A Bitter End, part 4: The pro-life coroner

In print, this story was split across more than one issue because of its length. Online, we've split it into six chapters: 

1. The very old man who wanted to die
2. The hospice
3. The overdose
4. The pro-life coroner
5. The strange prosecution of Barbara Mancini
6. The legal land mine, undefused

Or you can read the story as a single page. 

Part 4: The pro-life coroner

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On the TV series Homicide: Life on the Street, a detective puts it this way: “You go when you’re supposed to go, and everything else is homicide.”

But that’s not technically how it works. There’s five government-recognized manners of death. There’s natural, accidental and undetermined. “One that was initiated by the own person, that would be a suicide,” says coroner Moylan. “A homicide is a death that has been influenced by the hand of another person.” Only homicide results in prosecution.

In many areas, including Schuylkill County, the coroner is an elected official who isn’t required to be certified as a pathologist or medical examiner, nor have any special medical qualifications — the previous Schuylkill County coroners were a retired state police corporal and a funeral director. Smaller counties, where there’s fewer reasons and resources to retain a comparatively rare medical examiner full time, tend to use the coroner system. In most cases, the coroner outsources the actual death examination, but retains the right to make the final decision on the cause and manner of death.

Dr. Moylan has more medical qualifications than most coroners; he’s an oncologist with degrees from MIT and Georgetown Medical School, and has used his specialization in radiology and his own equipment and offices at the Simon Kramer Institute to do what he calls a “virtual autopsy” — using multiple CAT scans to put together a 3-D image of a body. Moylan’s not a medical examiner or pathologist, though — in passing, he mentions six manners of death rather than five, although he correctly identifies five shortly after.

Two years after being elected Schuylkill County coroner, he set his eyes on an ambitious prize: the U.S. House of Representatives. Moylan, who describes himself as “a Constitutional Conservative, and proud of it,” last month defeated two opponents in the Republican primary and is now preparing to challenge incumbent Democrat Rep. Matt Cartwright for his seat in Pennsylvania’s 17th Congressional District of Pennsylvania in November. (Incidentally, Harrisburg Republicans gerrymandered the 17th so hard in 2010 that articles about the race include lines like “Moylan dismissed the idea that the district is unwinnable for a Republican.”)

Moylan announced his candidacy on The Sam Lesante Show, a conservative-leaning talk show produced and broadcast in Northeast Pennsylvania, two months after he signed the final report on Yourshaw's death. On The Sam Lesante Show, Moylan said:

“What has motivated me to throw my hat in the ring … is the sanctity of human life. That’s why I get up in the morning and go to work, because I believe in trying to extend people’s lives,” Moylan told Lesante. “When I ran for coroner, I ran as a pro-life coroner.”

“You might say, ‘What the heck is a pro-life coroner?’ It’s important that every decision you make as a coroner to determine the cause and manner of death — how does that affect the sanctity of life? So I’ve done that for the past year and a half.”

Moylan is a practicing Roman Catholic, a religion which was using the terms “sanctity of life” and “pro-life” before they were cool. After Roe v. Wade, evangelical Christians adopted and popularized the terms in reference to abortion, but the official Catholic definition encompasses not just abortion, but contraception, suicide, euthanasia, embryonic stem-cell research, capital punishment, and any other “unauthorized usurpation by human beings of God’s sole lordship over life and death,” as Avery Cardinal Dulles put it.

Moylan’s said that his primary campaign issue is “the sanctity of life.” When asked what that phrase means to him in a telephone conversation, Moylan requests a minute to get some prepared notes: “I’m going to give you my expanded definition of ‘pro-life.’” There’s a long pause filled with sound of rustling papers, then he picks up the phone again.

“The most precious thing on the planet is human life,” he says. “To me, a pro-life agenda would support the protection and improvement of human life in all its forms. … One example of that would be the unborn humans, and their rights to be born and nurtured.”

But that’s only one example of what he thinks of as “pro-life,” he says. It means much more than that. “If you’re going to preserve life, health, liberty and happiness, education’s got to be emphasized … and we have to protect the people from crimes, terrorism, insults, discrimination and also national disasters.”

Asked for examples of decisions he’s made as coroner to protect the sanctity of life, Moylan cites several that are just broad, secular and synonymous with “good” as the latter half of his definition of “pro-life.” Acting as a voice for prisoners who died while incarcerated, for example, or the case of the woman who’d had a heart attack while driving and crashed her car — Moylan identified that she’d had a rare genetic heart condition, and was able warn her children to get tested for it.

He does agree that in today's political conversation, the primary meanings of “sanctity of life” and “pro-life” do not involve prisons or genetic screening, and that viewers of a conservative talk show would have assumed he was talking about abortion. Moylan says he believes faith does have a place in science, but declined to give specific examples of cases where his religious beliefs directly impacted a cause-and-manner-of-death decision. He says that faith had nothing to do with his judgment in the cause and manner of Yourshaw’s death.

“I just read the causes that came from my pathologist, Dr. [Rameen Starling-] Roney. What did the patient die of? Morphine poisoning.” Moylan says he also merely agreed with and certified Starling-Roney’s judgment on the manner of death being homicide rather than suicide. “His analysis, after poring through copious records, was that this man died at the hand of another human being. And that’s what was submitted. It had nothing to do with religion.”

Moylan refers to Starling-Roney as “a high-paid consultant” whom he called in “to look the case over, analyze it, and give me his considered opinion. … to allow an impartial determination.” However, it is not clear how this would have been different from any other case. Moylan says he did not recuse himself in any way from his usual role in the process. He would have had to outsource the autopsy regardless, and often uses Starling-Roney’s company, Forensic Pathology Associates in Allentown. (FPA said nobody there could comment on the case.)

In fact, records show that Moylan and Captain Durkin were present at Yourshaw’s autopsy, though each works about an hour’s drive away. Moylan says he recalls being there, but not what was discussed. The section of the autopsy report dealing with the circumstances of death, which is the information Starling-Roney would used to determine manner of death as homicide or suicide, reflects that much of the information he was working with was hearsay that Mancini never had a chance to deny.

Starling-Roney notes that Yourshaw “reportedly had suicidal ideations” without saying where that had been reported — Yourshaw’s hospice charts don’t say that he was suicidal until the day he attempted suicide. Starling-Roney also writes that Yourshaw “asked his daughter (who is a nurse) to give him morphine so he would die.” Mancini, again, vehemently insists she never said anything like “so he would die," and that it got into the official record in something like a game of Telephone.

This all may seem nitpicky and semantic. But in the legal system, semantics have enormous power. Subtle shades of meaning are what law enforcement uses to determine things like manner of death. And when you write down “homicide” or “suicide,” like writing down “dementia” or “suicidal ideations,” it’s often just accepted without question down the line.

For example: Durkin was asked in court if he’d reviewed Yourshaw’s medical records. He said he had, but “I'm a policeman, not a doctor or a nurse, and a lot of that really means nothing past the first line that cause of death was morphine toxicity,” he says. “I'm not a doctor. I leave doctoring to the doctors.”

Moylan declined to share his beliefs on assisted suicide, but did share an anecdote from when the case was getting a lot of media attention. “A doctor friend called me up and said, ‘Dave, what’s the matter with you people in Schuylkill County? You had an old guy —’” Moylan pretends to cut his upset friend off midsentence. “‘Oh, by the way — what type of cancer did [Yourshaw] have?’ You know what I had to tell him? He didn’t have any cancer. He didn’t have any cancer! His ailment was taking 93 orbits around the sun, that was his problem.”

“And then my friend said, ‘Oh, sorry to bother you.’ He thought the guy had a fatal disease that we weren’t treating properly with adequate doses of morphine. That wasn’t the case.”

To be clear: Yourshaw did not have cancer. But like everyone admitted to hospice, he had to have to doctors agree that he was dying and had fewer than six months to live. His terminal diagnosis on hospice enrollment was “debility, unspecified,” which is perfectly valid.

Moylan says he has no doubt that his office properly attributed Yourshaw’s manner of death. “Homicide doesn’t mean murder — it could be manslaughter, it could be many things. It just means ‘death at the hand of another human being.’ And that’s what occurred here.”

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Part 5: The strange prosecution of Barbara Mancini.