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“If you’re in debt, why would you go and do forensic pathology which requires more training than the general pathology?” Fowler said.
He also expressed his concern about the aging workforce of medical examiners in the country.
“A lot of us are starting to get closer and closer to retirement,” he said. “The rates at which we lose forensic pathologists right now is about equal to what we’re training, but at some stage it’s going to exceed it.”
According to its annual report, the OCME implemented a plan on Oct. 26 of last year to increase the speed of autopsy report completion and to cut down on the backload of cases. The plan involved hiring 12 additional staff members to assist medical examiners. Since the implementation of the plan, 79.6 percent of autopsies were completed within 90 days. In 2014, only 28 percent of autopsies were completed within 90 days.
In order to receive full accreditation from the NAME, Massachusetts’s OCME must complete 90 percent of its cases within 90 days, according to the NAME’s most recent Accreditation and Inspection Checklist. Fowler said that accreditation serves as assurance to staff members, citizens, the government and jury members that they “can reasonably expect an accurate, good outcome from every investigation.”
Nields said in this year’s annual report that in order to increase the speed of examinations, the OCME’s pathologists have also increased the number of cadavers that receive external examinations and decreased the number that receive autopsies, which take more time. In 2006, the OCME’s pathologists performed autopsies on 80 percent of cases. In 2015, that number dropped to 46 percent of cases.
Fowler said the OCME’s lack of speed in completing autopsy reports and death certificates prevents the deceased’s families from reaching closure on several levels.
“When you talk about closure, you’re talking about bereavement,” Fowler said. “You’re talking about the psychological closure and understanding. You’re talking about potentially getting medical screening for family members who may have inherited a congenital disease.”
Additionally, the absence of a completed autopsy report can prevent a family from receiving life insurance payouts, which can be especially devastating if the deceased was a primary breadwinner, Fowler said.
Fowler said that a timely completion of autopsy reports is also necessary to give public health offices important information about health trends such as drug overdose rates.
“If you have to wait six months before you get your toxicology back or longer […] by that stage, it’s old information and doesn’t help you to do any rapid interventions,” Fowler said.
He said government control over medical examiner offices’ budgets hinders their ability to hire new pathologists and improve autopsy rates.
“The government has to provide adequate resources, and then it can hold the staff of the offices’ feet to the fire and say ‘We gave you enough, now you need to use it wisely and efficiently,’” Fowler said. “You’ve got to have enough resources thrown at [the offices].”
The office’s need for staffing and funding increases were apparent in 2007 when the wrong body was released to a family, Nields stated in the 2016 annual report.
According to the most recent federal report by the Committee on Identifying the Needs of the Forensic Sciences, there are 400 to 500 full-time forensic pathologists in the US. The committee stated that there is a national need for about 1,000 pathologists.
“There are many forensic pathologists around the country who do superb work because they love doing it,” Fowler said. “They need more resources and […] really are under the gun trying to do the best they possibly can in the circumstances they find themselves.”
Photo courtesy Pavel Tcholakov, Creative Commons