State Medical Examiners Struggle to Keep Up with Overdose Deaths

By Paul Gaita 02/01/18

The drug overdose death toll has overwhelmed understaffed and underfunded state medical examiners' offices.

body bag

The national opioid crisis has taken its toll in a variety of ways—from ever-increasing overdose death statistics and emergency room visits, to drops in life expectancy and labor force numbers.

But the epidemic's reach has also extended to other, more unexpected industries and demographics, including state medical examiners. On January 28, the West Virginia-based Bluefield Daily Telegraph noted that the office of the state's Chief Medical Examiner has been so overrun by costs associated with the opioid epidemic, including autopsies and transportation of bodies, that it has been forced to boost its budget for 2019 to $6.54 million, up from $4.64 million less than a decade earlier.

The problem is not the sole province of West Virginia, which has the highest number of overdose death rates in the nation (52 per every 100,000 residents); the New York Times has also shown that medical examiner offices in a number of states, from New Hampshire to Ohio and Florida, have all been taxed to the limits of their budgets and manpower by the sheer overwhelming need for autopsies, largely related to the opioid problem.

West Virginia's medical examiner's office is a textbook example of the national scope of the problem: according to the state's Department of Health and Human Resources (DHHR), overdoses increased 76% between 2001 and 2016, while the number of autopsies performed during the same period rose by more than half (53%). According to DHHR public information officer Toby D. Wagoner, overdoses were the "most significant contributor to the overall rise in caseload" for the medical examiner.

According to the Chief Medical Examiner's office, each autopsy costs the state an average of $2,400, of which a fourth of the cost is attributed to transportation of the deceased. In 2017, DHHR paid private contractors more than $880,000 to move bodies, which is usually a two-fold trip—from the place of death to a state morgue and then from the morgue to a funeral home.

Five full-time forensic pathologists are on hand to oversee autopsies, as well as one part-time pathologist and two contracted pathologists that work remotely. Depending on the deceased and their cause of death, different autopsies may be required, including toxicology reports and invasive evisceration, all of which have their respective costs. According to the Bluefield Daily Telegraph, each of the five full-time pathologists performed at least 200 autopsies in 2016, and in one case, a single pathologist handled 402 autopsies in a single year.

The problem with such an extreme workload, beyond the physical demands of the job, is that the National Association of Medical Examiners can remove accreditation from a medical examiner's office if any pathologist performs more than 250 autopsies a year. The New York Times noted that the New Hampshire Medical Examiner's Office was in danger of losing its accreditation after its chief medical examiner and deputy chief medical examiner each performed 250 autopsies in 2016.

Other medical examiners are facing uphill battles in nearly every aspect of their jobs. In Ohio, the number of bodies is so overwhelming that the office has taken to storing bodies in cold-storage trailers. Dr. Brian L. Peterson, the chief medical examiner in Milwaukee, Wisconsin, said the overdose epidemic has not only placed his office under threat of lost accreditation, but also burnout among staff and overtaxed budgets. Adding to the problem is the fact that fewer medical students pursue forensic pathology as a career, due largely to low salaries.

To stem the fiscal drainage in their own department, West Virginia's DHHR has reallocated more than a half-million dollars in funding from two other state agencies, Primary Care Support and Center for End of Life. In the latter case, the monetary move wiped out the center's budget for the upcoming fiscal year. It isn't the only entity facing empty coffers for 2019; the DHHR's $2 million budget allotted for individuals who cannot afford the cost of burial was also drained within five months' time in 2017.

A possible solution may come with the passage of HB 4024, which would allow cremations to replace such burials, while also reducing costs for after-life services. But even these efforts can't stem the tide of overdose deaths plaguing West Virginia and other states.

"It's chilling," said Delegate Mick Bates (D-Raleigh). "It's shocking to think we're having to direct so much money. It's like the problem never ends, even in death."

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.