The Maryland medical examiner’s office is scrambling to fill persistent and new vacancies that are threatening its ability to handle a crushing load of cases stemming from the long-running opioid epidemic and a stubbornly high pace of homicides in Baltimore.
Compounding the problem, the state’s longtime and well-regarded chief medical examiner left the office at the end of 2019, citing the challenges the office faces in coping with the overdose crisis. An assistant is serving as acting chief examiner while a search is made.
The workload of the office, located in Baltimore, has exceeded national quality standards for years and could get worse given recent departures. And the office is again at risk of losing its accreditation.
With the retirement of the chief examiner and the departure of several assistants, the office has 16 examiners and needs to hire four more. It hasn’t had so few examiners in five years.
“It’s a crisis,” said state Del. Maggie McIntosh, chair of the House Appropriations Committee. “The bottom line is that we have several agencies or units within agencies that are stressed because of staffing shortages, and this is one,” she said. "It’s going to take this administration and the legislature to sit down and figure out how to resolve it.”
The examiner’s office is part of the state Department of Health, which says it has increased salaries to recruit and retain examiners, though its pay still lags behind competing agencies. After a Baltimore Sun report in 2017 about the workload, health officials added three positions. New examiners were hired eventually, but departures in the office have outpaced new arrivals.
McIntosh said solving the problem may involve better recruitment and retention methods, additions to a training program that has been a source of new hires, and higher salaries. “The positions are hard to fill and very specialized,” she said.
The agency, officially called the Office of the Chief Medical Examiner, investigates about a third of all deaths in Maryland.
Data collected by state auditors and obtained by The Sun show the examiners performed 5,787 autopsies in 2019. That’s a 50 percent increase from 2012, the last year examiners averaged fewer than 250 autopsies each, which is the standard limit set by the National Association of Medical Examiners.
Last year’s average was 283, according to the audit conducted by the General Assembly’s Department of Legislative Services. That was down from 334 in 2018, but the office has now lost several examiners.
If the number of needed autopsies remains the same and the office doesn’t hire new staff, the 16 remaining examiners could have to perform as many as 362 autopsies each this year. State officials said they have brought in some “per diem” workers to assist in less complex cases and reduce the burden.
The shortages of examiners is being felt nationally. The Association of American Medical Colleges reports that the number of active pathologists has been on the decline for years, dropping 14 percent from 2010 to 2017 to 12,839.
Dr. Sally S. Aiken, president of the National Association of Medical Examiners, said that’s led to a “critical shortage” of examiners. She cited National Institute of Justice data that show the country has 400 to 500 who practice full time while the need exceeds 1,200.
“The reasons for the shortage of forensic pathologists are numerous, but what is clear is that this professional pipeline is small, and the shortage will become worse in the foreseeable future,” Aiken said. “This has resulted in a sort of bidding war between offices to hire qualified forensic pathologists.”
There are dozens of jobs posted on the association website, including one for the newly open post of chief medical examiner in Maryland. Pay is not listed on the job posting, but Maryland’s recently retired chief, Dr. David Fowler, earned an annual salary of $289,000.
“Recruitment and interviews are underway and have yielded promising prospects,” said Maureen Regan, a Maryland health department spokeswoman.
Fowler told The Sun in November that a factor in his decision to retire was a lack of resources to handle the state’s opioid epidemic, which still produces four fatal overdoses a day. He could not be reached for comment for this article.
During a November meeting of the Post Mortem Examiners Commission, which oversees the Maryland medical examiner’s office, Fowler said some newer examiners performed fewer autopsies. That meant others performed more, a few more than 450, which he said “is so far from the typical workload at a forensic medical center that it is an obstacle to recruiting medical examiners.”
He said the office’s budget grew to $14.5 million from $11 million in 2014 but has not kept pace. Based on national averages for funding, its budget should be about $22 million.
Maryland pays assistant medical examiners a minimum salary of about $150,000, the lowest of 10 medical examiner offices polled by state auditors for their report. The maximum salary for assistants of $249,000 was mid-pack. But even that top salary was below other pathology jobs in Baltimore.
The report says the office is now at risk of losing its accreditation in May from the National Association of Medical Examiners because of the staffing shortage as well as a leaky roof in the agency’s 9-year-old headquarters in the University of Maryland’s BioPark in West Baltimore. State officials plan to begin fixing the roof in May.
The auditors’ report lists two vacancies, though the state health department reports there are three and a half. The report counted the per diem employees, though they typically don’t handle complex cases or testify in court. And even with their efforts, the office still exceeds the national standards.
And, to make matters worse, cases could continue to increase, the report says, even though overdoses appear to be leveling off. It cites concerns about the affect of "persistently high homicide rates” on workloads. There were more than 300 homicides in Baltimore in 2019, the fifth year in a row, while homicides in Baltimore County nearly doubled to 50 last year.
Accreditation is not necessary for the agency, but the standards are meant to maintain and assure quality and confidence in the findings. The Maryland medical examiner’s office has held the accreditation for three decades.
Loss of accreditation can undermine families’ faith in the explanation about a loved one’s cause of death. It also could undermine public health officials’ confidence in data used to set policy and direct resources, such as what kinds of deadly street drugs are circulating.
Already prosecutors who rely on examiners’ findings and testimony to bolster their cases have faced pushback in court. Fowler said caseloads had been raised to challenge medical examiners’ credibility in other states, though not yet in a Maryland case.
In addition to drug and homicide deaths, the agency investigates deaths caused by injury, suicide and those that are suspicious or not attended by a physician. Examiners and others in the office also look at thousands of cases for which no autopsy is needed.
CORRECTION: An earlier version of this article misidentified the Association of American Medical Colleges.