It’s a grim issue that too many of us would want to ignore in the best of times. But the coronavirus pandemic and its collateral harms have pushed beyond their limits the medical experts who study death, locally and nationally.
In Maryland, the chief medical examiner has resigned, and a deputy has been designated as the interim head of one of the nation’s busiest morgues, the Washington Post reported. Victor Weedn (shown right), who had served as the operation’s head since 2019, stepped down as the facility has gotten stuck in such snafus that it has more than 200 bodies awaiting autopsy, “the biggest backlog the office has seen.” The nightmarish mess matters, the Washington Post reported:
“The logjam has left families distraught as they experience extended delays in funerals. It has also created problems with some [criminal] prosecutions, with holdups in courts obtaining autopsy reports and getting stand-in medical examiners for murder trials. In the past couple of months, the caseload in Maryland has increased by nearly 400%. There were 50 bodies awaiting autopsies in late December. The number swelled to 240 last week. Weedn recently estimated that the office would have a backlog of 300 this month. He and other medical examiners across the country have blamed backlogs on a combination of staffing shortages and rising deaths because of violence, Covid-19, and drug overdoses.”
Indeed, the facilities of coroners-medical examiners have been overwhelmed from coast to coast, reported the Pew Charitable Trusts, which describes itself as a global nongovernmental organization that seeks to improve public policy, inform the public, and invigorate civic life:
“Faced with an overflow of bodies during the coronavirus pandemic, medical examiners around the country have had to add to their storage capacity. Many have brought in refrigerated trucks or other kinds of mobile units. A few have created racking systems that allow for the vertical stacking of bodies. Some, such as in Los Angeles, are considering building additional permanent storage if the current excess of bodies proves a harbinger rather than a blip. Dr. Jonathan Lucas, Los Angeles’ medical examiner-coroner, said he held off asking for additional resources last year because he hoped that the influx of bodies would ebb, even as he had to bring in 14 refrigerated trucks. As the third year of the pandemic nears, Lucas says he’s rethinking that. ‘Now I think we’re in a situation where I have no choice but to plan that this is not going to go away in the short term,’ he said …
“The overload at medical examiners’ offices across the country stems from two trends: More bodies are arriving at the offices, the result not only of additional deaths related to the pandemic but also an upward trajectory of homicides, overdoses, and even traffic-related fatalities. And the country is simply not producing enough forensic pathologists to keep up with the workload, especially during the pandemic.”
The Pew report says that the national group that sets standards for coroners and medical examiners (their job titles differ, depending on the jurisdiction) is not sanguine that specialists can follow its recommendations that they cap their annual autopsies at 250. Dr. Gregory Hess, chief medical examiner of Pima County, Arizona, which encompasses Tucson, told the Pew experts: “We do more than 250 [autopsies annually]. Most do. I think it’s hard for most offices to stick to that guideline nowadays.”
The facilities that perform the vital function of deciding officially how individuals die always struggled to persuade doctors to become specialists in forensic pathology, Pew reported, adding that the specialists’ group now “lists openings for more jobs than the number of forensic pathologists,” a group estimated at 40, “who enter the workforce every year.”
The forensic pathologists’ six-figure public pay may seem good to lay people, but it lags what doctors in other specialties can make. The job is uniquely stressful, dealing not only with those who die in extreme circumstance but also testifying in contentious court proceedings. Even when offices offer opportunities for younger professionals to try the field by working with them, they struggle to keep their own trainees. This is what the trust found in interviews with Lucas in L.A., Hess in Arizona, and Kathryn Pinneri, president of the National Association of Medical Examiners and the director of forensic services for Texas’ Montgomery County, and others:
“Alongside that increased number of bodies being sent to medical examiners is a national shortage of forensic pathologists. The title of medical examiner refers to professionals, usually doctors, who conduct examinations to determine a cause of death. Medical examiners often are forensic pathologists as well, but requirements differ among the states. Forensic pathologists have completed a medical residency in pathology and a fellowship in forensic pathology. During the fellowship, they receive training on autopsies and other techniques related to forensic evidence.
“The United States has about 500 full-time, board-certified forensic pathologists, according to Pinneri’s organization. ‘The reality is we need about twice that number,’ she said. Only about a fifth of people who die end up at a medical examiner’s office, estimated Hess … Usually, the deceased are sent to the medical examiner if they died suddenly, violently, or the cause of death is suspected to be unnatural or isn’t immediately evident, or if they hadn’t been under the care of a physician. The vast majority of the nearly 1 million Americans who have died of Covid-19 died in a hospital, so they were not sent for autopsy or post-mortem examinations. (A small minority of states require a medical examiner to issue all death certificates.) Despite that, the pandemic has increased the number sent to medical examiners. Especially in the early months of the pandemic, many people died at home without a physician. So, too, did many people with chronic conditions who were fearful of going to the hospital or medical clinic, said Lucas … Most of those cases likely ended up in a medical examiner’s office.”
In my practice, I see the harms that patients suffer while seeking medical services. My colleagues and I also see how they are debilitated and die to varied, unacceptable circumstances — in auto, truck, and motorcycle wrecks, due to defective and dangerous products, especially of the medical variety, and because of the abuse and negligence of others, especially health workers involved in misdiagnoses or medical error.
In more normal times before the pandemic, experts figured that medical errors claimed the lives of roughly 685 Americans per day — more people than died of respiratory disease, accidents, stroke and Alzheimer’s. That estimate comes from a team of researchers led by a professor of surgery at Johns Hopkins. It meant that medical errors ranked as the third leading cause of death in the U.S., behind only heart disease and cancer.
As for misdiagnoses, experts say they occurred once every nine minutes in pre-pandemic times with someone in a U.S. hospital dying due to a medical diagnosis that was wrong or delayed. Roughly one in 10 patients with a serious disease is initially misdiagnosed Diagnostic errors affect an estimated 12 million Americans each year and likely cause more harm to patients than all other medical errors combined. Misdiagnoses boost health costs through unnecessary tests, malpractice claims, and costs of treating patients who were sicker than diagnosed or didn’t have the diagnosed condition. Experts recently noted in a health care online report that inaccurate diagnoses waste upwards of $100 billion annually in the U.S.
Alas, for those seeking justice in both the criminal and civil justice systems, clarity about wrongdoing and systemic problems in dire need of correction may be possible only with rigorous postmortem investigation by skilled specialists. We need the experts in death to help us improve our care for the living. Many of these individuals work for us, the public, as government officials. They, like their health worker colleagues throughout the system, have gone through a lot during the pandemic. And we have much work to do to ensure that their key capacities keep functioning in the best, most appropriate ways possible.