Forensic Medical Group Inc. has faced little competition in growing into Northern California's largest autopsy provider.

Founded in 1975 by a Vacaville forensic pathologist who has since retired, the private firm has filled a niche in a part of California starved for autopsy services, where sheriff-coroners often ruled on deaths of undetermined cause based solely on medical records and death scene reports.

Forensic Medical Group expanded from serving three counties to more than a dozen during the tenure of Dr. Brian Peterson, who led the firm for nearly 15 years before joining Milwaukee's medical examiner's office in 2007.

The firm's total revenue is proprietary, but invoices show it had more than $3 million in autopsy billings in 2009, up about 30 percent from 2006, records show.

Peterson said he expanded the firm's reach by casting it as a more-professional, higher-capacity alternative to solo practitioners. Several of the group's biggest contracts were awarded without competitive bidding because no other vendor could provide the necessary services.

When Sutter County's in-house forensic pathologist left to become Alaska's chief medical examiner, administrators couldn't find a replacement and turned to Forensic Medical Group.

In August 2010, the Sacramento County Coroner’s Office fired its chief forensic pathologist, Dr. Mark Super, for unspecified reasons. Then, left with just one in-house forensic pathologist to handle more than 1,000 cases a year, the county hired Forensic Medical Group – where Super is a part owner and works full-time – to pick up the slack.

At one time, Sacramento's well-respected coroner employed four doctors full time.

"Coroners don't have nearly the resources that we did just three or four years ago," Coroner Greg Wyatt said.

Forensic Medical Group has little overhead, aside from its doctors' salaries. Dr. Arnold Josselson, the firm's vice president, said each doctor made more than $100,000, but declined to provide more exact numbers.

Its clients provide examination facilities and tools and pay for death scene investigators, toxicology testing and technicians to assist with physical labor. Its headquarters, a generic gray office building in Fairfield, is little more than an invoice processing center.

The group charges a la carte for a list of services: full autopsies, including an outer assessment of a body for markings and injuries as well as a dissection and inspection of internal organs; external examinations, which involve no cutting; and records reviews. There are additional fees for travel time, court testimony and responding to death scenes.

Forensic Medical Group also performs an unknown number of autopsies for hospitals and relatives who want a medical examination outside a coroner's or medical examiner's office.

The firm currently has five doctors, each of whom handle 300 cases a year or more (PDF), well above the annual workload the National Association of Medical Examiners recommends for forensic pathologists.

The firm lost Marin County's business in 2008 when Ken Holmes, then the county's elected coroner, saw indications its work was slipping.

Holmes said he received a call from a grieving husband. In reading over his wife's autopsy report, the husband told Holmes, he noted the document described her ovaries as "unremarkable." In fact, the husband said, his wife's ovaries had been removed 30 years earlier.

Forensic Medical Group, in a written response, said Holmes never informed the company about the alleged mistake. The firm added that it believed Marin County severed ties over autopsy scheduling complaints, not quality concerns.

Marin has since merged its coroner and sheriff offices. It now contracts with a certified forensic pathologist who retired from the Riverside County Sheriff's Office last year.

Invoices show Forensic Medical Group has increased its rates substantially (PDF) in the past five years, collecting as much as $1,250 for a full autopsy, up from $650 in 2006. Its price for external examinations has doubled from $300 to $600.

Although its prices are lower than those of smaller private autopsy companies, some of which demand $2,500 or more per autopsy, the firm still may not be a bargain for agencies that can attract doctors. Its largest customers appear to pay more per death investigation than comparable counties with in-house staffs.

Contra Costa and Sonoma paid the company an average of more than $800 per death investigation in 2009, records show. Alameda County, which has a full-time chief pathologist and two contractors, paid about $650 per death investigation.