A real-life “Kay Scarpetta”

Editor’s Note:

This profile of Marcella Fierro, MD ’66, originally appeared on the University at Buffalo alumni website in 2005. Fierro, former chief medical examiner for the Commonwealth of Virginia, later gained wider recognition as the real-life inspiration for Kay Scarpetta, the forensic pathologist created by novelist Patricia Cornwell. We’re sharing it again in light of the new television show Scarpetta, launching in March 2026.

After nearly 40 years in her profession, Marcella Fierro, MD ’66, finds herself in the middle of a pop culture phenomenon.

Fierro is chief medical examiner for the Commonwealth of Virginia. She’s the head of the state department that investigates the cause of death for anyone who has died violently, unexpectedly or suddenly. When she started out, few people even knew what a medical examiner did. Even Quincy, that ’80s prime-time, medical-examining sleuth, was still only a glimmer in some television producer’s eye.

Today, programs like The New Detectives, American Justice and the CSI franchise have helped turn up the interest in Fierro’s field.  So has the work of mega best-selling mystery novelist Patricia Cornwell, who actually worked in Fierro’s department for six years. The hero of Cornwell’s books is Dr. Kay Scarpetta, who is the . . . chief medical examiner for the Commonwealth of Virginia. 

Coincidence? Cornwell “was writing books while she was with us,” Fierro says. “I was the woman forensic pathologist that she knew. I can’t take credit for the character, but I can take credit for the job.”

Fierro’s own professional interest seems to have gestated during her medical school days at UB. She remembers using pathology regularly during her clinical training, and recalls her pathology professors as being especially good. Her residency positions focused also on pathology, culminating in a year as a fellow in forensic pathology and legal medicine at Virginia Commonwealth University (VCU) and the Office of the Chief Medical Examiner in Richmond, Va. 

Fierro’s path was somewhat predetermined by the times. In the late ’60s, she says, “I could only consider internal medicine or pathology because women couldn’t go into surgical specialties.” She knew she liked problem solving, so pathology seemed the natural choice. After her board exams, she became deputy chief medical examiner for Central Virginia. There, for 17 years, Fierro worked with police, fire and other professionals to figure out why and how people died.

Her most important lesson during those early years was finding out that people don’t always tell the truth. “In the criminal justice world, it’s not in suspects’ best interest to tell the truth," she says. “Sometimes the suspects are right at the scene, but you might not know they’re a suspect at that moment.” Thus, Fierro learned to trust evidence-based medicine to help her arrive at a conclusion about a case.

Sudden deaths due to heart disease or gunshot were what she encountered most often.  Her most memorable case centered on murders committed by a serial rapist named Timothy Spencer. Fierro conducted the autopsies of Spencer’s victims. “It was,” she says, “the first time I realized there was such consummate evil in a person, that someone could be so unbelievably cruel on a systematic basis. The pathologic material we recovered—hairs, fibers, seminal fluid, et cetera—were what ultimately identified him.”

Fierro took a brief detour in 1993, teaching general and forensic pathology as a professor of pathology for a year at East Carolina State University. Then, the chief medical examiner’s position opened up in Virginia, and back Fierro went. She’s been in the position ever since. Today, she’s responsible for the activities and policies of the department, supervising the main office and three regional offices where pathologists perform more than 3,000 autopsies each year. She frequently provides expert testimony in court and teaches about forensic pathology to everyone from law and medical students, to citizens, forensic scientists, and law enforcement professionals. She’s also chair of the Department of Legal Medicine at VCU.

Fierro still occasionally handles actual cases, but only when she’s on call or the case has a particularly high profile. Yet she’s still on a quest for the perfect case—one where the information she uncovers dovetails exactly with the investigation and the forensic science. The closest she’s come was a case in which a woman died in a fire. “She was incinerated,” Fierro says, “but she had a depressed skull fracture that looked like it was made by a hammer. No one believed me at first.”  Investigators doubled back over their investigative tracks and ultimately determined that the woman had indeed been murdered.

That kind of insight exemplifies what Fierro feels she’s gained from her years of experience: “As you see more of the unusual things, you begin to recognize them, especially pattern injuries like a partial shoeprint on a body.”  Her experience also has honed her feelings of compassion for victims’ families. “They get no warning, no chance to say goodbye. And there’s not a great deal you can do to help them in the short term. In the long run, you help in the criminal justice system so the victim gets justice.”

Fierro considers the blooming of America’s passion for forensic science and pathology “great. We need more forensic pathologists, so I’m in favor of anyone getting a flavor of it. If you want a job, be a forensic scientist, because the jobs go begging.”

The job has suited Fierro perfectly. “It’s my temperament and my interest,” she says. “I never had a day that I regretted it.”

Story by Grace Lazzara.