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05 April 2005

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It's often been said that "a mind is a terrible thing to waste." Usually though, that phrase comes up in the context of educating those at risk of permanently falling behind in life because they lack educational opportunities. Today, that phrase takes on new meaning, especially for the residents of King County, Washington, who have recently discovered that their local Medical Examiner's office has been selling the brains of the recently deceased for profit without either their consent or the consent of their families. (HT: Josef's Public Journal, who details much of the initial fallout from KIRO's reporting.)

Where Do I Begin?

Because the scandal involves so many different levels of mismanagement, poor judgment and outright contempt on the part of King County's public officials, it's difficult to even know where to start excoriating them. I think the place to start may be in examining the motivation of the King County Medical Examiner's (M.E.) Office (or KCMEO) in functioning as a "brain broker." I mean, come on, what on earth could have possessed these people to engage in this conduct in the way that they have?

People Are Motivated by MICE

There's an acronym that I picked up in studying organizational behavior as part of my MBA program that describes the factors that influence people in the workplace: MICE. Money, Ideology, Compromise and Ego. Combined, these factors represent a simplified means of "motivating" an individual or a group to engage in behavior they would not otherwise pursue.

Money Underlies the Scandal

First, let's consider money. According to the KIRO report, the agency received roughly $8,300 USD per brain, and nearly $1.49 million USD total since 1995. But the problem with money as a primary motivating factor is that much of the proceeds from the "brain business" went toward funding the salary of a pathologist and other technical resources in the years the M.E.'s office maintained its relationship with its sole customer for the organs, the Stanley Medical Research Institute (SMRI). While the money received exceeded the cost of operating the "business," the profit margin itself does not appear to be sufficient to justify sustaining the business on its own merits.

Ideology as a Motive

Ideology offers a more compelling rationale for initiating what later became clearly unethical behavior. The customer, SMRI, sought the brain tissue of the recently deceased mentally ill since they believe studying the organs might provide insights into their disorders, which might lead to cures for their illnesses. SMRI also sought "normal" brain tissue as well, since these brains would provide a "control" group for scientific comparison. On the whole, the families of the donors would be offered the opportunity to contribute to valuable medical research through the King County M.E.'s office, a noble purpose. But this factor only explains how the program began, not why it evolved into the unethical and potentially illegal practices the way that it did. So, we must look elsewhere for the reasons why it should have done so.

Compromised Behavior

Compromise often represents the direct influence of others upon a particular individual's behavior. Often, it takes the form of peer pressure, as in the case of Enron's energy traders, or the direct application of power by an individual in authority. In this case, Compromise does not appear to be much of a driver in setting the behavior of the King County Medical Examiner's Office's employees. By this, I am referring to how the consent of the deceased or their next of kin was cut out of the process, and will look at how this practice began in the M.E.'s office, and what was done to sustain this unethical behavior after it began.

Some background may be in order here. The agreement between Stanley Medical Research and the King County M.E.'s office (available online as a 1.9MB PDF document) indicates that consent of the deceased's next of kin was required, and would require some three forms to be completed prior to "harvesting" the deceased's brain tissue.

From what we know, it appears that the M.E.'s office did not strictly adhere to this requirement. Practices within the office appear to have evolved over time to potentially allow the agency's employees to initiate and execute all the paperwork required to harvest the post-mortem brain tissue of the deceased without the explicit consent of the deceased's next-of-kin. That this evolution occurred indicates that the King County M.E.'s Office lacked the necessary internal controls to sustain its ability to perform its functions according to its contract with SMRI. This evolution also indicates that Compromise may not be a driving factor, since Compromise would represent the agency's employees being "forced" to deviate from official procedures for the purpose of fulfilling the terms of the contract, which at this time does not appear to be the case.

Ego as the Primary Driver

Never-the-less something went seriously off track within the King County M.E.'s Office. Having already looked at Money, Ideology and Compromise as potential driving factors in the behavior of the M.E. office employees, and ruled them out as primary elements, Ego therefore represents the most likely candidate to be the primary driver behind the M.E.'s office employees behavior in the scandal. But how would that work?

Consider the following as if you were a manager: In the twisted world of government, or some other similarly complex or bureaucratic organization, the more people who report to you within your organization, the more power you have, the more money and budget you can command, and the more people you can add to your empire within the government to restart this "unvirtuous" cycle. Ego is what motivates this pattern of conduct and decision making.

To understand why Ego may be the primary motivating factor here, we need to go back to look at what the proceeds of the brain brokerage business were used to provide to the M.E.'s office. According to a press release issued by the King County Medical Examiner, Dr. Richard Harruff, in defense of the office's actions, it was noted that:

There was no financial incentive to acquire tissue samples, in other words there was no quota and no profit. All funds paid for the salary of a full-time pathologist and other costs to provide the capacity within the medical examiner’s office to take the samples when needed.

So, for the going price of $8,300 per brain, the King County M.E.'s office received a trained pathologist and other technical resources. Of course, it's not clear whether the pathologist or other resources were exclusively occupied with satisfying the terms of the contract with SMRI, or were otherwise utilized within the agency. Never-the-less, I believe that maintaining this additional employee on the M.E.'s office roster represents the real reward to the agency for never correcting its scandalous conduct.

Finally, on another more damning note which is in direct conflict with Dr. Harruff's claim to the contrary, the agreement between SMRI and King County M.E.'s office (linked above) indicates that there was in fact a target (or quota) for the minimum number of specimens that would be provided by the agency:

It is mutually agreed between the parties hereto that the KCMEO will try and collect a minimum of 50 specimens during the calendar year.

Positive Reinforcement

Update (added 7 April 2005): KIRO has an e-mail written by a manager within the King County M.E.'s office further disputing Dr. Harruff's claim there were no quotas. Here are the details as reported through Seattle Weekly:

The management e-mail congratulated staffers for collecting "40 brains" in the first six months of the year, when they expected only 50 for "the entire year! This is great work."

One can only wonder what the pathologist funded through this enterprise would do for the remainder of the year once the fiftieth brain was collected. This e-mail does however suggest that Compromise may have been more of a factor in motivating the employees of the King County M.E.'s office than I had originally believed, as it certainly would indicate management's interest in promoting the enterprise.

Ultimate Responsibility

All in all, the conduct of the King County Medical Examiner's Office represents a case study in slippery slope ethics with multiple layers of culpability. At the very least, someone within the M.E.'s Office needs to be held accountable for the office's lack of accountability. The question remains as to who in King County's government will stand up to meet the challenge?

Update (9 April 2005): KIRO reports that legal action has been initiated against the King County Medical Examiner's Office.

For More Information

P. Scott Cummins (The Urbane Republican) has been following the "Brain Broker" scandal since the initial reports - his summaries and links to published reports are well worth reading:

1 April 2005

Coroner Profits Without Consent From Tissue Sales
King County Signed Contract to Profit From Autopsies: Selling Brains of Mentally Ill

2 April 2005

Same Practices as King County's Brings Maine Lawsuits

4 April 2005

Weekly's Rick Anderson: Scandal Nothing New for Alonzo Plough

5 April 2005

Time For Your Voice On King County Medical Examiner Scandal

For Breaking News

About the King County Medical Examiner's Office

Readers interested in catching the latest news of the scandal may use the news search links below to find the most recent reports.

About the Stanley Medical Research Institute

Update (9 April 2005): More information about previous and ongoing controversies surrounding the Stanley Medical Research Institute (SMRI) and it's Associate Director for Laboratory Research Dr. E. Fuller Torrey is available. (HT: Kangaroo-Court). SMRI has been probed since at least late last year in connection with a similar controversy in Maine.

Editor's Note: This article was modified from the original version to correct several grammatical errors on 5 April 2005 and to clarify the concepts discussed on 7 April 2005. The sections linking to more information and breaking news reports were added on 6 April 2005.

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