Dr. Nizam Peerwani is probably the highest-profile medical examiner in the United States. His territory covers four counties, but he’s been called upon often to lend his expertise as far away as Afghanistan and Bosnia. Since he was hired here in1979, he’s built what was a county morgue into a top-flight medical examiner’s office equipped with state-of-the-art laboratories. County officials, co-workers, and peers sing his praises.
But at least one detail-oriented crusader thinks that Tarrant County’s whole medical examiner’s office may be built on a shaky legal foundation because of the way Peerwani’s contract is written and the way he and his top staffers are paid. If David Fisher is right, and the contract is deemed illegal, that could open a can of worms that might have lots of convicted murderers calling for new trials. Some folks in Tarrant County are concerned – and with reason. Fisher claims responsibility for a recent shakeup that forced Lubbock County to completely reorganize its medical examiner’s office. In Travis County, officials say that his efforts contributed to a reorganization of the M.E.’s office there.
There are other concerns about the complicated financial arrangements involving Peerwani, Tarrant County, other counties, and his private work – an arrangement apparently used by no other medical examiner’s office in the state. Some local attorneys question Peerwani’s willingness to go along with Fort Worth police on cases involving deaths by Taser. And there’s some controversy about Peerwani’s work for the federal women’s prison hospital at Carswell. Judges, attorneys, former inmates, and families of inmates who died at Carswell or at local hospitals are outraged about the poor quality of the prison’s medical care, which evidence suggests has led to many deaths. And yet, because Peerwani’s private company holds the contract to do Carswell autopsies, families of inmates can’t get copies of his findings on the deaths of their loved ones.
“I will answer all your questions,” Peerwani told Fort Worth Weekly. “I have nothing to hide.”
David Fisher, who’s originally from Austin, is a pit bull when he gets his teeth into something. He spent most of the 1980s in the oil and gas business and most of that time suing a Colorado gas company for breach of contract on mineral leases he owned. “I had to learn the law because I represented myself,” he said.
He won the suit, eventually, and since then, despite having no formal legal training, he’s acted as a private consultant for individuals and lawyers – primarily in capital murder cases – who needed someone to read the fine print and figure out what it really meant. He’s worked for the U.S. Postal Service enforcement branch in Houston, helping track down workers on disability who were committing insurance fraud. And he’s consulted with a number of Texas government agencies that don’t want to publicly acknowledge his work. That’s because he has a tendency to stick his nose in other people’s business. The Austin Chronicle once called him a glorified pest. He refers to himself simply as a butt-inski.
“Look, there are rules, there are regulations, and there are laws. And most people cannot navigate them,” he said recently. “So that’s where I come in, sometimes uninvited.”
Fisher has been poking into Texas medical examiners’ offices since 2001 because of what he found when he was asked by a newspaper reporter to look into the 1998 capital murder conviction of Rodney Reed.
Reed, who is black, was convicted of killing a white woman with whom he said he’d been having an affair. Looking through the case files, Fisher came to the conclusion that prosecutors hid evidence that could have exonerated Reed. His work didn’t directly affect Reed, who is still on death row and still fighting his conviction with the help of the Innocence Project. But in poring over autopsy records in the case, Fisher said, he also came to believe that the prosecutors had pushed the M.E. to falsify his report. “And if a state prosecutor could have a medical examiner edit and falsify his report, what wouldn’t they [medical examiners] do?” he asked himself.
Fisher’s work in Travis County contributed to a reorganization of that medical examiner’s office, said Danny Hobby, who, as executive director of emergency services for Travis County, also oversees the M.E.’s office. “I can’t credit Fisher with any given point of the reorganization, but just having his input, hearing his ideas – some of which I agree with, some of which I don’t – has been very helpful to us. He’s smart and extremely enthusiastic in getting the medical examiner offices around Texas to function as they really should.”
In 2008, Fisher started hounding Lubbock County officials about their M.E.’s office, which was being operated via a contract with the medical school at Texas Tech University, something Fisher insisted was illegal. Officials never admitted he was right, but eventually the county dropped its contract with the medical school and appointed a separate medical examiner.
Even some of his detractors – a county official and a defense attorney in Lubbock County, for instance, neither of whom wanted to be named in this story – say that while Fisher tends to see conspiracy everywhere, he is still right on a lot of points.
“Out here in Lubbock,” said the defense attorney, “we had a medical examiner who was from out of state who was working here on an institutional license from the medical school. And Fisher kept browbeating everyone that since the doctor didn’t have a Texas medical license he was illegally operating as the M.E. He was talking about how all these capital murder cases should be granted relief because of that license. Still, for all his being a pain in the neck, he was right. He is one smart man. And he is right about going after the M.E.s in Texas. Somebody needs to watchdog these guys, and I’m actually glad he’s doing it.”
Told that Fisher was raising questions about Peerwani, the lawyer laughed. “He’s going after the guy with the most impeccable reputation in the state, maybe the country? Well, that’s Fisher for you.”
What Fisher is gnawing on right now are two key points in Tarrant County’s contract with Peerwani.
The Texas Code of Criminal Procedure defines how large counties must hire and pay their medical examiners. It establishes that the commissioner’s court appoints the M.E., who serves “at the pleasure of the commissioner’s court,” and that the court “shall … pay the salaries and compensations of the medical examiner and his staff.”
But in Tarrant County, Fisher maintains, the contract is not with Peerwani as an individual, but with what is called Peerwani’s professional association – technically a partnership, formed in 1981. While hospitals can legally hire professional associations, Fisher said, “the medical examiner is a county official. And a professional association cannot be a county official.”
A copy of the contract provided to the Weekly by Tarrant County Administrator G.K. Maenius shows that the entity with which the contract is made is “Nizam Peerwani, M.D., P.A.” The P.A. stands for Professional Association, and Fisher asserts that legally, the “P.A.” means that the agreement is with Peerwani’s professional association.
County officials disagreed. Neither the county judge nor any of the four commissioners returned the Weekly‘s calls asking about the contract. But Maenius said the district attorney’s office and the commissioners have gone over the contract and approved its wording.
“There’s nothing hidden here. We’ve looked into it, and we’re satisfied,” he said. “It’s a similar contract to what Tarrant used not only for his 30-year tenure here but for his predecessors as well.”
Assistant District Attorney Marvin Collins agreed. “Tarrant County hired Dr. Peerwani as the medical examiner. That is very clear. The county did not hire a professional association – they hired Dr. Peerwani. He is personally appointed as a county official. And there is also a contract with his professional association.”
However, Peerwani the individual and Peerwani as the proprietor of a company run together when it comes to pay: He does not draw a separate salary as medical examiner. Instead, the county pays Peerwani’s professional association a flat fee, now close to $1 million per year. And out of that, the P.A., under the direction of Peerwani, pays Peerwani and his top four associates – the people who actually do the county’s autopsies. Those people are not county employees but employees of the association. Other workers in the office, including lab technicians and the scientists who do everything from death- scene investigation to toxicology work, are paid directly as county employees.
“By allowing Dr. Peerwani to pay his assistant M.E.s, they are beholden to him first and the county second, which opens the door to all sorts of corruption,” Fisher said. “His assistants are supposed to answer only to the county, which pays their salaries. But that’s not what’s being done.”
The Tarrant County Medical Examiner’s Office is only one of 12 such agencies in Texas. Harris, El Paso, Travis, Bexar, and other large counties have their own M.E. offices. Tarrant is unusual in that it has a medical examiner district, through which Denton, Parker, and Johnson counties pay Tarrant County to handle their M.E. work. Most of Texas’ counties with populations under a million use the justice of the peace system, in which a JP hires medical examiners or forensic pathologists as contract employees and signs off on their autopsies.
Tarrant’s is the only M.E.’s office in the state in which the chief medical examiner’s professional partnership receives a lump sum, and the partnership decides whom to hire as forensic pathologists and what to pay them. Other counties simply hire the chief medical examiner as a county employee with a regular salary and benefits, and all other employees of the office are also direct county workers.
“All you’ve got to do is look at Peerwani’s contract as written, and you can see it’s not legal according to Texas law,” Fisher said. “And if the contract is not legal, then Peerwani is not a medical examiner and cannot use that title.”
Tarrant officials, he said, “are hoping this will just go away. But the truth is that the county is paying a professional association, not Dr. Peerwani. The professional association pays him. So he’s a contractor, not a county official. It may seem like splitting hairs, but it’s not that by a long shot. It changes the whole way the county deals with him, and it changes the way his assistants deal with him.”
Ten years ago, the Fort Worth Star-Telegram reported that then-Tarrant County Judge Tom Vandergriff wanted to “do away with the contract and make Peerwani a county employee, giving the county more control over his practices.” Vandergriff wasn’t available to answer questions for this story.
If the questions involving Peerwani and his professional association weren’t complicated enough, there’s another company in which Peerwani and the county’s business mixes.
Anatomic and Forensic Pathology Consultants Inc. is the company through which Peerwani and his chief deputy medical examiner, Marc Krouse, perform autopsies for private clients, ranging from defense attorneys seeking a second opinion on a cause of death to the Federal Medical Center-Carswell.
The 1995 Star-Telegram story raised questions about whether Peerwani’s private firm was benefiting financially from his public position. It was. Calls to the firm were answered by county employees in the M.E.’s office. At least one autopsy done privately was signed by Krouse using his official Tarrant County title, and officials from several counties said they thought they were dealing with the county medical examiner’s office when in fact they were dealing with Peerwani’s private company.
After that, Maenius said, the county changed how Peerwani’s private company functioned in relation to the county. “His private autopsies are performed outside of the medical examiner’s office. The private company phone is no longer answered in the medical examiner’s office,” he said.
Since then, Maenius said, that business has been separate. Unless, that is, Peerwani and his associates need to use the M.E.’s laboratories. “In that case he is billed for that,” Maenius said. “It’s all in his contract and very clearly stated.”
In terms of finances, there really is no issue, the county administrator said. “The monies paid to him by the county through his professional association go to pay himself and his assistants. The county pays for everyone and everything else at the M.E.’s office.
When Peerwani’s medical examiner team does work for one of the counties within its district, Maenius said, that is paid for under the lump sum contract.
But when other government entities come calling, Tarrant County and Peerwani’s group split the fees. “When he works for non-jurisdictional entities, Wise or Taylor County or any other county as the medical examiner, Tarrant County gets a fee for that work, which is done at the medical examiner’s office. Of that fee, Tarrant County gets 40 percent, and he gets 60 percent,” Maenius said. “That way the county is reimbursed for any laboratory costs involved in those autopsies. And we don’t pay him until we have a check in hand. It’s a very transparent situation and one that we’re very comfortable with.”
Tarrant County hasn’t done an audit of the M.E.’s office in at least 10 years, said County Auditor Renee Tidwell. But, she added, an audit of the office was recently started and should be finished in June. “We didn’t start it because reporters began asking questions,” she said. “It was just time.”
Tidwell explained that the frequency of audits of various departments depends on how much taxpayer money is at risk. “The tax assessor’s office, which brings in $3.5 billion a year, has a much higher risk factor than Dr. Peerwani’s office,” she said. “But now that the office is generating $2.5 million to $3 million a year for the county … it’s time for an audit. Don’t read anything more into it than that.”
Tidwell said it’s not her job to look at how Peerwani’s professional association spends the money it is paid annually by the county. The analogy, she said, would be to a county employee or contractor who is paid by check. “What you do with that is none of our concern,” she said. “He’s got to pay his staff out of it, and his staff is still there, so we know he’s paying them, and that’s our only concern with that contract.”
Fisher also questions the propriety of the Carswell prison hospital’s contract with the Peerwani’s company, Anatomic and Forensic Pathology Consultants Inc.
Peerwani said he sees nothing controversial about the arrangement. “I have had a personal contract with Carswell for about 10 years now,” he said. “The medical examiner’s office does not do that work.”
Fisher asserts that the Texas Code of Criminal Procedure requires an official medical examiner and not a private contractor to autopsy the bodies of those who die in prison hospitals.
“The law states that in the case of an inmate who dies in a prison hospital where the cause of death cannot be ascribed with legal certainty, that body is to be turned over to the medical examiner in localities where they have one. It’s very clear. It does not state that the body may be turned over to a private company or anyone else. Only to the medical examiner. And there is good reason for that.”
He contends that Carswell’s arrangement with Peerwani’s company frees Peerwani of any responsibility to treat those autopsies as public records. That, he said, gives Carswell officials a way to keep families from discovering whether the prison hospital contributed to inmate deaths.
“It works like this: Peerwani’s company does the autopsy. You’re a family member of the deceased, and you want the results. The prison tells you to go talk to Peerwani. But Peerwani did the autopsy for the prison and so cannot release the results. So you to go back to the prison. You see what’s going on?” Fisher said.
The Weekly, in stories over almost a decade, documented several cases in which families were unable to get copies of autopsies done by Peerwani.
“It allows the prison to cover up for their lousy care,” says Fisher. “It even allows them to cover up for deaths they might be directly responsible for.”
Carswell officials did not return calls seeking comment for this story.
Peerwani said he knows of nothing improper about the contract. But he did agree that, without the prison’s permission, he is not allowed to provide families with autopsy results.
However, he said, “No one has ever come to me to ask for the autopsy results connected to a death at Carswell. Not once. If they did, I would tell them to talk to the prison, but it has never happened.”
If others deem that the Carswell contract with his company is improper, he said, “we can always fix it and have those four or five autopsies a year done by the medical examiner’s office.”
The job of the chief medical examiner and his staff is to explain the “cause and manner of death in cases where the death has occurred unattended or unexplained, and where the death is due to unnatural causes or suspicions of unnatural causes,” according to the Tarrant County M.E.’s web site.
It’s a dirty job that involves picking up the pieces at auto wrecks and homicide scenes and trying to determine why people died. It involves investigating the sudden deaths of babies and children and sometimes establishing the identitities of the deceased.
In Tarrant County, that work is done by Peerwani and his four associates, plus a staff of 64 county employees and scientists who, according to officials of several outside agencies, run some of the best laboratories in the state for toxicology, medical anthropology, forensic dentistry, DNA, and other investigative needs. The consequences of those investigations – and any mistakes – are enormous.
According to those who have worked with him, Peerwani and his staff are meticulous in making certain that mistakes don’t happen. Dr. Jeffrey Jentzen, chairman of inspections and accreditations for the National Association of Medical Examiners said the Tarrant M.E.’s office is one of only five in Texas that are fully accredited by the national group. “I’ve know Dr. Peerwani for over 20 years, and he is a real leader in the field,” Jentzen said. “He runs the kind of institution that you want your cases to go to. And he personally makes presentations at our annual meetings, an indication of how highly he’s thought of among his peers.”
Fort Worth attorney Fred Cummings is similarly impressed. “I’ve known Nizam Peerwani since I was a police officer working crime scene searches in the late 1970s, before he became the M.E. And I worked with him as a prosecutor on capital murder cases for 15 years. Now I work with him as a defense attorney. And throughout all that time I’ve nothing but the highest regard for his work.”
In a 30-year career, even the most meticulous medical examiner earns his share of controversies, and Peerwani is no different.
In 2006, when two-month-old Cynthea Gonzales died in San Marcos, Travis County Chief Medical Examiner Roberto Bayardo found evidence of a skull fracture and healing ribs, both of which indicated the infant might have suffered abuse. But he concluded that the skull fracture was old and did not contribute to the death. He determined that the cause of her “sudden, unexplained death” could not be determined conclusively.
Travis County Justice of the Peace Margie H. Hernandez, pushed by police investigators, ordered a second autopsy, this one by Peerwani. According to a police affidavit, Peerwani’s preliminary findings indicated that the infant died of “severe head trauma.” Shortly thereafter, police arrested the infant’s parents, Cipriano Gonzales IV and Esther Marie Gonzales, and charged them with capital murder.
In fact, Peerwani said, only the skull, not the baby’s body or brain, was sent to him, and he did no autopsy and made no official or even preliminary determination about the cause of death. All he did, he said, was to talk in broad general terms to the San Marcos officials.
But because of his reputation and his “findings” listed in the police affidavit, the baby’s parents went through two years of hell before charges were finally dropped in June 2008.
Police in that case, Peerwani said, “just took my general talk and used it as they wanted. I was very careful with my choice of words to them, but I’ve learned to be even more careful because of that case.” He took a public bashing for his part in the case.
After the Branch Davidian debacle near Waco in 1993, an attorney representing one of the surviving cult members objected to Peerwani being chosen to identify and autopsy the remains of the dead. A 1993 Dallas Morning News story noted that Jeff Kearney made the request because, he claimed, Peerwani’s office in the past had lost body parts “before and during autopsies” and that “officials once sent out the wrong body for burial.” Kearney didn’t return calls from the Weekly, but Peerwani was willing to discuss the claims anyway.
The allegation of the wrong body being sent for burial, he said, was flatly wrong. The allegation of “lost body parts,” he said, stemmed from a case in which two young men, driving drunk on Randol Mill Road late one rainy night, crashed into a ditch. “My investigator went there and found they were thrown from the truck. So he had the bodies brought to the office. They were in bad condition,” Peerwani said. “Well, a year later, family members returned to the scene and claimed they found pieces of tissue still hanging from a tree and such. They sued us. But when we asked for the evidence, they never produced it, so the suit went nowhere.” He was skeptical, he said wryly, that any piece of tissue could still be recognizable after being outside that long.
In another case that caused him grief, a young gunshot victim was pronounced dead at John Peter Smith hospital, and his body was picked up and brought to the morgue. “I got a call a little later from my investigator saying that the man was breathing about twice a minute and what should he do. I told him to call 911 and have the body brought back to JPS.” That was done, he said, and when the man’s breathing stopped, he was brought back to the morgue, and the autopsy went on from there.
The medical examiner’s offices are located on Feliks Gwozdz Place just behind JPS hospital. On the wall of the foyer, a large frame holds several dozen patches from the law enforcement agencies with which the office has worked, from local police departments across Texas to the U.S. Department of Homeland Security and the United Nations.
Peerwani, a father and grandfather, is robust and charming, with a ready smile, a shock of white hair, and a bushy white mustache. He was born in Pakistan, but shortly after World War II ended his family moved to Tanzania, where he spent most of his youth. He attended the American University in Beirut, and, since he’d always wanted to come to the United States, did his postgraduate work at Baylor University Medical School.
At Baylor, Peerwani worked part-time for Tarrant County Medical Examiner Feliks Gwozdz. In 1979, when Gwozdz became ill, Tarrant County officials asked Peerwani to fill in. Gwozdz died shortly thereafter, during a trial, and Peerwani testified in his place. During the trial Mike Moncrief, then the Tarrant County judge, pulled him aside, Peerwani said, and appointed him as the county’s interim medical examiner on the spot. Not long after, county officials offered him the job on a permanent basis. He said he would take it if the county would build a real M.E.’s office, something he said Moncrief got done in 10 years time.
An ardent student of politics, religion, and human rights, Peerwani has traveled a great deal for organizations such as Physicians for Human Rights, the United Nations, and Human Rights Watch, investigating claims of genocide and other abuses in far-flung corners of the globe – all pro bono.
“So I hear you’re running around town asking people about my contract,” he said in a gentle voice, as we sat in his small, comfortable office library. “Well, I was appointed. How I get paid is a different thing. But the law doesn’t say how I should be paid, so I don’t understand why that is an issue.”
He said the details of his contract and the M.E.’s office arrangement weren’t his call. “You’d have to ask county people that question. The county offered me the contract. I didn’t ask for it,” he said. “I was in no position to ask for anything 30 years ago.”
Asked about his international work, Peerwani launched into a story about going to Rwanda in 1996, where his group had to be protected by Nigerian special forces under the banner of the U.N. while they searched for mass graves. “We found one that had 550 bodies in it. Our group only did one grave, but there were many more from that time.”
Such work has taken him to killing fields in Bosnia-Herzegovina, Indonesia, El Salvador, Iraq, and Peru. He was called to Afghanistan in 2002, shortly after the United States sent in troops, to investigate what had happened to about 2,000 suspected Taliban and al Qaeda members who allegedly had surrendered to a local warlord and U.S. ally and then been killed. Their bodies had not been located, but human rights officials believed they’d been buried in mass graves in the desert. Peerwani and others with Physicians for Human Rights questioned local shepherds, found the bodies, and identified them as those of the men who had surrendered to the warlord.
A spokesman for Physicians for Human Rights noted that the organization has always been “very pleased with Dr. Peerwani’s work for our program and with what he’s contributed to the cause of human rights worldwide. His work is just exceptional.”
There’s another area of human rights work where Peerwani is a player in a much different way. Amnesty International and other groups around the world for years have complained about the abuses of Taser electric-shock weapons by police agencies – especially in the United States and in Texas in particular.
Questions have been raised about several cases in which people died after having been tasered – in most cases, repeatedly – by Fort Worth police. Those deaths, in part, led the police department to change some of its policies on Taser use a few years ago.
In one 2005 case, Eric Hammock, a Midland architect and cocaine user, died after Fort Worth police tasered him 25 times during a nine-minute span. Peerwani’s autopsy showed very little cocaine in Hammock’s system for a regular user, yet he ruled the cause of death an accidental cocaine overdose.
Peerwani said there are reasons why even a small amount of cocaine can lead to death. As for the role of the shocks from the Taser, he said police told him that the computer chip in the weapon (which records how many times and for how long it is discharged) had malfunctioned, and they couldn’t tell how many times it had been fired.
In fact, records eventually released to the Weekly by the police department, long after the death, showed the 25 firings just before Hammock died.
“If that case occurred today, I would look at it very differently,” Peerwani said. “And if I had known he had been hit with that weapon 25 times, I would also have looked at it differently. But the whole issue with those weapons is a difficult one,” he said.
It’s still very difficult to determine the role a Taser charge may play in a death, but, Peerwani said, “What we can learn from history is that there are people in certain excited states who perhaps should not be shocked.”
He has taken note, he said, of the actions of Taser International, the company that makes the weapons and that has a policy of suing medical examiners who find Tasers as having contributed to or caused a death.
“That can be very intimidating, of course,” he said. But, he added, it doesn’t affect his decisions. “We are working on a case right now where the Taser was used, and we are looking at it very closely. And if we determine that the Taser was a contributing factor, we will be clear on that.”
Despite Peerwani’s reputation both in Texas and in the international community, Fisher said he will keep after Tarrant County and Peerwani until they make changes to comply with the law. “I will file a formal complaint with the state attorney general and even with the Justice Department if I have to,” he said. “Him being famous doesn’t make him untouchable.”
It’s not a prospect that many people are looking forward to. One defense attorney who has worked extensively with Peerwani’s office and who asked not to be named said he found Peerwani to be a straight shooter “who’s going to tell you what he found, whether you like it or not.
“And I certainly don’t want some contract detail to allow all the cases he’s ever testified to as the medical examiner to be reopened,” the attorney said. “You take someone who’s been out there raping and pillaging and is behind bars for good reason – well, I sure don’t want that person released on a damned contract detail.”
Fisher’s reply: Well,” he said, “then they should have done it legally to
begin with.”
