A yearslong staffing crisis in the state medical examiner’s office in Baltimore is leading to unprecedented delays in autopsies, an emergency request to federal officials for help and now a legislative push for more workers.
To deal with “bodies piling up,” one lawmaker said the statewide agency that investigates sudden and unexpected deaths has turned to a ready source of labor — contractors “flown in from out of state” and recent retirees earning $850 per autopsy.
State officials say that labor pool is vital to clearing cases. But lawmakers and union representatives deride the vacant positions across state government generally and say excessive use of contractors may be particularly wasteful and morale-busting in the medical examiner’s office.
“We have a full-fledged disaster on our hands, though it’s a man-made one rather than a natural one,” said Del. Kirill Reznik, a Montgomery County Democrat who introduced a bill requiring adequate staffing in the department, officially called the Office of the Chief Medical Examiner.
At a legislative hearing on the measure Wednesday, Reznik said the state has not hired an examiner since 2019, though the office got a new chief in 2021 to replace the one who retired more than a year before. He also said the office hadn’t significantly raised examiner pay until this year, though workloads are now at their highest levels per examiner.
“Instead they opted for per diem personnel to come in on nights and weekends, often flown in from other states at our expense to deal with the backlog,” he said. “In the last year, five pathologists have retired only to be rehired as per diems by the state office, getting a higher daily rate for clearing backlogged cases that are less complex and creating an even larger morale problem within the office.”
He said other examiners, who are board-certified pathologists, have left for other jobs that pay better or provide a better “work-life balance.”
The office, long a model for examiner’s offices across the country with a stable workforce, has seen an exodus in recent years due to a spike in homicides and opioid overdoses that vastly increased workloads. The coronavirus worsened the situation by adding some COVID-19 cases, but also more cases of the other kinds.
Its former chief, Dr. David Fowler, retired at the beginning of 2020 after 17 years on the job, citing in part the lack of resources to deal with the caseload. He was replaced in early 2021 by Dr. Victor W. Weedn, a former examiner in the office.
Documents provided by state officials to lawmakers show that the office had 20 full-time medical examiners in December 2021, down by four from the year before.
Officials at the Maryland Department of Health say the situation is the same in many parts of the country, as the number of working pathologists totals about 750 while about 1,200 are needed.
In a letter to the lawmakers ahead of the hearing, health officials said the department “continues to aggressively support” the medical examiner’s office.
In the past year, the office has raised salaries by more than 50%, with an assistant medical examiner who is board-certified able to earn $238,842 to $370,086 as of January.
State officials also assigned 21 new positions to the office in fiscal 2022 and 2023, including examiners, toxicologists, autopsy assistants and administrative workers. They sought aid from a pool of federal pathologists last week. They also are working on permanent cold storage, as Reznik said bodies were stored in hallways before they were moved to a temporary facility in a garage.
They also said they are seeking to identify more contract, or per diem, workers. Those workers provide flexibility as cases rise and fall, and offer a chance to recruit for full-time jobs. The main source of workers now is a fellowship program that offers training in forensic pathology.
The number of per diem pathologists dropped to seven in December 2020 from 10 in 2019, but the department didn’t provide a current number of such contractors.
Spending on per diem workers in the state fiscal year that ended June 30, 2020, was $632,400, and was on track to outpace that total in fiscal 2021, when spending was $321,300 for July to December 2020. No more recent spending data was available.
State officials noted in the information provided to state lawmakers that five examiners had resigned or retired since 2019 and two more are or will be eligible to this year. They acknowledged being unable to hire a pathologist for the past two years, though the office has hired two fellows from this year’s class and another plans to stay at the end of his fellowship next year.
Reznik said that while the medical examiner’s office is in a uniquely bad situation, there are about 6,000 vacant state positions.
Some of the problem is due to a tough labor market, but he and others believe some is due to the policies of Republican Gov. Larry Hogan.
“That is a destabilizing force and we’re seeing the effects in the medical examiner’s office,” he said. “It’s such a difficult situation right now and we should do what we can to keep us from losing more people.”
Rehiring retirees to fill positions on a temporary basis isn’t unique to Maryland, and it allows departments to retain experienced pathologists, said Dr. Kathryn Pinneri, president of the National Association of Medical Examiners.
“There is a significant number of forensic pathologists who are retirement eligible or soon-to-be retirement eligible, including myself,” she said. “It isn’t uncommon for an office to rehire a [pathologist] who retired from their office to fill gaps in coverage.”
She said pay “is certainly better,” with some offices paying more than $1,000 a case, which also aren’t usually the high profile cases that include homicides. The pathologists, however, have to maintain their licenses and sometimes obtain their own insurance, which can be a burden.
Union representatives, however, say those workers get the less stressful cases and can make workloads far worse for those remaining by not only adding autopsies but often the most complex ones.
The state push for more workers and increased salaries now may not come in time to stave off more departures, said Patrick Moran, president of AFSCME Council 3, which represents about three dozen support staff in the medical examiner’s office.
The Morning Sun
He added that while the state may save on paying benefits to the contractors, it could end up paying more per autopsy and more overall if the workers also are collecting state pensions.
“This administration has refused to hire anyone in the course of the last two years and refused to compensate people competitively, and as a result they are grossly understaffed,” Moran said. “It’s not exclusive to the Office of the Chief Medical Examiner.”
He noted the high caseload that has nearly cost the medical examiner’s office its accreditation, a status needed to earn public trust in the work and bolster law enforcement cases.
The state office performed more than 6,200 autopsies in fiscal 2021, a load that exceeds the 250 per individual examiner that the National Association of Medical Examiners says is OK to maintain accreditation. At 325, the offices can maintain a provisional accreditation, which Maryland held for years until the pandemic caused the association to loosen the threshold.
At times in fiscal 2021, the office reported its highest ratio at 390 autopsies per examiner, state data shows.
State health officials maintain they are doing what they can in a difficult labor environment, especially for pathologists, and will continue to rely on contractors, including retirees.
The state health department “supports the [Office of the Chief Medical Examiner’s] ability to take advantage of the flexibility provided by per diem forensic pathologists,” said Andy Owen, a department spokesman. “Per diem work allows the state to retain the benefit of forensic pathologists’ services after their scheduled retirement and in other circumstances where it may not otherwise be possible.”