Source: nytimes.com

Dr. Charles S. Hirsch, center, with Mayor Michael R. Bloomberg and Police Commissioner Raymond W. Kelly. Dr. Hirsch said a detective had died from ground up pills, not ground zero dust.

By ANTHONY DePALMA
Published: November 25, 2007

No New Yorker is privy to as many secrets of the dead as Dr. Charles S. Hirsch. During nearly two decades as New York City’s chief medical examiner, he has quietly overseen autopsies on more than 100,000 people, hoping to learn something more about the way they lived, and why they died.

After a long run marked by few major controversies, Dr. Hirsch, 70, now finds his objectivity and independence being questioned because of his review of a single autopsy — on the body of James Zadroga, 34, a New York City police detective who died in New Jersey last year. The Zadroga family had hoped he would agree with the Ocean County medical examiner’s finding that the detective’s death was linked to ground zero dust, which would add his name to the official list of victims of the 9/11 attack.

But last month Dr. Hirsch shocked the Zadroga family and others with his conclusion, “with certainty beyond doubt,” that the material in Detective Zadroga’s lungs was not dust from the trade center but ground up pills he had injected into his veins.

Dr. Hirsch, a tall, trim Midwesterner whose suspenders and pipe could make him a character on the TV show “C.S.I.,” is averse to publicity and has said nothing publicly about the case; in a brief telephone interview he declined to discuss details of his findings.

“I have no interest in embarrassing those people or dragging this out,” he said. “I have absolute confidence in our opinion.”

But the police union, members of Congress and others have raised doubts about his ability to make such a determination by himself. At the heart of their criticisms lies a single question: how could the same tissue samples, autopsy slides and medical records lead different forensic pathologists to radically different conclusions?

Dr. Hirsch is well known across the country as a meticulous investigator and a scientist who measures his words carefully. But certainty is an elusive quality in science. Dr. Gregory J. Davis, a University of Kentucky professor who is chairman of the forensic pathology committee of the Congress of American Pathologists, said that “certainty beyond doubt” was not a phrase he had ever used.

“But if Dr. Hirsch used it,” he said, “he must have had his reasons.”

Dr. Hirsch said he had used that phrase in cases when the cause of death was so clear — say, from an accident — that there could be no possible doubt about the cause. “It doesn’t come up very often,” he said, “But in our own discussions in the office, it’s a routine thing.”

Dr. Hirsch’s determinations about Detective Zadroga sharply conflicted not only with the conclusions drawn in the Ocean County autopsy but with the findings of other experts. A former New York City medical examiner, Dr. Michael M. Baden, examined the autopsy slides and said he was convinced that trade center dust had killed Detective Zadroga. The Police Pension Board in 2004 linked Mr. Zadroga’s illness to the dust when it approved a disability pension for him. And the September 11 Victim Compensation Fund concluded in 2004 that he had been harmed by the dust and gave him a substantial monetary award.

Detective Zadroga was at ground zero in the weeks immediately after 9/11, though it is not clear exactly where he worked or how many hours he remained on the site. His medical records show that he was sickened by his work at ground zero.

Dr. Hirsch’s findings about Detective Zadroga have generated controversy in part because many cases involving ground zero workers may have to be reviewed if the workers are to be included on the 9/11 victims list. The 9/11 victims’ fund gave more than 1,300 ground zero workers the same kind of injury award Detective Zadroga received, opening the door for future claims. Similarly, more than 175 police officers and 725 firefighters have received disability pensions for illnesses related to the trade center. And more than 20,000 workers have registered with the New York State Workers’ Compensation Board in case they become sick in the future.

Several members of New York’s Congressional delegation said they did not think Dr. Hirsch should have the power to decide whether deaths were linked to 9/11. This month, they urged Mayor Michael R. Bloomberg to create a panel of independent medical experts. But the mayor rejected the proposal, saying such decisions should be based on science, not politics.

There is no national standard for determining a cause of death. Medical examiners and coroners set their own guidelines, and each relies on a combination of experience and interpretation to come to conclusions.

A medical examiner’s job is a mix of detective work and scientific observation. In determining the cause of death in most routine autopsies, a pathologist offers his or her “best medical opinion.” In civil lawsuits or legal proceedings, the standard rises to “preponderance of evidence.” Experts said that a stricter standard — “with a reasonable degree of medical certainty” — is used in criminal investigations or trials. Dr. Hirsch’s certainty in his review of the Zadroga case is exceptional.

“The general public likes to assume that pathology is an exact science and everything is objective,” said Dr. John Sinard, director of the Autopsy Service at Yale University School of Medicine. “The reality is that everything is subjective.”

During 18 years as head of one of the country’s busiest medical examiner’s offices, Dr. Hirsch, who once served as a captain in the Air Force Medical Corps, has earned a reputation among forensic pathologists as a skilled practitioner and a respected teacher, having held faculty positions at N.Y.U.’s medical school and others. He has trained 16 of New York City’s 26 deputy medical examiners and dozens of the 500 medical examiners in the country.

“He is a very conservative medical professional,” said Dr. Yvonne I. Milewski, the chief medical examiner of Suffolk County. “Nobody who knows him doubts his motives.”

Dr. Thomas A. Andrew, chief medical examiner of the state of New Hampshire, studied with Dr. Hirsch at the University of Cincinnati in the early 1980s. He was so influenced by Dr. Hirsch’s “quiet dignity” that he chose to follow in his footsteps, he said, switching his focus from pediatrics to forensic pathology.

“For me, he defines the word ‘mentor,’ ” Dr. Andrew said, “but I can’t tell you Word 1 about his private life, his social life or what makes him tick.”

Dr. Hirsch was appointed chief medical examiner by Mayor Edward I. Koch, who had dismissed Dr. Hirsch’s two immediate predecessors, Dr. Baden and Dr. Elliot M. Gross, faulting their performance.

Dr. Hirsch focused on managing the complex office instead of performing autopsies (he had already conducted 6,000 autopsies at other offices, and served as the Suffolk County medical examiner). Still, he said, he goes into the autopsy rooms every day, consults with his deputies, and is the final arbiter on all causes of death.

But, experts say, what seems certain can turn out not to be. In early 1989, Dr. Hirsch ruled that a 25-year-old black man named Richard Luke died while in police custody as a result of cocaine intoxication. Friends who said they believed Mr. Luke had been brutalized by the police, said that Dr. Hirsch had unjustly exonerated the police, and hundreds took to the streets in protest. Months later, an inquiry by the State Commission of Correction’s two-member medical review panel, which included Dr. Baden, concluded that Mr. Luke had choked on his own vomit.

Despite a lingering perception among some that the medical examiner’s office protects the police, there have been times when Dr. Hirsch’s rulings have put the department in a bad light. For example, in May 2003, Dr. Hirsch blamed the police for the death of a 57-year-old Harlem grandmother, Alberta Spruill, finding that the stress and fear of an early morning police raid had caused her fatal heart attack.

Yet his review of the Zadroga autopsy could help the city defend itself against the suits brought by more than 8,000 ground zero workers who say they became ill after working at the trade center site, said Michael Palladino, president of the Detectives’ Endowment Association.

The families of 9/11 victims have praised Dr. Hirsch for the sensitive way he has handled thousands of human remains that still have to be identified. But he was criticized by Mr. Palladino, among others, for being insensitive to the Zadroga family last month when he told them that he was certain that what looked like dust in the detective’s lungs was, based on a chemical analysis, actually talc and cellulose from ground up pills.

According to interviews with several pathologists around the country, including Dr. Michael Graham, the chief medical examiner for the city of St. Louis and a specialist in heart and lung pathology, the combination of talc and cellulose in the lungs usually indicates drug abuse. Dr. Hirsch said the talc was found in the capillaries of the lungs, not in the air sacs, another tell-tale sign of intravenous drug use.

Still, Dr. Graham said he would be reluctant to use Dr. Hirsch’s “certainty beyond doubt,” phrase.

“Unless we’re talking about metaphysical certitude,” he said, “there is no such thing as absolute certainty.”