BERKELEY — Dr. Mary Case, an institution in forensic pathology, stepped down this week as chief medical examiner for St. Louis County.
She left the top job, she said, because of her age — she’ll turn 80 next year — and mounting stress over a building that isn’t big enough to store all the bodies.
“We have a need for a new building; that has been evident for the last 10 years,” Case said in a recent interview. “That space problem, where to put the bodies, is so stressful that it led me to think I no longer wanted to be in charge of that operation.”
As overdoses spiked in recent years, so, too, did bodies in the county morgue. The morgue and storage at the Medical Examiner’s Office are so crowded that the office sometimes parks a portable, refrigerated trailer in its parking lot. Some corpses are kept at off-site funeral homes, and two or three bodies are stacked on carts designed for just one.
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“At this time in my life, I don’t need this much stress,” she said.
Since taking over as the county’s chief medical examiner in 1988, Case played a key role in some of the area’s biggest murder investigations, including Angie Housman, a 9-year-old St. Ann girl who was abducted, raped and tortured, and Paula Sims, an Alton woman who admitted killing two infant daughters.
In all, Case said she’s conducted about 300 annual autopsies in recent years. Backbreaking work, she calls it.
A homicide victim with multiple gunshot wounds, for example, can require an autopsy that takes a forensic pathologist six or seven hours. Every injury has to be described, every bullet pathway traced. And multiple bullet wounds are becoming more common with the proliferation of assault weapons.
Case once spent two days conducting an autopsy of a man shot 37 times.
She told a reporter she had no further comment on the county’s progress in replacing its outdated and cramped building. But during an otherwise wide-ranging interview Tuesday, Case sat in her office amid stacks of paperwork and reminisced on her storied career.
Despite stepping down, Case isn’t gone for good. She’s just semi-retired.
Case is packing up her office inside the George Gantner building in Berkeley and moving down the hall to a smaller, windowless room, still within the Gantner building. She will still work part time as an assistant medical examiner for the county.
Dr. Gershom Norfleet, an assistant in the office, took over this week as chief medical examiner for St. Louis County. Norfleet is perhaps best known as the doctor who performed the autopsy on Michael Brown, who was killed by a Ferguson police officer in 2014.
Norfleet, 46, grew up in University City and graduated from Louisiana State University School of Medicine. He said the lack of storage for bodies at the county office is a concern for him, too. “It’s something we combat on a daily basis,” he said.
Case will remain head of the regional offices as chief medical examiner for Franklin, Jefferson and St. Charles counties, duties she’s held for several years. It is a lighter load for homicides, though she still expects to perform about 150 autopsies a year.
“I’ll have at least one, and maybe two days free a week,” she said. “And I won’t have as much weekend responsibility.”
When she’s off work, Case enjoys gardening at her home in St. Charles, which she shares with her longtime partner Charles “Max” E. Million. A voracious reader, Case is a fan of fiction and belongs to two book clubs, one in her neighborhood and one at the local country club. She especially loves beach reads. She steers clear of thrillers.
“I just love to read and will essentially read anything except those killer things,” she said.
Crime novels, Case said, can be convoluted and tend to get a lot wrong.
“Sometimes they get the science wrong,” she said, “and they kind of make up stuff to make it interesting.”
A Jefferson City native, Case has been intrigued by science since the age of 5. Her mother was an artist, and her father and stepfather were engineers. Case went to the University of Missouri, with the idea of becoming a neurosurgeon. She got a job at the medical school after her freshman year, and she worked in the pathology department, which she calls a “life-changing experience.” She graduated from St. Louis University School of Medicine in 1969 and has training in neuropathology.
In February 1975, she started as an assistant medical examiner. Her boss, Gantner, died in 1988, and Case became the chief. She was only the second person to serve as chief medical examiner for St. Louis County. She also is professor emerita of pathology at St. Louis University Health Sciences Center.
Faisal Khan, acting director of the County Health Department, called Case “an absolute legend” in the world of forensic pathology. Case is a national expert, Khan said, on child abuse and shaken baby syndrome, having provided expert testimony, authored books and given lectures on the topic.
Case was instrumental in changing the way Missouri investigates child deaths. Missouri’s child-fatality review process, established in the early 1990s, is considered one of the country’s best and most comprehensive. Missouri mandates an investigation anytime a child dies.
Case has been critical of the county coroner system, saying that many coroners are funeral home directors without medical training, and she fears that some have signed off on deaths that might have been murders. The child-fatality review process, she said, has improved things across the state.
Case has no children of her own.
Case has collected examples of baby deaths since 1975 and has written two books about the topic in the last couple of years, largely for other forensic pathologists, detectives or social workers involved in child-abuse investigations. Using a technique involving beta amyloid precursor staining, she studies child brains to detect damage, looking to see if the child’s head had “an abrupt acceleration” that would suggest what happened.
The death of a child has always fascinated her, often a mystery to be solved. Most child homicide victims die from head injuries, abused by someone who “flew off the handle, got out of control, grabbed a child” and fatally injured the child, Case said.
“Child abuse, in general, is done in the privacy of a home ... very seldom is it ever witnessed,” she said. “So it’s a mystery as to what happened. You have to figure it out, working backward.”
Case began sounding a warning to county officials a decade ago as drug deaths spiked and the morgue started to get overcrowded. Her office and the morgue are in a single-story brick building near Interstate 170 and Airport Road. The county is in “severe need of a new facility,” she said.
The Post-Dispatch documented the surge in bodies in a 2017 article. At the time, Case envisioned hooking up a refrigerated trailer to her office’s power source to store bodies.
Her warnings became reality. Today, an 18-foot refrigerated trailer is parked next to the Medical Examiner’s Office. The office also sometimes uses space at two funeral homes. About a month ago, Case suggested the county consider moving bodies into a county ice rink.
In the past few weeks there have been as many as 69 bodies in the morgue on a single day, with eight stored off-site. Bodies were coming in three or four at a time.
“This is not a dignified way to handle bodies of loved ones,” County Executive Sam Page said in March, describing how they were stacked on carts. “But the Medical Examiner’s Office has no other option to make room,” Page added.
Overdose deaths from fentanyl, heroin and other opioids are a major factor — St. Louis County had 343 opioid-related deaths in 2021, tying the record high set one year earlier. This year may surpass that.
And progress on upgrades is moving slowly. Planning and construction would take years. The county hasn’t even authorized a study yet.
On Tuesday night, legislation was introduced to the County Council for a feasibility study on the potential replacement of the Medical Examiner’s Office and the North Central Community Health Center in Pine Lawn, the busiest of the county’s three public health centers.
Christopher Ave, a county Health Department spokesman, said the department wants the $300,000 cost of the study to be reimbursed by federal American Rescue Plan Act funds.
A storied career
Asked about her most memorable investigations, Case immediately mentioned the 1993 death of Angie Housman. The fourth-grader was abducted while walking home from her bus stop in St. Ann, and her body was found days later in a wooded area of St. Charles County. Case conducted the autopsy.
“It was a horrible, horrible thing,” Case said. “She was a little girl who wasn’t just raped and killed. She was held for several days while repeatedly sexually assaulted and starved. And then she’s tied to a tree naked. Imagine how frightened that child was.”
Case said another unforgettable case was the death of singer Walter Scott in St. Charles County. Case accompanied deputies to a home in 1987 on the day they discovered Scott's decomposed body, with a bullet wound in the back, floating in a cistern. Case laid on the ground and reached into the cistern to pull out his head.
“Finding his body was the most thrilling thing I’ve ever seen,” she said.
The back story, though, is what Case likes best. It explains what brought investigators to the cistern in the first place.
A woman named Sharon Williams died in October 1983. The hospital physician signed off on her death as an accident — a head injury suffered in a car crash. Two months later, Scott mysteriously vanished. Then Sharon Williams’ widower, James Williams, moved in with Scott’s wife, raising suspicions.
After Case became St. Charles County’s medical examiner in 1986, as the county’s first forensic pathologist to serve in that role, police asked her to examine an old case. They handed her the crash report of Sharon Williams. Case got the medical records and decided the wounds to the back of Sharon Williams’ skull weren’t consistent with an accident where a car dropped into a ditch.
Case had the body exhumed. Sharon Williams had suffered two separate blows to the back of her head. Case had no doubt the death was a homicide.
Detectives then confronted the eldest son of James Williams, telling him it appeared that Sharon Williams had been murdered. They were still searching for Walter Scott and asked James Williams’ son where his father likely would hide a body. The son mentioned the cistern behind their home.
James Williams was convicted in both deaths. Authorities said he hit Sharon Williams twice in the back of the head, soaked her with gasoline and staged the automobile accident to cover up her killing. Prosecutors admitted it was a mistake that no autopsy had been performed on Sharon Williams until more than three years after her death.
‘’We did not have Mary Case as our medical examiner at that time; it’s as simple as that,” assistant prosecutor Kent Fanning said after the trial.
All these years later, Case cites the Walter Scott probe when she talks with death investigators at training conferences.
“It’s a case that I use all the time when I give lectures about how forensic science works,” Case said. “Those are cases you never forget.”
Editor's note: The cistern mentioned in the 1987 case was behind James Williams' home. The story has been updated.