A look at America’s dire need for medical examiners
Wednesday, March 25, 2020
Medical examiners’ offices work closely with law enforcement agencies to assist in death investigations and help uncover crimes. Autopsies play a significant role in law and order, and thousands of autopsies are performed each year.
But the strains on examiners have been rising with no solution in sight, leading to delayed medical examinations, slow response times, and overdue toxicology tests. Metropolises like Chicago, Los Angeles, and New York are overburdened, but the crisis is now affecting smaller cities as well.
The shortage of pathologists is a national problem that demands the immediate attention of the government. Medical examiners’ offices are struggling with resources and affecting counties large and small. The inability to aid in law enforcement investigations is a big system failure. But the crisis also hinders other processes, like issuing death certificates on time or reporting overdose causes to the authorities to prevent those drug deaths from spiking.
A study based on facts and figures obtained from the Association of American Medical Colleges shows that there has been a 17.53% decrease in the number of active pathologists in the U.S. from 2007 to 2017.
Hiring and retention are problems. Fewer people are applying for medical examiners’ offices today, and only 40% graduate from fellowship programs to become forensic pathologists. Experts say that this is just enough to keep up with the retirement rate.
On top of that, most medical examiners' offices around the country are also struggling to maintain accreditation and funding. While accreditation is not mandatory for all states, they come in handy for criminal investigations, especially when MEs need to appear in court and discuss homicide cases and their findings.
The Maryland Medical Examiner's Office, already reeling from the long-running opioid epidemic, is now trying desperately to hire new people. The high pace of homicides in Baltimore has led to a crushing load of cases, of which is the skeletal staff is unable to cope with.
It is no surprise that the workload they face has exceeded national quality standards and added to stress and staffing shortages. One needs to understand that these positions are hard to fill and very specialized. Better recruitment and retention methods are required, along with better salaries and training programs.
This is not a good time for our health system to be overwhelmed. We need better information about COVID-19 following autopsy results after the virus causes fatalities. Infected people, the degree of the infection, and cause of death would help guide decisions and actions of disease modelers and governments. Reported case fatality rates are causing horror, but we need accurate data about the exact level of the pandemic’s activity.
An autopsy is the most direct means to uncover the virus. Autopsies on COVID-19 patients in China have yielded vital discoveries. The discoveries have been reported to related authorities, and the findings would be discussed with clinical doctors to improve understanding of the virus.
These experts would study the cause of death, then compare pathological and clinical changes to reveal the nosogenesis of the disease and bring about improved clinical treatments and disease prevention and control measures. The American health system should be ready for these autopsies immediately.
An autopsy is done on a fraction of cases. The rate has fallen from 60% in the 1970s to 5% today. Lessening that number would mean lost opportunities to conduct critical diagnostic exercises, lack of assessment of causes of death, and inability to obtain accurate health statistics.
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