows their effectiveness and lengthens the time of the execution.