So we're going to do Item Number 8, SB 1189 post mortem examinations or autopsies forensic pathologist. Good afternoon, welcome. >> Thank you. Thank you Chair, Senators, I first would like to thank the Chair and committee staff for working closely with my office on the bill. And sergeants should have passed out a mockup of amendments to reflect the amendments agreed to by the authors and the Chair. Actually you know what? My coach Senator Jackson is here.

Okay, well, I have a the joint author, I just want to be sure she is being called. Okay, these amendments differ sightly from the analysis in your binders by deleting a requirement that a forensic autopsy be considered to practice medicine. The amendments also require in that the autopsy be conducted by a licensed physician or surgeon and further clarifies a post mortem examination definition to say that it is to determine the cause and manner of death. These amendments should address concerns that were brought up, but we will continue to talk with the opposition to try and address any remaining issues. So, again, today Senator Jackson I present to you SB 1189 dealing with postmortem exams and autopsies. This bill builds public confidence and ensures that we have accurate and objective autopsy reports, which provide critical pieces of information determining the cause and manner of death. By giving the trained medical examiner more control over the autopsy suite and clearly defining who is allowed to conduct autopsies.

Not only do families deserve to know what happened to their loved ones. But the public and juries need to trust that they received accurate, objective information to make the correct verdict on a criminal case. Yesterday was the one year anniversary of the death of Freddy Gray, who passed away while in custody. And at the time, of course, there was a lot of questions surrounding his death. And a trusted autopsy report was essential to helping bring clarity and essential to achieving justice. However, current law here in California does present some gray areas which could undermine public confidence in autopsy findings by allowing non-medically trained individuals who may be elected or appointed to conduct the autopsies. Current law also allows law enforcement involved in the death of the individual inside the autopsy suite during the procedure, which could unfortunately create an appearance of influence on the findings, which then could create public distrust of our criminal justice system. That's why SB 1189 will prevent any law enforcement personnel directly involved in an individual's death from being allowed in the autopsy room. And guarantees that the licensed physician who conducting the autopsy has control over who is present in the room.

The public relies on accurate objective autopsy reports performed by appropriately done professionals to have faith that justice has been done. I respectfully ask for an aye vote, and I have witnesses in support. And I think as soon as my joint author shows up, she may want to make a statement too. >> Thank you, before we proceed, we don't have amendments. We're making copies right now because I want to make sure that all the members see the amendments reflect that you'll be taking at this point, but please proceed, state your name and position.

>> Thank you, Mr. Chairman and committee members, Douglas Chiappetta on behalf of the Union of American Physicians and Dennis with AFSCME. We represent the county medical examiners. We want to commend Dr. Pan, along with Senator Jackson and you Mr. Chair. Your staff have worked very diligently to find a common ground so we can move forward with this legislation. Specifically this bill would require forensic autopsy to be considered the practice of medicine. It also defines a forensic autopsy as a medical examination of the body.

Our support statement is as follows Mr. Chair. The Union of American Physicians and Dentists write that elected officials back the medical expertise necessary to perform a postmortem examination to the same degree as a forensic pathologist. As such we feel this bill is necessary. We encourage your aye vote. I have with me Dr. Judy Melinek, who's a member of our union, and can speak with great expertise to this issue. Thank you. >> Thank you, please proceed. >> Good afternoon, Chair and Senators. I'm Dr. Judy Melinek with UAPD. A death certificate is the most important document you will never know you need. It tells a family why their loved one died and provides information that could be used in a case against the person responsible for the death. If the death was a homicide, the district attorney will use it in court as evidence. If the death was from an infectious disease or overdose, researchers will collect that data to try and prevent other similar deaths.

I have worked in California as an assistant medical examiner and coroner's pathologist for over 13 years. I'm board certified in forensic pathology, and I've taught forensics at Stanford, UCSF, and UC Davis. It is crucial that a medically trained physician or surgeon is able to determine the cause and manner of death. In my own experience working for a coroner, I determined in one case after a complete autopsy and death investigation, that the cause of death was blunt force trauma in the death of a child. I unequivocally said to the sergeant that the manner should be undetermined. There was insufficient evidence to conclude whether the trauma was intentional or accidental. However after speaking to a pediatrician at the hospital, the coroner wrote that the manner was homicide, and the child's mother was indicted for murder. After speaking to several DAs for many months and consulting with the defense, I supplied them both with all the citations and articles supporting my position.

The case was eventually dropped by the DA, but caused great expense to the family. The mom still has a death certificate for her son that says homicide. This is wrong. No autopsy pathologist should have to defend a death certificate or manner of death determination that can't be substantiated by science. SB 1189 ensures that autopsy reports are accurate by allowing a trained medical professional who is an unbiased, independent party determine the cause and manner of death.

I'm speaking out on behalf of many of my medical colleagues who have had similar experiences, have become frustrated by, or have even felt threatened when they spoke out. In all due respect for the Senators' time, I'm available to answer any questions the committee may have. Thank you and I ask for your support on SB 1189. >> Thank you, anyone else in support? >> Good afternoon, Mr.

Chairman. George Osborne in support of SB 1189. Mr. Chairman, I'm here today because of my experiences in the autopsy room as a former police officer. I may be one of the very few people in this hearing room who've ever witnessed an autopsy. Over the course of my career as a law enforcement officer I witnessed several autopsies of homicide victims, all of whom were killed by gunfire.

My role in the course of the autopsy was very clear. I was not a physician, certainly not a forensic pathologist, not qualified in any way to comment on the procedure or guide in any way the examination of the body by the pathologist. My role was to identify the body, witness the autopsy, and retrieve evidence in the form of a bullet or bullets, as the case may be when removed from the victim's body. I witnessed the removal of the evidence from the homicide victims, took custody of the evidence, and established a chain of custody of that evidence. So that I could testify in court that the bullet or bullets that were subsequently introduced into evidence at trial were the same bullet or bullets that were recovered from the body. That was my only role. I'm happy to answer any questions you might have.

And thank you very much for the time, Mr Chair. >> Thank you, anyone else, support? Would Senator Jackson like to make a statement? >> Yes, thank you, Mr. Chair, members, I apologize, we were caught a little bit by surprise. But certainly I appreciate the opportunity to speak with you. First, I want to thank Senator Pan for letting me join him in this effort to protect the integrity of autopsies. As some of you may have learned, in my district in Ventura County, we recently had a series of incidents that led to the dismissal of the Ventura County Medical Examiner. In this case, which was investigated by the Ventura County District Attorney for possible criminal prosecution, a whistle blower brough to light forensic autopsies that were being conducted by unlicensed and unsupervised staff. In some cases while the County Medical Examiner was on vacation in Florida. As a result of this investigation, it became apparent that no crimes were committed, not because of lack of evidence but rather because the statutes are unclear as to what constitutes an autopsy and who may perform them.

This came as a great surprise to me and to many in my district who are under the belief that autopsies conducted by the county were done so with great integrity in alignment with the highest standards of practice and with respect to the deceased. In response to these findings it became readily apparent that legislative action was needed. To address the identified lack of clarity in law in order to ensure that the public's faith and confidence is retained as to how, when, and by whom a forensic autopsy is conducted. SB 1189 will help to reinforce the public's faith in our county coroner system, and ensure that the appropriate requirements are in place.

To ensure proper accountability in how autopsies are performed, and the determinations of death, of causes of death rather, are accurate. I appreciate the concerns that are expressed by the California State Sheriffs Association and Coroners Associations. And although they're currently in opposition to the bill, please know that we are working diligently with them to balance the interest of law enforcement and the need to ensure the integrity and accuracy of forensic autopsies. And, recognize that the bill is a work in progress but strongly believe that the amendments do go a long way to address varying medical, law enforcement and basic humanitarian concerns. And thus respectfully ask for your aye vote to allow as to continue this important policy discussion. >> Thank you, anyone else in support? Seeing none, opposition? >> [INAUDIBLE]. >> I'd asked earlier and I pointed it to you and you didn't say anything, but go ahead. >> Apologize. Thank you Mr. Chairman and senators. My name is Greg Bentley, I'm President-Elect of the Consumer Attorneys of California in support of of SB 1189. CAOC supports all of the provisions of SB 1189 but I'm here to testify specifically on two sections.

First, if an individual dies incident to law enforcement activity, law enforcement personnel directly involved with the care and custody of that individual, shall not be inside the autopsy suite during the performance of the autopsy. If an individual dies while in police custody, it is important to keep the process as transparent as possible for both law enforcement and the victim and the victim's families. Clear lines need to be drawn to avoid the appearance of a conflict of interest. For example, I am currently representing a young man who died while in police custody. While we are still investigating the facts surrounding the incident, we have confirmed with the Coroner's office that law enforcement personnel were present during the examination. In fact, this is quite often the norm, not the exception. But it's a major conflict of interest to have law enforcement personnel directly involved in an incident, to also be involved in an autopsy. Precluding law enforcement personnel from autopsies, caused or contributed by their conduct, it's only rational and will help to reduce any undue pressure or bias in the course of the autopsy.

The second provision of the bill I'd like to address is the section that states quote, any police reports, crime scene or other information, videos or laboratory tests that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity, shall be made available to the forensic pathologist prior to the completion of the investigation of the death. In this current case that I'm handling, I have been provided with video footage of the takedown and the restraint of the decedent which shows the officer conducting a choke hold, restraining the decedent.

The police has this video. I called the Coroner's office to confirm that the video had been provided to the examining pathologist. I was told that it had not been. I was also told that I was not authorized to send a copy of the video to the department. We have seen quite often law enforcement refusing to provide witness statements, video footage, photographs, and other helpful information within its possession to the examining pathologist. Quite often, this information will assist the pathologist in determining the circumstances surrounding the death of an individual. And should be provided to the examining doctor. This bill will help to provide pathologist a more complete picture of the potential cause of death. And will further eliminate potential bias that is possible when pathologist are provided only part of the relevant information. In conclusion, SB 1189 addresses and eliminates conflicts of interest and provides a mechanism of full disclosure to the examining pathologist that will elevate trust in the autopsy and the legal system, thank you. >> Anyone else in support? >> Yes. >> Seeing none, are you support? >> [UNKNOWN] I don't believe this is on yet.

Bob Ackerman with the California Society of Pathologists. Been working with the two author staffs on some amendments, and we support in concept, with the intent is we'll get there, thank you. >> Hi, Amy Durbin with the California Medical Association. Still reviewing the amendments, but definitely supportive in concept and look forward to continue to work with the authors moving forward. >> Thank you. >> Good afternoon Mr Chair, Sean Hoffman with the California District Attorneys' Association. Kind of in-between at this point. We think there are some important issues that need to be addressed as were raised by Senator Jackson in her testimony. We look forward to working with both authors and staff as the bill moves forward, thank you.

>> Good afternoon Mr Chair and members. Connie Delgado with the California Hospital Association. After the recent set of amendments we are removing our opposition, thank you. >> Thank you. Opposition? >> Thank you Mr. Chair and members. Corey [UNKNOWN] here on behalf of the California State Sheriff's Association in opposition to the bill. First, we note as evidence by the question about amendments and what's in print and what's not. The bill's in a state of flux and we're concerned that these are pretty significant issues that are being addressed on the fly.

But getting into the policy concerns, as I suspect, 50 of the state's 58 counties have consolidated offices of the sheriff coroner. In limiting law enforcement officer's access in the autopsy suite, creates very significant logistical issues. It also creates problems, since the body in a homicide case or potentially other criminal cases is often evidenced or contains evidence. So to say that a peace officer can't be in the room while an autopsy is being conducted is very problematic for chain of custody issues and for just questions about law enforcement in general. I'm concerned about this notion about law enforcement influencing a doctors decision as to how to assess the cause of death in a particular circumstance is a pretty significant allegation. And I would just close and we have representatives of the California State Coroners Association here as well that can talk about some of the more technical issues. But let me first tee that up by saying that there's a very significant distinction that's, I think that we haven't made clear yet.

And that's that there is a significant difference between the cause of death and the manner of death. And while the cause of death may be determined by a physician in concert with other individuals, the manner of death is almost always determined by someone other than the physician, or at least the physician is just acting in concert with the coroner and other officials. And so for this bill to take away that authority and to take away the necessary expertise of investigators and non-physicians who are part of the determination process as to the manner of death, this bill creates significant problems. So for the reasons stated, we are opposed. >> Thank you, anyone else? Opposition? >> Mr Chair and members, Danielle Sanchez on behalf of the California State Coroner's Association in opposition today as well.

I do want to note that we've had very good discussions with both of the offices of the authors. And we certainly appreciate that dialogue, but we have been able to take a look at the amendments. We appreciate the recognition of our concerns and seeking to move in the right direction, although we continue to remain opposed at this time. I would like to introduce Kim Gin, who is the coroner of Sacramento County, to speak to some of the technical parts of this bill. >> Thank you. Mr. Chairman and members of the committee, thank you for allowing me to address the committee today. On behalf of the California State Coroners Association, we must respectfully oppose Senate Bill 1189. Please allow us to underscore our commitment to a full and unbiased death investigation. We are never opposed to changes that aid in our commitment. However, we are concerned about the practical implications of this bill and the burden it will place on the individual counties financially, as well as the already overburdened field of forensic pathology.

First, it is important to note that all the counties in the state currently use a pathologist, a licensed physician, either by contract or as staff doctors to conduct autopsies. And some of these counties, it is not uncommon to wait days in order to have an exam performed. This delay can cause undue hardships on families waiting to bury their loved ones and later trying to obtain insurance monies. Second and the sheriff coroner agencies the manner of death is usually determined by non-medical staff. The cause of death that is obtained from a physician is only a portion of the investigation that aids in the matter. Having a physician determine both the cause and manner on every death that falls under the Sheriff Coroner Medical Examiner jurisdiction would require more physicians on staff or contracted with to meet the added duties.

The nation is currently at crisis, at a crisis level, with very few new doctors choosing the field of forensic pathology each year. The demand is much higher than the supply. It is unclear where the counties would obtain more doctors In order to fulfill the requirements of the bill or the money to pay for these new doctors. Lastly, an argument could be made also that having one person give both manner and cause could create an illusion of bias, as there are no checks and balances like the team approach exercised in the sheriff coroner and coroner agencies. Manner is not just a medical diagnosis.

Determining manner solely based on the cause and not considering every facet of the investigation is not true unbiased death investigation. The California State Coroner Association appreciates the discussion it has had thus far, and appreciates the opportunity to give testimony today. But unfortunately, respectfully opposes the bill as written. Thank you, Mr. Chairman. >> Thank you. For the record, can you state your name? I don't think I- >> It's Kim Gin, G-I-N. >> Thank you. Anyone else in opposition? Any questions? Yes, Senator Roth. >> Thank you, Mr. Chair, just a couple. Now I just want to make sure that I'm clear on this point. The bill would prohibit, for example, the officer involved in an officer involved shooting from being present in the autopsy room. But would not, I assume, prevent another representative of the law enforcement agency being present to collect evidence and secure the chain of custody. Is that correct? >> Yeah. That's your understanding sir? >> Right the ban is on officers that are involved in the incident that involves law enforcement officials. >> May I address that too Mr. Chair? >> Yeah you may.

Because I'm not sure if his question was answered with regard to the overall investigation in having police available or present. >> Right. So the bill would specify that, say there was an officer involved shooting. The officer who fired the weapon would be precluded from being in the autopsy suite, pursuant to the bill. >> Right. >> The bill also contains language though that says that law enforcement officers may only be permitted in the autopsy suite at the discretion of the forensic pathologist or the physician that is performing the autopsy. So there is no right or guarantee that law enforcement would be permitted. That decision, under this bill, is given solely to the physician performing the autopsy. >> And so I can see an issue with that because there's a requirement to preserve the chain of custody of evidence that the forensic pathologist or whoever else is doing this may or may not pay attention to.

May or may not be sufficiently aware of which could cause subsequent problems in the subsequent criminal case for sure. So I would think that you all might want to consider addressing that issue. >> Actually, perhaps Dr. [UNKNOWN] who's a forensic pathologist can speak to that and I think it's noted earlier by the coroners that there is a close partnership between coroners and a forensic pathologist. But perhaps as someone who's been in the autopsy room, she can speak to how we address the chain of custody issue. >> As a forensic pathologist, I can testify that we are all trained to maintain chain of custody. And all of the jurisdictions that I’ve worked. I've worked in three.

I've worked in Santa Clara County. San Francisco which is a medical examiners system. And I currently work in the Alameda County Sheriff Coroner system. All of them have policies in place with regards to tags that are put on the body that lock the body bag. And there are personnel who work at the coroner's office who are qualified and capable of collecting evidence and maintaining chain of custody. You don't physically have to have the same officer follow the body from the scene to the morgue and then back out to the mortuary. There are mechanisms and protocols of chain of custody having to do with qualified employees and documentation that is done by coroners staff. This bills specifically addresses law enforcement officers that were involved in the death of the individual. It does not bar coroners staff or law enforcement personnel who work for the coroners office from coming in and taking care of the custody and evidence. >> So why make it discretionary with the forensic pathologist? >> Because the autopsy, sorry. >> Because the bill, excludes peace officers who are directly involved in the shooting, if it's a shooting, from being present in the autopsy room, during the autopsy, so that alone should be sufficient.

>> Let me explain, because there have been many pathologists who have found themselves working for coroners facilities where all of a sudden the morgue gets opened up and we have sometimes dozens or scores of recruits coming in and police officers coming in, and we are conduct A medical examination. There are blood-borne pathogens. There's risk to personnel. I've cut into bodies without expecting that there be tuberculosis, and there it is, and now everybody in the morgue has been exposed. So that aspect of the bill is in there to keep those officers and the personnel in the in the morgue safe, but second of all, we do not need the extra distraction of people coming in, and there have been medical examiners, forensic pathologists who have asked the personnel to leave, and they have refused, and that has happened to me. Where, I've told officers you're putting yourself in danger, you're getting too close to the body, please step back and they have refused to leave.

>> I have one more question- >> Sure. >> On a different subject but before I leave this one, let me just say, I am very concerned about locking out so to speak, a detective for example, who may have a very real and necessary interest in observing what you do in the autopsy suite, in making sure that the evidence in a case that he or she is responsible for.

Is preserved in a way that is, makes it sure as is best as possible that it's admissible in a subsequent criminal trial and so I would certainly, if this bill gets out I would certainly expect that issue to be repaired before we see it again. Let me move onto this coroner versus forensic pathologist issue, which sort of fascinates me now. So if there's a conflict between the forensic pathologist and the non-M.D., O.D. coroner, who determines the manner of death? >> Currently under state law, the manner of death is determined by the coroner.

So the forensic pathologist can write an autopsy report and write the cause of death on the autopsy report. For example, blunt force trauma, but the coroner can write whatever they want on the death certificate. They could even write that it's pneumonia. They can change the cause of death and they can determine what the manner of death is. >> So focusing on the representatives of the coroners. As I recall, I have a sheriff coroner in the district where I live. Under what circumstances would the sheriff as I recall is our coroner but with the coroner overrule the determination of forensic pathologist as to the cause of death. And based on what information and evidence? Can you give me some examples? >> I would guess, or I would say, that one of the times that would happen is if the pathologist was found to be incompetent. And gave a cause that was not competent.

I've never overridden any cause from any of my doctors that have worked for me. Nor do I know of any of our former coroners that have overridden any of the causes. >> But in that circumstance, wouldn't you as a non physician, non osteopath, non-forensic pathologist, wouldn't you take the file and have another medical professional review it and then, and then take that medical professionals determination and write whatever that is in the form and sign it as the non-medical coroner? >> Yes, absolutely. I could. >> Okay, I'm just trying to understand the opposition in manner of death determined by a non-medical professional. I can't imagine that being used in a subsequent criminal prosecution and how that would work, and the impact of that on family members and the like, so I have concerns about that. >> About allowing the coroner to make a manner causes? >> A manner of death determined by a non-medical personnel. >> We've been doing that for many, many years. >> But based on the determination of a medical professional.

>> Absolutely. >> [INAUDIBLE] >> We take the cause and- >> [INAUDIBLE] >> Go ahead. >> Sorry [INAUDIBLE]. >> No, go. >> We take the cause. All the circumstances surrounding the investigation. We might look at other reports from other agencies. We look at medical records. Manner's not something that you decide in a vacuum. You don't. And, what the cause from the doctor is a very big part of it, but it's not the only part. >> Really? >> Yes. >> I guess, Senator, through the Chair. >> Hold on, hold on. Let him finish his question and if called upon you'll be asked. >> Mr. Chair, may I have the forensic- >> By all means. >> Yes, I've worked in both medical examiner and coroner jurisdictions so I could speak to this. Manner of death is pretty much determined by default by the pathologist anyway in how they write the cause.

So in writing the cause as acute opioid intoxication many coroners, in fact the majority of them, will consult with a document that's written by my professional organization, the National Association of Medical Examiners, which actually has written guidelines on how to determine manner of death. So that professional organization of physicians creates those guidelines. And in the medical examiner jurisdiction, I wrote the manner of death. So it's not true that the majority of cases are written by lay practitioners. The majority of manners of death in California, if you look at our population base, is actually written by physicians. San Francisco, Los Angeles County, Ventura County, those are all medical examiner's offices where the doctors determine the manner of death, no law enforcement. And not administrators. And the remainder of the jurisdictions, the coroner of jurisdictions the ones that I've worked in, the coroner asks the pathologists if they're not clear. Which manner is this? Is this accident or natural? Would you call this a homicide? So in the majority of cases they will come to the doctors and ask us what manner it would classify it at.

This bill, therefore, basically just codifies what is happening anyway, except in the minority of cases where there's a conflict. Where the pathologist, like in the case that I gave you, thinks it's undetermined and the coroner says no, I have other people who are telling me it's a homicide, it's a homicide. And then you've got a disconnect between the law enforcement perspective and the physician's perspective. And the physician is the one who has to get called to court to testify to this death certificate. Furthermore, the death certificate is also a public health document.

It's used in research, in scientific research. So public health researchers, for example, ones that I'm working with, concurrently with UC Davis, looking at opioid death intoxication. If the manner of death is done by someone who doesn't know how to distinguish between an accident and a suicide, they're going to capture the wrong data. So we will not have accurate data comparing county to county with regards to how many are accidents and how many are suicides.

And so that's why it's important to put it back in the hands of the physicians officially and legally, instead of just the defacto which is what's happening right now. >> Thank you Mr. Chair. >> Senator Hall, question. >> Yes, I'd like to hear his comment and then I'll have some follow up questions. >> Senator Hall, thanks, I was just going to clarify the point, excuse me Mr. Chair. I just wanted to clarify the distinction between manner and cause of death. That those are two separate things, and that the cause of death is the medical. As the doctor pointed out in the manner is more of the, the manner can also include trajectory of the bullet, for example, in a homicide. So I just wanted to clarify that. Thank you. >> Will additional physicians be required as a result of this bill? >> What did he ask? I- >> Would additional physicians be required as a result of this bill? And I don't see why someone would say no when we're mandating now physicians to be present, so additional physicians to be present.

So I want to hear what the coroner has to say first. >> Yes I believe there will be more physicians required to actually cover cause and now manor. The doctor's going to have to play the role of the investigator now as well as the medical doctor. So we do believe that is going to happen. >> And, who would have to pay for those physicians? >> The counties would have to pay for them.

Each county would have to pay for them. >> And you say what? >> I agree. I agree that this bill presents the likelihood that more physicians will be required. >> It seems like it's a mandate. >> Were the case, it would be a county cost. >> Right. >> I believe Senator Roth had another follow up question. And then Senator Manning? Okay. So the sheriff coroner's a good friend of mine in the county. I can't imagine the coroner making a determination in a case that someone fired a weapon and murdered a victim. Without having a physician examine the body, determine that there were bullets in the body, do your trajectory analysis, which I've seen from autopsy pictures of [INAUDIBLE] been involved in these cases.

I can't imagine a non-physician making that determination. So are you separating criminal cases from, I hate to use the word run of the mill, but run of the mill things that happen in life. When you say that the coroner can determine a cause of death without input from a physician in your county? >> We're not saying that. >> So don't you use a physician each and every time? When there's an autopsy to take a look at the body and make a determination as to cause of death. >> We do. We use a physician for cause of death. >> So to get to my colleagues question, what's going to change in your county as a result of this bill if it moves out of committee on to the floor and out of the legislature? The doctor wouldn't be able to just base the manner on cause any longer.

That doctor would have to actually investigate or have an investigation done on this manner question. So they would have to review everything. If there are videos to watch, if there's witness testimony, all that would have to be reviewed by the doctor to make the manner determination. >> So if a non-medical- >> I don't- >> Person reviews a video and sees a hammer hitting someone on the head, you might assume that that caused, and there was a death. You might assume that the hammer hitting the head caused the death. But a trained medical person, a physician or an osteopath, a forensic pathologist examining the body might conclude that yes, that was a significant event, but the death was really caused by something else, right? >> They could, and that's why we depend on our doctors and staff, our agencies with doctors, our contract with doctors, to give us the accurate cause.

>> Okay, I won't take up anymore time, Mr. Chair, I appreciate your patience. >> No, by all means, you have every right to ask questions. I believe Senator Monning had a question?.



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