A small investment to fight the overdose crisis

When the Department of Health and Mental Hygiene sets its priorities for spending a limited pool of tax dollars, we can see why increasing staffing at the Office of the Chief Medical Examiner wouldn't necessarily rise to the top of the list. There are so many unmet needs in public health interventions to save and extend lives that adding resources to an office that investigates the causes of deaths might not seem like the best investment.

Yet the agency serves a largely unseen but crucial role in both law enforcement and public health, and as The Sun's Meredith Cohn reported on Sunday, an increase in the office's caseload, spurred largely by Maryland's drug overdose crisis, is putting its ability to perform it at risk. Fortunately, Hogan administration officials say they recognize the problem and are working to address it.

The National Association of Medical Examiners characterizes a department as deficient if medical examiners conduct more than 250 autopsies per year, and Maryland has exceeded that standard since 2013. The organization considers a caseload of more than 325 to be a major deficiency, which is grounds to lose accreditation. The Maryland medical examiner's office approached that level in 2015 and 2016 and is on pace to exceed it this year.

The Hogan administration had included some extra resources for the office in its fiscal 2018 budget, and subsequent to Ms. Cohn's report, officials say they are working to do more. The budget that takes effect in July will allow the agency to fill five open support staff positions, which are also important to accreditation, though the NAME doesn't have hard and fast standards for the number or lab technicians, investigators and the like. And the governor has increased the agency's overall budget modestly during his tenure, though much of that money covers increased operating costs related to the increased caseload (body bags, transportation fees and the like). The new budget also increases salaries for the existing medical examiners.

The agency's leadership considered the raises necessary for recruitment and retention of medical examiners, who despite their additional training earn substantially less than general pathologists do in private practice. Because of the additional caseloads, each medical examiner is now handling about 100 more autopsies per year than they did 10 years ago, and they don't earn more for the extra work. Without the raises, the agency's accreditation situation might be even worse if it found itself losing medical examiners and unable to recruit new ones.

Losing accreditation wouldn't mean the agency would have to shut down, but it would be a problem. Autopsy results are often critical evidence in homicide and other cases, and the last thing prosecutors need is for defense attorneys to have an easy avenue to question the validity of medical examiners' testimony. This year, the Hogan administration pushed for legislation making it a felony to distribute opiods that result in a death, but such prosecutions would be impossible without credible testimony from the medical examiner's office. The version of the bill that eventually passed instead enhances penalties for people who sell heroin mixed with the synthetic (and extremely dangerous) opiate fentanyl, but those prosecutions will potentially rely on medical examiners' testimony, too.

From a public health perspective, the increased caseload presents a problem as well. The timeliness of data about deaths from drug overdoses is critical to designing life-saving interventions. But as the medical examiner's agency's workload has increased, the percentage of autopsies completed within the 60-day standard has decreased.

We certainly hope that the increased attention, funding and prevention strategies Governor Hogan and others have brought to the heroin overdose crisis will eventually cause the number of deaths to decrease, and with it the medical examiners' caseloads to decline. But for now, a few more medical examiners are needed. A spokesman for Mr. Hogan said Health Secretary Dennis R. Schrader is aware of the problem and is working to move funds within his budget to allow the hiring of more examiners to protect the agency's accreditation. Just how many, the department couldn't say, but three to six would likely do the trick.

This isn't just a Maryland problem. Medical examiners' offices across the country are struggling to keep up with the opiod epidemic. Few new forensic pathologists enter the field every year, and the current working conditions aren't making it any more attractive. Maryland should do what it can to maintain what has always been a well-regarded agency, and one that is crucial to addressing the overdose crisis. A relatively minor investment will keep it functioning effectively.

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