The state medical examiner's office will begin a search Wednesday for additional examiners to help handle a sustained surge in fatal overdoses from opioids such as heroin and fentanyl.
Faced with a overwhelming number of bodies needing an autopsy to determine the cause of death, examiners in Maryland have struggled to perform the procedures in a timely manner.
The opioid crisis has pushed the office along with others like it around the country beyond the national standards for examiner workloads. The Baltimore Sun reported April 16 that the office was at risk of losing its accreditation as a result.
With no money in the state budget for additional medical examiners, the state Department of Health and Mental Hygiene conducted an internal search for vacant professsional positions and found three. The governor's office confirmed that acting Health Secretary Dennis R. Schrader approved transfers of those positions to the medical examiner's office.
"As soon as this additional need was identified, Secretary Schrader worked quickly and effectively to ensure these essential positions will be filled," said Amelia Chassé, a spokeswoman for Gov. Larry Hogan. "Our administration is continually working to make sure that agencies on the front lines of this crisis have the vital resources they need."
Christopher Garrett, a health department spokesman, said the moves would be effective as of Wednesday.
It's not clear how long it will take to find qualified examiners to fill the new positions. It also appears unlikely the addition of three examiners would fully offset a workload that continues to increase with the number of fatal overdoses largely attributed to powerful illicit opioids, including heroin and increasingly the more potent fentanyl.
And an even deadlier threat may be on the horizon. Health officials recently attributed three overdose deaths — two in Anne Arundel County and one in Frederick County — to carfentanil, a synthetic opioid used as a tranquilizer for large animals such as elephants and not intended for human use.
Opioids already account for the bulk of the state's drug and alcohol related deaths, which reached 1,468 in the first nine months of 2016, exceeding the death total of 1,259 for all of 2015 and double what they were in 2010.
Overdoses now kill far more Marylanders than car crashes and homicides.
State health officials have been working to stem the deaths by adding funding for treatment and training residents to use naloxone, which can revive overdose victims. The governor recently declared the opioid crisis a state of emergency and has sought funding increases for the medical examiner's office in each of the past several years.
The state leaders had not included money for extra medical examiner positions in the next state budget, beginning in July, instead funding raises for existing examiners to help retain experienced pathologists who are difficult to replace.
Maryland's medical examiners perform so many autopsies that they have been exceeding national standards for workloads for about four years, according to figures compiled by the office in December.
Dr. David R. Fowler, the state's chief medical examiner, has said he fears lapses in quality if the burden continued. Fowler was not available to comment on the new positions.
The National Association of Medical Examiners' standards say an examiner should perform no more than an average of 250 autopsies annually. If the examiners in an office meet or exceed 325 autopsies each in a year, its accreditation by the association could be in jeopardy.
It's estimated that Maryland's examiners will perform an average of 328 autopsies this year, up from an average of 280 in 2013 and 234 in 2010.
Medical examiners investigate deaths caused by injury, homicide or suicide, and those that are untimely, suspicious or not attended by a physician. In Maryland, that's about a third of all deaths.
Fowler has said the office would need three examiners to avert the loss of accreditation and six examiners to meet national workload standards.
Inspectors from the medical examiners' association can consider the commitment of new funding for positions when they begin evaluating the Maryland office in May, said Dr. Brian L. Peterson, the association's president.
The office can operate without accreditation, but that could jeopardize the now well-regarded office's credibility by raising the prospect of mistakes. That could pose challenges for prosecutors who rely on information and testimony from examiners, as well as for public health officials setting policy and directing resources.
Autopsy delays also can frustrate families waiting to bury a loved one.
Finding examiners to fill the spots likely will be difficult because the number of practicing pathologists who work as medical examiners dropped more than 11 percent from 2010 to 2015, according to the Association of American Medical Colleges. That was a steeper drop than in any other specialty.
"Hiring in this climate is very tough, as the forensic pathology tree is pretty much picked clean," said Peterson, who is also the chief medical examiner for Milwaukee County, Wis. "However, inspectors are absolutely allowed to consider action being taken. At my own office, for example, we sustained 'provisional accreditation' for the three to four years it took us to achive the necessary accreditation for our lab."
These offices aren't alone in facing opioid-related work burdens. Offices in Florida, Hawaii, West Virginia and New York, among others, have reported such jumps.
Peterson said many such offices risk losing accreditation. Some offices, such as his own, have reduced the number of full autopsies performed when possible or taken other steps.
"Many offices are struggling," Peterson said.