American Autopsy

American Autopsy by Michael Baden is a very interesting read; a memoir of over fifty years of medical examiner experience and an insight into the man himself as a husband and father. While there is a WHO’s Who of celebrity autopsies, there is an undercurrent of fighting for racial justice in a broken system, where the medical examiner is expected to go along with the police report of an incident where a citizen dies under police care, and the wishes of the local DA; be “ one of the guys.” Baden has always strived for complete honesty of what the actual evidence shows him, regardless of what others expect. His dedication to the truth has put him at odds with superiors at times, but his reputation and ability to gather evidence that others missed is undisputed. Baden also shares the price of fame through a broken marriage and a heartbreaking loss. He has performed second autopsies on Medgar Evers and George Floyd, as well as testifying in the O. J. Simpson trial. He is appalled at the ratio of black-to-white deaths at the hands of police officers each day across the nation for simple offenses, and rallies for better police training. The book was very informative in many ways, and our library will be purchasing a copy.

The Dead Keep a Record

A deep sense of humanity pervades this medical examiner’s memoir.

After a distinguished career as a medical examiner in various areas of New York, Dr. Michael Baden has written a compelling memoir, American Autopsy. It’s focused as much on social injustice as on his experiences in the autopsy suite. What he witnessed significantly informed his career trajectory. One line stands out as a central theme: “Death investigations mirror society.”

There’s a psychological side to any death investigation, including what motivates people in power and how they persuade others to be a “team player.” Attorney Peter Neufeld, co-creator of the Innocence Project, clarifies this in his Afterword: “While multiple studies have described and analyzed how explicit and implicit racism have infected policing and the prosecutorial function, American Autopsy is unprecedented in revealing the critical role that forensic pathologists have been expected to play in helping convict the ‘bad guys’…while thwarting attempts to hold police accountable.”

It’s distressing to learn about the political compromises, reliance on junk science, lack of care for some populations, and plight of people with scant resources that Baden describes. Yet, he did what he could to improve some practices. For example, he created conditions for better oversight and prevention of suicides in prison by making the prison staff more accountable and by identifying key vulnerabilities, i.e., shoelaces and shower rods. He also contradicted official rulings, despite the threat to his job, and worked pro bono to help ensure justice in cases that might otherwise have been covered up.

I interviewed Baden twenty years ago for Court TV’s Crime Library. Here’s how I started that piece: “Michael Baden, M.D. interprets the dead. He pays attention to the nuances of bruises and abrasions in ways that few people can.” In short, he was a medical detective. Yet, this new book shows that, thanks to politics, it’s not that simple. All investigations work within a system, and if the system is tainted, seeking the truth about someone’s death can get derailed.

Baden got his early training in Bellevue Hospital and the New York City's Medical Examiner’s Office. In the latter, he had a short-lived stint as its chief. He also became the state commission’s forensic pathologist and co-directed the Medicolegal Investigative Unit of the New York State Police. At one point, Baden chaired the Forensic Pathology Panel of the U.S. Congress Select Committee on Assassinations, which investigated the cases of President John F. Kennedy and Martin Luther King, Jr.

The committee found that the Kennedy autopsy was badly botched: "One of the recommendations we made," said Baden, "was that there should be some national attention paid to improving death investigation in this country… Those doctors made lots of mistakes, such as creating false descriptions for why they couldn't find the bullet. They said it and they were wrong, and it lives with us even today."

The co-author of two earlier books, Unnatural Death: Confessions of a Medical Examiner and Dead Reckoning: The New Science of Catching Killers, Baden also hosted HBO's innovative Autopsy series. But Baden’s career has been controversial, in part because he decided that the ME’s office would not be used as a tool to shield sloppy crime scene management and police misconduct. “I envisioned the office as independent, scientific, apolitical,” he writes. This memoir shows his side of those clashes. He witnessed plenty of racial bias in New York and around the country that deeply offended him. Initially interested in healing the living, a single case redirected him to forensic pathology.

Baden described it to me. "We had a patient who was a heroin addict who had an infection of the heart. In those days, that condition was difficult to treat and most patients with it died. We treated him and he survived, which was a real triumph. Then when I came down that weekend, there he was, dead on the autopsy table. He'd gone out and gotten back on heroin. We'd treated his infection but not his addiction. That made me think I could contribute more to society by looking at people on the autopsy table and feeding back the findings so that lots of people could benefit, rather than just treating patients one at a time."

People who pay attention to high-profile criminal cases know that Baden has been an investigator and expert witness in many of them, including Nicole Brown Simpson, Ted Binion, George Floyd, Phil Spector, Eric Garner, Jeffrey Epstein, and JonBenet Ramsey.

Baden challenges the practice of protecting people in power as he describes his involvement in the 1971 Attica tragedy in which rioting prisoners were blamed for the deaths of hostage-guards. His reasoned, methodical approach to that volatile situation shows why he became such a prominent forensic pathologist. It also shows why he lost his standing with certain politicians. His chapter on the OJ Simpson case reminds us of a turning point regarding forensics. Without this case, there might have been no C.S.I. and perhaps little to no oversight on the exploding field of forensic science.

However, Baden’s focus is on police misconduct and the country’s racial inequality: “We are at a pivotal moment in history. I believe it’s necessary to help the public understand how the criminal justice system really works.” Protection of power feeds a cognitive bias toward supporting smaller personal goals over the greater good of humanity. Baden’s book will likely strike a chord in those who are trying to educate police on bias and on how to improve relations between cops and communities. Maybe pressure from the bottom up might erode the thug approach to “team player” politics as well. We can only hope.

Interesting and sometimes heartbreaking.
We rarely think of politics when we think of medicine even when it's forensic, there is something uncomfortable in thinking about it that way and this book offers a rather unflinching if very human approach to the question.
I particularly enjoyed the section where Baden details how the bogus diagnosis of excited delirium came to exist and to be popularized even though the "science" that was used to bring the idea forth has been thoroughly debunked. This book is well worth the read just for that part alone.
Baden is very critical of the buddy-buddy system between prosecution, law enforcement and medical examiner's office and the tendency these institutions tend to have to see themselves as colleagues but if you're critical of the police as an institution you might find yourself at odds with him because he is also a firm believer that police officers in general are good people doing a hard job.
While it's clear that Baden is someone with a lot of heart who made a lot of decisions in his life based on a strong moral code the writing in this book is sometimes a little dry and I was sometimes taken aback by it when he talked about things that should have been very poignant.

This book had me engaged from the very start and I ended up reading all of it in a day. Quite often people assume that the impacts of racism are not present in the medical system. Baden highlights and proves that often times it is present. The language in the book was strong and really highlighted the system in place between prosecution, law enforcement and medical examiner's office and how if you rock the boat you are deemed " not a team player" and a poor fit for the role. It is important that these systems are challenged as it helps to prevent compliancy which impacts the actual justice. I agree with his approach that forensic pathology should be about the evidence without any biases involved and more pathologists need to approach their work with this lense. I found the book to be very informative, it sparked discussions with my friends and it is a book I would absolutely read again.

Thank you to NetGalley and the publisher for the ARC.
Great job on this book. I’ve always liked Dr. Baden and have watched shows with him and read other books. This one really delved into a lot. While I was not a huge fan of the political aspect of the book I did appreciate that it fit in and was appropriate.
Anything with Dr Baden is always bound to be good and enlightening.

I like this book for providing detailed insights into the malfunctioning of the police and criminal justice system in the USA, with many examples of racism as the motivating factor for police brutality. The author has more than 50 years of experience working as a medical forensic examiner and describes how the system is stacked against blacks and Hispanics while police officers get mostly away with killing suspects through the use of excessive force. It is a sobering and revolting reading, with some hope provided at the end, which refers to the murder of George Floyd and the subsequent judgment of the responsible police officer to 22 years in prison, an absolute novelty, and a breakthrough for the black lives matter movement. While the book has some length, the ever-new cases and evolving insights presented by the author kept me going on to the end.