In Black America; Dr. Joyce M. Carter, Chief Medical Examiner

From the Long Horn Radio From the Longhorn Radio Network, the University of Texas at Austin, this is in Black America. Once I became infatuated with forensic and I was quite young, I decided to go to the library and see what was really going on. I read up quite a bit about it. And I located a mentor at Dr. Joe Davis, who is a former chief medical examiner of Miami, been in place for 30 some years. And I wrote to him as a student in school and he was very encouraging. And I later worked for him in my fellowship with him. He was just a very honorable person. He did not try to discourage me from reaching my goal. So I had to go outside and I, you know, outside of my normal environment for people who were willing to mentor me.

Dr. Joy M. Carter, the first female chief medical examiner in Houston, Texas. When Dr. Carter viewed an autopsy as a high school student, she knew where her life was headed. She finds it fascinating to gather facts and put together the puzzle pieces that explains a person's death. Also she enjoys knowing that the information she obtains is of help to the living. Dr. Carter is one of only a few female and African-American medical examiners in this country. The last 1996 she came to Houston from Washington, D.C., where she had also served as chief medical examiner. She is board certified in forensic, anatomic, and clinical pathology. I'm John L. Hanson, Jr. and welcome to another edition of In Black America. On this week's program, Dr. Joy M. Carter, Harris County, Texas chief medical examiner in Black America. Number one, forensic pathology is a non-hospital-based specialty and you have to be introduced to it in the right way.

As it is, it's a very small field. There are approximately 400 board certified forensic pathologists in this country today. The majority would fit into the category of a middle-aged white male, breaking down barriers. I think it's important that people are not turned away. I think someone tried to tell me years ago that it's too hard. It's too hard to be to learn all of this and I was not going to be daunted by that. My technique was someone was telling me, no, they couldn't tell me why. I went around them and went to somebody else who's going to tell me, yes. From a search committee's list of 20 applicants, Dr. Joy M. Carter became the first female chief medical examiner in Houston, Texas, and the county's first new medical examiner in more than three decades. Born in East Liverpool, Ohio, Carter graduated cum laude from Whitonburg University in 1979, and joined the Air Force to pay for medical studies.

After earning her medical degree from Howard University in 1983, she went on active duty. At the age of 34, Dr. Carter was the military's deputy chief medical examiner for forensic education and training. In 1992, she was appointed chief medical examiner in Washington, D.C. Flustrated with the city's indifference towards the medical examiner's office and hearing that there was an opening in Harris County, she decided to apply. And I guess you could say the rest is history. I majored in biology and chemistry. And what sparked the interest to become a forensic pathologist? Well, it was realizing that this type of medicine was multifaceted. You didn't have regular hours or routine days. And I still think it's very distinctive in trying to put together a piece of a puzzle to come up with some answers. The way to help people and to kind of satisfy that curiosity that I've always had about what happens at death and after death.

Now, you selected the armed forces to assist you in paying for that medical education. Yes, I did. I just happened to be in the right place at the right time. I'd already entered medical school, but then I became aware that the armed forces was offering a complete scholarship package for physicians, which paid your entire tuition to medical school and bought your books and supplies. And I went through out of the Air Force. And were you attending medical school at this time? No, I was still in college. I was in Ohio, a school called Wittenberg, very close to Wright Patterson Air Force Base. And once I became aware that I applied for the scholarship, and they did support me entirely throughout medical school. Give us an idea of what that particular experience was like going to medical school. Well, going to medical school, I chose to go to Howard.

I'd gone to Wittenberg, and I felt it was very important that I have role models that looked like me and had concerns about a particular health care and being good to minority patients. And I went to Howard, and I was really pleased with the training that I had. I think I learned from a lot of the old masters about good bid-side techniques. They're very strong and academically, really didn't let you fall down. Being in the military, several of my professors were also military to go. I have an extra interest in helping me survive and learn in and out of medicine. I think that really set the stage for me building up for my pathology career to see how the people that taught me loved learning about medicine. Is there a difference in the learning process of being a physician for the living versus becoming a pathologist? Well, not in the beginning. Pathology is a course actually taught in medical school as part of the basic sciences.

Also a medical specialty. The pathologist training is longer than most other specialty because you have to learn everything that you can about medicine. The whole idea of recognizing normal from abnormal is very important. So the pathologist must learn a little bit about every other medical specialty. Being able to tell a person why their loved one has died from a heart attack as well as from a congenital birth defect is important in explaining and understanding that. One method of basic scientific principles as to why someone dies from a gunshot wound. What is it that actually kills? One method of very science that loss of blood means loss of oxygen. So you have to have a very well rounded science background and you need to be able to retain a lot of information also be able to go forth and to a reference book. You have to be able to communicate well and express your ideas and to ask questions. Once you graduated from medical school in the Air Force, what was your next step? Well, my next step was to do my postgraduate medical training. I spent a year doing internal medicine in New York City.

I then went, I returned to Washington DC and spent four years studying general pathology, both anatomical and clinical. All the while I was still in the arm services and working as an inactive reserve officer. Following that training in Washington, I went to Miami Florida where I studied my forensic pathology specialty. Following that, I went on active duty with the United States Air Force as a medical examiner for the federal government. From that position, I went to Washington DC to become the chief medical examiner. First female in Washington to serve in that position, which was quite challenging at the time. And from that position, I came to Houston. For some of us that are not familiar, I want to ask you some of the terms and some of the differences in the positions. What is a corner? A corner is an elected official that may or may not be a physician and may or may not be a pathologist.

A corner usually serving an area where they would be charged with an investigating death and they would usually hire a pathologist to do an autopsy for them in the corner in turn may interpret those findings. A medical examiner on the other hand has to be a board certified forensic pathologist and a medical examiner is a neutral person. We are not elected and we have to maintain an air of neutrality to work with all forces. We have the same obligation to provide information to families, prosecutors and defense attorneys. There's a pathologist and then there's a forensic pathologist. That's correct. The difference. A forensic pathologist is an ultra specialist. A pathologist can be a general pathologist, meaning they stop at that training of either anatomical where they would do biopsies in the hospital and read surgical slides or clinical where they would do, they would assist in detecting disease by looking at body fluids and perhaps itself. You take it a step further to become a forensic pathologist where you spend a year or two years concentrating in investigating death.

The whole idea of a forensic pathologist is one who investigates death due to illnesses, diseases and injuries. The forensic pathologist is trained, certainly, to go to court. It is part of our regular duty versus an occasional appearance by another type of doctor. You work with attorneys, again, both prosecution and defense. You work with families very much. We also are charged with making sure that vital records are accurately determined in file so that future concerns for preventative care can be done by learning how people die. On average, how large is the staff that you have in Harris County, Texas? The total staff I have is 81 individuals. We have a crime lab here that is all under my jurisdiction to run the county crime lab. We have eight full-time forensic pathologists that copy. We have a full investigative staff of ten individuals who take information and visit the scene.

We have a whole complement of secretaries and a whole laboratory staff to do drug testing and also to perform DNA analysis. In your opinion, why is this particular position important for society in general? It is very important that you have a person that is willing to accept the responsibility for being truthful. A person that can go into the courtroom and present testimony to explain why a person died that can remain neutral. The medical grandmother is often the only person in that courtroom that has really nothing to gain other than to be truthful and educate the injuries. I think it is very important as a minority person because oftentimes the defendant and oftentimes the victim are a minority person. And it is important that someone is willing to help the criminal justice system and to receive very little benefit from it. I think it is very honorable calling.

I am glad you brought up the minority point of view. How was it working in Washington D.C. considering when you were there that Washington was quote unquote the murder capital of the world? Well, it was very sad. And I established a goal within there to do a lot of research and do a lot of public speaking on why we still have a lot of violent deaths in the minority communities. We did research for a two year period to find out and try to find out why Washington D.C. in particular had so many deaths due to multiple gunshot wounds. And I still try to spread the word that when you start looking at the number of minority people that are victims of violent crimes, that are victims of black on black crime, that number is disproportionate to our population. You look at the number of minorities who are in the prison system is the same thing. And it is going to take constant education in the whole society taking some responsibility and trying to help right rights is wrong.

You know, I like to impress people that even though we still have a considerable number of young people that graduate from high school, we still have too many people that fall victims to black on black crime. Was it particularly disturbing considering the age of these young victims? Yes, it was. When we began to look at the numbers very closely, the national level age for homicide was higher than that we found in Washington. That made it more critical. If you're seeing younger and younger people who should be enjoying their teens, either victims of violent crimes or incarcerated for perpetrating a violent crime. And with each person that dies you have at least two families that are changed forever. Have you found it difficult being a female chief medical examiner? I don't know any other way to be. How do you accept it from your other colleagues in the profession?

I am respected. People know that I am very stern in my principles. I believe very much in the olipi took the Hippocratic oath as a physician. And I will not compromise my values. And I've stood in that principle since I became a doctor. That was my whole reason for becoming a physician. And I certainly get a lot of calls from my colleagues and I know I'm going to give them to them straight. Well, we know there were other African-Americans in your medical classes particularly because you attended Howard University. But also were there other African-Americans that wanted to become forensic pathologists such as yourself? Well, not in my medical class, there are very, very few of us. In fact, you can count us and we'll be less than the number of the fingers and toes. Is there a reason for that in your opinion or have you thought about it? Well, yes, I think about it quite a bit.

I think number one, forensic pathology is a non-hospital-based specialty. And you have to be introduced to it in the right way. As it is, it is a very small field. There are approximately 400 board 35 forensic pathologists in this country today. And the majority would fit into the category of a middle-aged white male, breaking down barriers. And I think it's important that people are not turned away. I think someone tried to tell me years ago that it's too hard. It's too hard to be to learn all of this and I was not going to be daunted by that. My technique was someone was telling me no and they couldn't tell me why I went around and went to somebody else who's going to tell me yes. Do you have an opportunity to express that to young people? Yes, I do and I try to take every opportunity that I can. No matter what they're going to go into, whether it's medicine, law, business, that they try to be as best they can and make sure they are grounded in what they're going to do. That they learn about it.

You know, it's one thing to say that you want to be a doctor, but what does being a doctor mean? Find out about it. And then see if this is what you really want to do. Find out that you really want to do it. Prepare yourself so that you level that playing field. And I always say to them, make the basics. I no longer believe that a black person has to be twice as good. I'm going to be as good and tell me that I'm not. Prove it to me. How does one or does one get past the daily observation of death and dying? Well, for me, that was never really an issue. My religious beliefs are such that my training is at the time of death. The person that what makes us a person is the soul and that soul separates. And that is no longer the person, but that's the best thing I can do. And their memory is to do a very good examination. Our oath to first do no harm. I don't think I'm doing harm by doing a complete examination. I'm helping to tell their story. This is one of my patients. They can't tell me verbally what happened.

But they can show me by me taking very, very careful analysis of what their body presents to me. My job is to speak for the dead. The most famous corner or medical examiner, I can't figure out which one he is. It's Quincy. Seeing that television series is it pretty much accurate or a good portray of what corners and medical examiners do? Well, I would say it is not very accurate. Certainly it was a TV show made for TV. Unfortunately, it did bring our field out into the public forum. But it also did a lot of disservice. You still have people that walk around and think that you can take a bone and make a whole body out of it. Or that a medical examiner is going to get personally involved with every family he comes in contact with. That doesn't happen. That doesn't happen. And that's not proper. And I constantly say that Quincy isn't something we really have to continue to educate people against. It does present itself in the courtroom and that causes me some concern.

Considering that you all are operating on a budget. Are there times restraints and budgetary considerations when you all go into a case? Well, no. We do have a budget and we are a public entity under a government agency. And therefore we are using taxpayer dollars. We have to be accountable for that. But we have to do what is prudent and what's going to help achieve those answers. All cases will look at differently. There are routine that are done on every case. But each case will see how am I going to be able to answer the question what happened. It might be a simple just doing all talks and determine a person had a heart attack. Or it might take DNA analysis. It might take some drug testing. Whatever it takes we try to do to answer those questions. Quite naturally you cannot perform all the autoptis that come before you. And I'm quite sure you have to sign off since you are the chief medical examiner. How do you go about that process?

Well, the licensed physicians that work here do find their own cases. The review problem cases and those that are here for training, they get direct supervision. Doing an autopsy is relatively a solo practice. It's one person to an autopsy. And then you put your heads together and we have weekly meetings. We discuss problem cases, interesting cases, unusual cases. But certainly one of my main duties to sit here and to resolve problems that come up either problems families have or that attorneys may have or going back and revisiting old cases that may or may not have been rehandled. Or because techniques have changed over the years. So I have to make myself available to those people that do have questions. How has technology assisted you in the performance of your responsibilities? What technology has improved so much in the area of forensic sciences? And there are a lot of people that are in forensic scientists. We often employ other specialists such as anthropologists, dentists, geologists, engineers, question documents. They're all forensic scientists.

And scientific advances have helped all of us tremendously. The signs of DNA analysis has improved in last 10 years. I mean it's completely 360 degree difference in what's being done. New techniques in developing the ability to look at fingerprints has changed as well. The computer also looks extremely helpful because we have to communicate with what's going on. There have been developments and drug testing. You might have mentioned new drugs that are coming on to the scene, such as the date rate drugs, Rohipnaal and Gamahadroxybutyrate. These weren't seen a few years ago. So it is that technique that allows us to discover these are in the system and also what they do. So what we say is that medicine is an art that we all practice. It is not an exact science that we use the benefit of science and technology to further practice this medicine. I'm quite sure you can't remember all of your cases, but have there been any cases in which you've done an autopsy and basically had changed the decision of a criminal investigation or verdict?

Well, there have been some and again my role is to base my opinion on all available facts and information. I have investigated numerous cases through my military experience in Washington. I take the role that the medical laminar is neutral and it is not my responsibility to determine someone's guilt or innocence but to provide the jury with the facts. And that's very important in Texas because as you know, Texas does capital punishment. So it's very responsible that the grand jury people are aware of what goes into a pathologist making a decision as to how somebody died. So we actually bring those that are on a serving grand jury in Harris County. They come in for a full day tour of our facility and they interact with the pathologist and figure out what it is that we do.

Because again, we don't do what Quincy did. But when we look at it, when I look at a case that is old, I have all the information in front of me. I will ask the person who did the initial autopsy, what they did, what they found. I will interview all people involved and come up with a neutral opinion. I do not serve directly defense or prosecution. In July 1996, you became Houston's first female chief medical examiner. Why did you leave Washington to come to Houston? Well, I left Washington because it was becoming more and more difficult for me to do a quality job. How so? The resources in Washington were certainly cut drastically. Here is tremendous controversy with the local government and Congress. And that impact on those trying to perform their duties. I was unable to do the testing and answer questions for families that began to really disrupt the entire office. And the new change in Houston?

Well, the change in Houston there is a lot more support for this office getting the job done. I really wasn't impressed with that. There's independence of the office. The Austin, Washington was really so deeply embedded in the health care system. It was not getting the priority that it needed. And I often say to the politicians here that while we serve, they did. We try to help the living through serving the dead. But we cannot compete with the living for finances. It's very hard to say that we need a microscope here and someone needs an vaccination. So this in this area of Texas, the medical government's office is separated from the Department of Health and that's very wise. And the commissioners here are supportive of what the office is trying to do. Were there any changes in which you initiated once accepting the position in Houston? Yes, there are several changes that I have initiated looking at this office running better and being more accountable for what it does. We have higher, more staff. We have modernized the equipment that is here.

We are planning a computer system for the office. We have tried to open the office to be more community oriented. We have a lot of tours to try to guide young people what they might want to do and also to try to keep them from straying along the wrong path. We educate those that are in the beginning part of law and medicine and other areas of community service. Your clinical associate professor of pathology at Houston's Baylor College of Medicine. How does that play into what Joy Carter is all about? Well, I am a teacher at heart and I believe in each one teach one. And I believe that I have to share the knowledge and let people know that forensic psychology is a very viable field and is very important. This is one area that we are not going to be replaced by robots. It is very important that we maintain that we are one, we are doctors, we are physicians.

And we have to keep abreast and it is one of my duties to help train those that are in medical school. Are you finding people of color and minorities becoming more interested in your profession? I think that is one of the benefits of people finding out that I am here and what I do. I think it is very important. Yes, I had a young man of 14 in my office. And I try to never turn a child down. It is very important that you nurture them. Once you decided to embark on this field, what were some of your support systems? Who were your support systems? Well, number one was the library. Once I became infatuated with forensic and I was quite young, I decided to go to the library and see what was really going on. I read up quite a bit about it. And I located a mentor, Dr. Joe Davis, who is a former chief medical examiner of Miami, been in place for 30 some years. And I wrote to him as a student in school and he was very encouraging. And I later worked for him and did my fellowship with him. He was just a very honorable person.

I did not try to discourage me from reaching my goal. So I had to go outside and I, you know, outside of my normal environment for people who were willing to mentor me. Are you involved in any professional organization within your profession? Well, yes, there are two main ones. There's the National Association of Medical Vaminer, also known as NAME. And there's another one, the American Academy of Forensic Signs. If I'm involved with both organizations, it's important that you are aware of changes that are going to be made in your medical profession that you're there at the board table. It's going a lot of how it's going to impact you. I'm involved with the local medical societies here in Houston. I'm also embarking on a new grant to try to increase minority participants in the Texas Medical School System. Dr. Joy M. Carter, Chief Medical Examiner, Harris County, Texas. If you have questions or comments or suggestions asked your future in Black America programs, write us. Also let us know what radio station you heard us over.

The views and opinions expressed on this program are not necessarily those of this station or of the University of Texas at Austin. Until we have the opportunity again for IBA Technical Producer Cliff Hargrove. I'm John L. Hansen, Jr. Thank you for joining us today. And please join us again next week. Cassette copies of this program are available and may be purchased by writing in Black America cassettes, Communication Building B, UT Austin, Austin, Texas, 78712. That's in Black America cassettes, Communication Building B, UT Austin, Austin, Texas, 78712. From the University of Texas at Austin, this is the Longhorn Radio Network. I'm John L. Hansen, Jr. Join me this week on in Black America.

When you start looking at the number of minority people that are victims of violent crimes, that are victims of black on black crime, that number is disproportionate to our population. Dr. Joy M. Carter, Chief Medical Examiner Harris County, Texas this week on in Black America.