Harvest of Corneas at Morgue Questioned
Corneas taken without survivors' permission are resold at huge markup by eye bank, which pays coroner's office a fee. The practice is legal, but critics cite ethical lapses.
November 02, 1997|RALPH FRAMMOLINO | TIMES STAFF WRITER
A renowned eye bank has paid more than $1 million during the last five years to the Los Angeles County coroner's office in exchange for thousands of corneas, harvested without the permission or knowledge of the families of the dead.
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Although the practice is permitted under a little-known state law, officials of the coroner's office and Doheny Eye & Tissue Transplant Bank have used the statute so extensively that critics say the morgue has become a virtual cornea mill.
"Totally immoral," is how former Doheny technician Julia Brain described what is happening behind the coroner's doors--and behind the backs of families.
"Repugnant," said former coroner supervisor Peter Linder.
Under the 14-year-old state law, coroners are allowed to remove corneas in cases targeted for autopsy if there are no known objections from the next of kin.
When the law was passed, there was a shortage of corneas and long waits for people seeking transplants of the dome-like tissue that covers the eye's colored iris. Speed was of the essence because corneas usually disintegrate within 24 hours after death. For that reason, coroner officials are not specifically required under the law to seek time-consuming permission.
There is no doubt that the wide availability of corneas has helped thousands of people overcome a variety of vision-impairing maladies. But a mounting number of medical experts say the law is unnecessary today because corneas are so plentiful that none need be procured without the blessings of loved ones.
San Francisco Medical Examiner Boyd Stephens, for one, said he will not allow cornea removals without family approval. He said surveys by his office have shown that even people willing to donate internal organs draw the line at eyes.
"When you think of somebody you know, you envision their face, their eyes and nose," Stephens said. "You don't identify anybody by their liver."
In Los Angeles, that has not deterred coroner's and eye bank officials, who say they have been guided only by humanitarian concerns and the dictates of the law.
An investigation by The Times has revealed that the coroner's office and Doheny are invoking the state measure on an unprecedented scale. This has generated a cheap source of corneas that the eye bank resells for a markup of more than 1,200%. In return, the cash-strapped morgue receives payments of about $250,000 a year.
In all, at least half of Doheny's corneas--more than 1,000 annually--come from coroner cases in which consent has not been obtained, a number unmatched by any eye bank in the state.
Along the way, critics and medical experts say, ethical lapses and procedural breakdowns have occurred.
Internal documents, a computer analysis of hundreds of coroner cases and scores of interviews disclosed that:
* Employees of the coroner's office and the eye bank say they have been discouraged by superiors from asking permission of family members, even when easily accessible at death scenes, through the police or by telephone. In that way, no objections can be lodged and the corneas can be harvested under the state's so-called Coroners Law.
* The eye bank's employees are under such intense pressure to procure corneas that their productivity has been charted on monthly bar graphs. Earlier this year, when the numbers dipped, a veiled warning of possible "downsizing" was issued by the president of Doheny's management organization, Tissue Banks International, a driving force behind the 1983 Coroners Law.
* The ties between Doheny and the coroner's office are extremely close--some say incestuously so. The morgue's former director is now a key executive of Tissue Banks International. In recent years, Doheny has hired relatives of pathologists working for the coroner's office. At times, full-time morgue employees have moonlighted for Doheny. Some of the eye bank's technicians have their own keys to the coroner's office, giving them free run of the facility and its investigative files.
* Contrary to federal health-safety guidelines, Doheny technicians have removed corneas from people recently incarcerated and from drug users--high-risk candidates for infectious viruses, including hepatitis and AIDS. In addition, no family or medical histories are sought to discover other possible health dangers. Although chances of disease transmission through corneal transplants are extremely remote, most eye banks and coroners outside Los Angeles say they prefer to err on the side of safety.
Doheny and the eye bank's management firm, both of which are listed as nonprofit organizations, say they not only have complied with the law but have been motivated solely by a genuine desire to help those with vision that has been impaired by such things as cataract surgery and scarring from accidents and infections.
The Coroners Law, according to Doheny Executive Director Jeffrey A. Thomas, "enables everyone with need [for] the rapid access to sight-restoring corneas."