So many lives have been claimed by the opioid epidemic, forcing the Maryland medical examiner’s office to exceed the national caseload standards of 250 autopsies per examiner each year. The agency had exceeded these numbers in each of the past four years, putting it as risk of losing its accreditation status, which would have serious implications for the state.
Medical examiners’ offices across the country are dealing with a combination of more complex and additional cases, especially along the East Coast. Many of these agencies are on the verge of losing accreditation.
The National Association of Medical Examiners categorizes the Maryland Office of the Chief Medical Examiner as “deficient”, even though its peers hold the agency in high regard.
The association advises against operating without accreditation, saying quality and confidence could be jeopardized if too many autopsies are performed. The situation could hinder the work done by prosecutors and public health systems. Prosecutors rely on medical examiner’s testimony and autopsy findings to strengthen their cases, while public health officials utilize the agency’s data to direct resources.
Since 2010, the number of autopsies performed by state pathologists has increased by 40 percent, nearly 100 more autopsies each. Along with this, the toxicology lab is operating almost nonstop. The office is having difficulty keeping support staff and failed to take significant action to properly boost the ranks of its medical examiners.
The state medical examiner’s office investigates deaths related to homicide, suicide, suspicious, unsuspected and injury. These account for nearly a third of all deaths in Maryland. In 2016, the agency handled 14,385 cases and performed 5,439 autopsies.
According to the Maryland health department, the problem began in 2013. The categorization “deficient” stems from the agency’s inability to meet the national standard.
The pathologists were back on schedule after the first quarter of fiscal 2017, performing a total of 328 autopsies, but still exceeded the 325-autopsy limit to maintain accreditation.
The Baltimore health commissioner, Dr. Leana Wen, noted that the state health department had not yet released the 2016 overdose death totals, even though it had been over three months since the end of the year.
In 2015, the office had 15 medical examiners on staff, today it has 17, but six more are needed for the agency to meet the standards. Each medical examiner costs an estimated $171,000 so when Maryland’s chief medical examiner, Dr. David R. Fowler requested three in the most recent state budget, his request was denied.
The national standards require 90 percent of autopsies to be completed in 60 days, but the agency has only been able to complete about three-quarters of its autopsies in this time period.
The state budget for fiscal 2018 does not include funding for additional examiners. However, state officials have added $400,000 raise the examiners’ salaries, since they do not earn overtime.
In fiscal 2015, the medical examiner’s office budget was $11.4 million, in the coming year it will be increased to $12.8 million. In the past two years, the city has recorded a historical number of homicides. However, overdose-related deaths are much higher, with 1,468 reported in the first nine months of 2016, compared to 1,259 for all of 2015. In 2016, the 900 of the fatal overdoses were linked to heroin, another 700 was linked to fentanyl.
According to the Association of American Medical Colleges, from 2010 to 2015, the number of practicing pathologies in the United States that work as medical examiners has decreased by 11 percent.