The opioid epidemic took its toll on the state’s longtime chief medical examiner. Frustrated by the immense increase in caseloads caused by record overdoses, Dr. David Fowler has said he will leave the job by the end of the month after 17 years. Simply put, he didn’t have the staff and other resources to perform the autopsies on the bodies funneling through his office. Things have gotten so bad that the agency has become dangerously close to maxing out national caseload standards and risks losing a crucial national accreditation.
Mr. Fowler’s departure underscores the dire nature of the drug epidemic that has gripped both Maryland and the country for years and only recently began a slowdown. In the first half of the year, total drug and alcohol-related deaths dropped by 150 to 1,182 compared to 1,332 the first six months of 2018.
But nobody’s breathing a sigh of relief yet because drugs and alcohol are still claiming 200 lives a month — 90 percent of them opioid related — and circumstances could swing at any moment.
The Hogan administration hasn’t ignored the problem. It has pumped some extra funding into the office, with the help of some federal grants. Since March 2017, the office has received more than $412,000 in money and resources, the governor’s office said. The funds went toward testing equipment and infrastructure needed to handle a larger number of bodies. The state Office of Human resources last year assigned a recruiter to the medical examiners division, who helped bring on 11 per diem medical examiners. Beginning in 2016, medical examiners received an average 16% salary increase, or around $937,000, that came out of the general fund, as a retention tool employed by the state.
The Maryland Department of Health also repurposed five positions to help with the load, including two medical examiner positions, one toxicologist, one autopsy assistant and one forensic investigator.
But these additional resources don’t discount the concerns expressed by Dr. Fowler. It is telling that he was willing to resign, rather than face not being able to do his job effectively. We should mention, that Dr. Fowler has raised a red flag about the shortage of resources for years. At some point, you realize nobody’s listening, or just doing enough to put a Band-aid on the problem.
To be fair, overwhelmed medical examiner offices are problems in other states. In 2013, state medical examiners each handled more than the national standard of 250 autopsies a year. By 2017, the average was more 325, a threshold that could put accreditation in jeopardy. The volume can cause delays in reporting findings and releasing bodies. This leaves families in emotional limbo and unable to find closure, and it delays police investigations.
The state should look for ways to infuse more resources into the office. As long as the opioid epidemic remains strong, the obstacle of keeping up with autopsies will remain. Of course, the ideal way to deal with the issue is to stem the epidemic itself: Stop the overdoses and the pressure on the medical examiner’s office will naturally disappear.
The state could start by investing more resources in Baltimore. Some would recall that as overdoses have dipped in the state, they continued an uptick in Baltimore. The state needs to address these disparities to end the epidemic.
Continuing the push for naloxone, the drug that prevents overdoses, should also be a priority. This helps save lives until people are able to work through their addictions to stop using.
One way to reach people is when they enter the prison system. The General Assembly voted overwhelmingly last year to begin administering three federally approved medications to treat alcohol and drug addiction to inmates in every county jail and Baltimore’s state run detention facility. This was a great first start, but needs to go much further and expand the use of methadone, buprenorphine and naltrexone to the state’s prisons, where most offenders end up. Lawmakers have a chance to make that happen this year.
People who don’t get treatment while incarcerated come out with the same addictions. They turn back to drugs when released, but their bodies often can’t handle it and they are at a higher risk of overdose.
Dr. Fowler is a respected medical examiner, and his presence will be missed. We hope the administration takes his departure as a signal to do more to reduce the strains on the medical examiners office.