Three days before the bereaved family was scheduled to say their final goodbye, a Maryland funeral home was still waiting for the state morgue to release the man’s body. Ordinarily, a decedent is released from the state medical examiner’s office within a few days of a death, allowing morticians time to properly prepare for services. But with a backlog of autopsies, funeral homes are waiting weeks or almost a month for a person’s remains.
The man’s funeral would have to be rescheduled. It was the second postponement the funeral home had in the last month, Victor C. March Sr. said. In his 43 years working in the funeral business, March said he has never experienced the type of delays he has witnessed this year with the Maryland medical examiner’s office.
“No, never,” said March, the president of March Funeral Home in Baltimore, of the week-long waits. “And I haven’t gotten much clarity, just that they are backed up.”
The Maryland medical examiner’s office, one of the busiest morgues in the country, has more than 200 bodies awaiting autopsies, the biggest backlog the office has seen.
Maryland joins medical examiner’s offices nationwide — from New Hampshire to Washington state — struggling with a mounting number of bodies of those who died suddenly or unexpectedly or under unexplained or suspicious circumstance awaiting autopsies. Many say a combination of staffing shortages along with rising deaths because of violence, covid-19 and drug overdoses has contributed to or aggravated the backup.
In the last couple of months, the caseload in Maryland has increased by nearly 400 percent. There were 50 bodies waiting for autopsies in late December. The number swelled to 240 last week.
In addition to delaying funerals, the logjam is affecting some prosecutions, leading to delays in courts obtaining autopsy reports and getting stand-in medical examiners for murder trials.
Chief Medical Examiner Victor Weedn, who expects the backlog to hit 300 later this month, recently asked the federal government to deploy its disaster mortuary operational response team — a group that includes medical examiners and forensic specialists who handle mass fatalities connected to terrorists attacks such as Sept. 11, 2001, pandemics or natural disasters such as Hurricane Katrina. A spokesperson at the U.S. Department of Health and Human Services said a team of five fatality management experts from the National Disaster Medical System will be deployed Monday to provide support to the Maryland Office of the Chief Medical Examiner. The federal government has also offered help to medical examiner officers in New Mexico.
“The situation is tragic,” said Del. Kirill Reznik (D-Montgomery), who serves as the health subcommittee chairman of the House Appropriations Committee and recently grilled state health officials about the backlog and understaffing. “Up to a few weeks ago, they didn’t have storage for the decedents. … There were bodies in the halls. That means they weren’t stored properly, which can ruin the pathology and render the autopsy useless.”
The office — where employees have in recent months complained to union officials of working alongside the odor of decomposed bodies — has since moved most of the bodies to a makeshift morgue of refrigerated trailers parked in a downtown city parking garage in Baltimore.
State officials blame retirements, resignations and staff covid-19 infections for the staff-to-caseload ratio crushing the office. The office took a massive hit after David Fowler, the former longtime chief medical examiner, left in 2019 after 17 years in the office. Those who left along with Fowler included a deputy chief, about five assistant medical examiners, the chief of investigations and the supervisor of medical records.
As forensic pathologists quit or retire, the state has been unable to replace them, leaving positions unfilled and the department understaffed.
Medical examiner offices across the country are struggling to fill open positions, said Kathryn Pinneri, president of the National Association of Medical Examiners (NAME).
There are between 500 and 800 full-time, working board-certified forensic pathologists across the country, Pinneri said, which is about half the number needed to handle increasing caseloads.
“I think the biggest problem is a combination of the workforce shortage within the forensic pathology specialty, combined with the increasing numbers of drug-related, violent and now pandemic-related deaths that are going through medical examiner and coroner’s offices,” Pinneri said. “So the caseloads are drastically increasing by 20 to 30 to sometimes 40 percent in some offices … and that’s hard to maintain with an inadequate number of forensic pathologists.”
In Maryland, there are eight assistant medical examiners performing autopsies, which is three fewer than last year, according to information Weedn provided to the Post Mortem Examiners Commission earlier this month.
Andy Owen, a spokesman for the Maryland Department of Health (MDH), said in an email that the department is approving money to pay for 21 positions at the office, including assistant medical examiners, toxicologists, autopsy assistants, forensic investigators and administrative support.
Reznik applauded the effort but argued that “the department has been ignoring this problem.” He said the union, which represents employees who assist with autopsies, investigators and other support staff members, has repeatedly sounded the alarm about understaffing at the office.
“This is not something that just snuck up on them,” said Stuart Katzenberg, a union official with AFSCME Maryland Council 3, the largest union representing state employees in Maryland. “Budget hearing after budget hearing we’ve raised this to MDH.”
The department has been supplementing full-time forensic pathologists with per-diem doctors — temporary staff members hired on a day-by-day basis — mostly from out of state, Reznik said. The per-diem workers, however, do not get to the root of the larger understaffing issue.
“If in fact there are only, as they say, 750 pathologists in the entire country, simply expanding the number of [positions] is not going to solve our problem,” he said. “We are going to have to do something to create more medical examiners.”
Pinneri said there are several hurdles to hiring forensic pathologists, including the training required. It takes about a decade to complete the necessary training to become a forensic pathologist.
“There aren’t a lot of physicians going into the field of pathology. And on top of that, there’s not a lot of pathologists going into forensic pathology,” she said. “Part of that is you make a lot more money as a regular pathologist in private practice than you would working for a government agency as a forensic pathologist.”
Pinneri said NAME has been working with federal agencies to obtain loan forgiveness for forensic pathologists and increased funding, as well as recruitment at medical schools, colleges and even high schools.
Reznik said the state may need to consider attracting students to the field by offering to pay off their medical school tuition.
“It takes a special kind of student to choose this path. Most go to heal the sick, not autopsy the dead,” he said. “But this job is critical.”
Lewis N. Watson, who owns and operates a funeral home on the Eastern Shore, said he has waited up to three weeks to get clearance from the morgue to pick up a couple of bodies this year.
He said families tend to understand, given the ongoing pandemic.
“We’ve never seen anything like this,” Watson said. “I was told they are short of help and they can only do so many a day.”
Staff pathologists are not allowed to handle more than 250 autopsies per year to maintain accreditation, Pinneri said, but the number can rise to 325. Offices with NAME accreditation are also required to complete 90 percent of the cases within 72 hours, Pinneri said.
Reaching 250 autopsies in a year can lead to a Phase 1 violation of the accreditation standard, which has happened a couple of times within the Maryland office, according to state officials. Topping 325 in a year is a violation that could risk an office losing accreditation.
Anne Wagner, senior policy analyst at the Maryland Department of Legislative Services, said at a meeting Wednesday that medical examiners have had to perform, on average, 65 more autopsies per examiner than the 325 standard.
Though a concern, offices experiencing staffing issues are given time to hire in more help before losing accreditation, Pinneri said. Instead of losing their accreditation because they have an occasional high caseload, some offices could be dropped to provisional accreditation until the problem is fixed.
In a recent email to staff members, obtained by The Washington Post, Weedn asked the remaining workers to “maintain hope for our office” as they continue to try to shore up staffing.
He said there are two applicants who have accepted assistant medical examiner positions and that he hoped two more would join, but none is expected before June or July. Five new out-of-state per diem forensic pathologists are also lined up, but they will need Maryland licenses.
Meanwhile, the phone continues to ring in the Baltimore office. On the other end are often funeral homes. And, a lot of times, it’s distraught family members.
“We are receiving endless calls from families, who have to wait without being given an answer to their question when will their loved one be released,” Weedn wrote in a recent email to his staff. “We have no good answers for them.”