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Eddy Lilavois, a medical examiner with the Northern Regional Medical Examiner's Office, testifies during a 2012 trial. He later conducted autopsies on John and Joyce Sheridan that helped lead investigators to conclude their deaths were a murder-suicide. (Michaelangelo Conte | The Jersey Journal)

Frank Presswalla is seen in 2003, the last year in which he served as New Jersey's state medical examiner. He says the role is a weak one, unable to meaningfully manage the state's patchwork of county and regional ME offices. (Mark Sherman | The Times)

New Jersey will have its first state medical examiner in a dozen years, if a nomination Gov. Chris Christie announced Monday night is confirmed. Christie has recommended Andrew Falzon, the former Middlesex and Monmouth County medical examiner, for the job.

In most other states, the post would be a powerful one -- providing expertise and oversight for regional and county medical examiners. The head medical examiner would be an advocate for the dead when there are disputes about how their lives ended, a final arbiter for thousands of residents.

But former medical examiners and other critics say the position is a toothless one. New Jersey, they say, has a fragmented medical examiner system without any central oversight. There's no backstop against incomplete or botched autopsies at county and regional ME offices where quality control and the qualifications of those in charge can vary wildly, they say.



"There's really no constituency for the dead," Adam Guziejewski, spokesman for the New Jersey Funeral Directors Association, said.

No one at the top

The longstanding vacancy -- New Jersey last had a state medical examiner in 2003, and an acting state ME in 2009 -- was highlighted in recent weeks by Mark Sheridan, son of the close Christie ally investigators determined stabbed his wife to death in their Skillman home before killing himself.

Mark Sheridan and his brothers dispute that finding -- and point to even basic mistakes over his father's height and age in an autopsy by Eddy Lilavois, the medical examiner at the Northern Regional Medical Examiner's Office who conducted John and Joyce Sheridan's autopsies.

"Had there been a state medical examiner, perhaps it would not have been necessary for our family to retain (our own forensic pathologist) to identify the failures of the initial autopsy," Mark Sheridan wrote in a letter to the state attorney general.

But it's not clear that a state ME could have intervened in the way the Sheridans want. Zach Hosseini -- a spokesman for the Division of Criminal Justice, which operates the state medical examiner's office -- said the post is "not endowed by the law" to resolve disputes regarding county examiner's autopsies.

Guziejewski, of the New Jersey Funeral Directors Association, said the association also has concerns about the quality of autopsies. He said funeral directors had reported a number of complaints about the medical examiner system in New Jersey in the past decade including "haphazard autopsies," "delayed body releases" and cases of a cause of death not being finalized for months after an autopsy was performed.

For the past 15 years, the governor-appointed Child Fatality and Near Fatality Review Board has urged authorities to overhaul the fragmented system, and give the state medical examiner a strong hand as a central authority. Those pleas, board members said, have fallen on deaf ears.

Without a centralized administration, there's no system-wide quality-control, and "no mechanism to appeal or question what goes on because basically the (county or regional) medical examiner is their own boss," said Anthony D'Urso, one of the board's founders and its former chairperson. D'Urso is also a psychology professor at Montclair State University.

D'Urso and Kathryn McCans, a child abuse pediatrician and current chairperson of the board, said they've had cases where their determination of a cause of death differed from a county medical examiner's. In others, they've seen information not filled out in autopsies or standard procedures that weren't utilized.

The Northern Regional Medical Examiner's Office.

"To say something is a homicide and it wasn't, is a big deal," McCans said. "To say it's not a homicide and it is, is a big deal."

Ernest Leva, a former vice chairperson of the child fatality review board, was more blunt. Leva, chief of the division of pediatric emergency medicine at Robert Wood Johnson Medical School, said county medical examiners have had a history of "what I would consider poorly run exams" over the past 15 years.

Leva said board members had written "no less than 125 letters" to various medical examiners regarding concerns they've had with post-mortem exams of children. In October 2013, the board convened to review the death of a child who had been abused from birth whose cause of death was initially ruled accidental when it should have been murder, he said.

The next month, Leva sent a letter to Christie -- one be believes torpedoed his reappointment by the governor. He told Christie several child homicides had been overlooked: "I have come to perceive that in the right circumstances it is legitimate to murder children in our state."

McCans, who was appointed to the board after the state failed to reappoint Leva and D'Urso last year, said of Leva's letter, "It's really frustrating when you care about the well-being of children and it can be hard to be politically correct."

Are local examiners qualified?

Lilavois, the regional medical examiner who did the Sheridan autopsies, had famously botched a New York City autopsy in the 1990s.

According to a story by the New York Daily News, Lilavois changed the cause of death on a 3-year-old boy's death certificate without notifying his family, the police or the Queens District Attorney's Office. The change should have quickly cleared the boy's father of a homicide charge.

Critics say the qualifications and skill levels of county and regional examiners can vary. That's in a system where D'Urso and Leva said some medical examiners have been performing twice the number of autopsies recommended by the National Association of Medical Examiners per year.

Only six of the 14 current county or regional medical examiners are board-certified forensic pathologists, and between 1990 and 2013, five medical examiner's offices in New Jersey, including the state medical examiner's office, had received accreditation by the National Association of Medical Examiners. By 2013, all of those offices' accreditations have either lapsed or the offices failed the re-accreditation process.

Hosseini, though, said New Jersey's requirements for medical examiners "are some of the most stringent in the nation." And he's noted the accreditation is voluntary, and most offices nationwide do without.

Former MEs: We had no power

Under state law, the state medical examiner is a governor appointee who is charged with the "general supervision" of county medical examiners.

In 2009, Victor Weedn, the acting state medical examiner at the time, resigned in protest over what he said was a lack of support from the Division of Criminal Justice. Weedn said he had no real authority -- and was just expected to be the system's "top professional."

A patch for a Division of Criminal Justice medical examiner.

He couldn't set the office's budget, couldn't appoint personnel at the two state-run regional ME offices and he couldn't hire or fire the heads of county medical examiners' offices -- those are appointed by local freeholders.

And, Leva said, county medical examiners don't have to follow the state medical examiner's advice.

Legislation proposed by state Sen. Joseph Vitale (D-Middlesex) and Sen. Kip Bateman (R-Somerset) would give a chief state medical examiner "explicit supervisory authority over the entire medical examiner system, with the power to intervene at his discretion in any medicolegal death investigation in this state." It would also move the role to the Department of Health, making it more independent of criminal investigations.

But it's not clear what future that legislation has. Several previous overhauls have fallen flat in the legislature. The last hadn't left committee during the 2012-2013 legislative session.

The last confirmed medical examiner, Faruk Presswalla, who departed the role in 2003, wasn't any happier than Weedn with the position.

"There is no state (medical examiner) system, period," Presswalla told NJ Advance Media. "The state medical examiner is merely a figurehead. It's a county-based system because of New Jersey's insistence on county rule. The state medical examiner has no powers. Why do you think I left?"

Justin Zaremba may be reached at jzaremba@njadvancemedia.com. Follow him on Twitter @JustinZarembaNJ. Find NJ.com on Facebook.