By Kristin Zachary
Wednesday, May 1, 2013
Local medical examiners expect major delays and a greater potential for mistakes as about 400 autopsy cases are sent from the Greenville office to Raleigh, but an official there said pathologists at the central office will get the job done.
Cases from 22 of the 24 counties served by East Carolina University’s Department of Pathology and Laboratory Medicine are expected to begin funneling into the Office of the Chief Medical Examiner on June 1 when a federal grant expires.
The estimated 400 autopsies a year will add to the office’s already large caseload from 28 counties. Last year, the central office had 1,407 cases, according to Julie Henry, spokeswoman for the state Department of Health and Human Services. The medical examiners system falls under the Division of Public Health, which is part of DHHS.
“The cases that come from the eastern part of the state will not be treated any differently than any cases that come to Raleigh,” Henry said. “We’ll use our standard protocol for processing cases.”
Henry said she hopes there are no ramifications for the eastern counties, but there may be some delays.
“It may not go as quickly as people would like it to be,” she said.
The goal turnaround time for completed autopsy reports is 60 days, but “I think it would be fair to say it could be a longer turnaround time when we’re shorter staffed,” Henry said. “It’s very challenging to find forensic pathologists. We’re actively recruiting all the time.”
The office has no plans to add any pathologists with the extra caseload but hopes to have a full staff of six, Henry said. Right now, there are three. By July 1, the office expects to have five.
“We have not been fully staffed previously, but the pathologists have managed,” Henry said.
Six isn’t enough
Even if the central office had a full staff of six, it still would not be enough to handle nearly 1,800 cases each year, according to Dr. William Oliver, the ECU department’s director of autopsy and forensic services.
Standards set by the National Association of Medical Examiners indicate the maximum number of cases handled by a pathologist who only conducts autopsies should be no greater than 250 a year to ensure no errors, Oliver said.
At the central office in Raleigh, pathologists have a large administrative role and should be conducting even fewer cases, he said. If the work was split evenly among five pathologists whose only role is to conduct autopsies, each would handle about 360 cases.
“You basically have to decrement (the number of pathologists) by about one and a half” because of administrative duties, Oliver said. “There’s no way to get around that because it’s their job.”
Dr. Deborah Radisch, chief medical examiner, should only be doing enough autopsies to “keep her skills up,” with her focus on administrative work, he said. “If she has to do 400 autopsies in a year, then she cannot run a state medical examiner system.
“… So that’s one big problem,” Oliver said. “When you say, ‘We’re going to have four or five pathologists,’ you’re not going to have four or five pathologists that are doing autopsies, or if they are, they’re not doing the work they should be doing. The claim that the OCME will simply pick up the slack is a nonstarter.”
ECU is one of 10 facilities across the state contracted by the OCME to conduct autopsies and is not the only one experiencing troubles, Oliver said.
“This is not an issue of ECU versus the OCME. This is a systemic problem.”
Each medical examiner’s office receives only $1,000 in state reimbursement for each autopsy conducted, as required by state law, but that does not cover the cost of more than $1,700 to complete the procedure.
“We certainly are aware of the challenges our partners are facing,” Henry said. “This is a vital service to the people of North Carolina, and we want to continue to work and collaborate to ensure the services continue.”
A Centers for Disease Control grant administered by the OCME provided an additional $600 to $700 per case to ECU’s Brody School of Medicine, Oliver said. The local office completed nearly 530 autopsies last year at an individual cost of $1,731 and absorbed the small loss from each case, he said, but the expiration of the grant greatly increases the loss, and the program is not sustainable.
As the office reduces its service area to Pitt and Greene counties in an attempt to keep the program afloat, Oliver and other local officials believe counties previously served will see disastrous results.
Decreasing the number of cases handled locally by about 400 will “tremendously” reduce educational opportunities, limit training and leave the staff in limbo, Oliver said.
And, in one year, if no solution is found and the program is completely shuttered, the consequences are going to be even greater in Pitt County, with homicide investigations being hampered by delays.
Having pathologists complete more cases than the 250-a-year standard set by the National Association of Medical Examiners, in addition to administrative work, will produce significant delays in case turnaround, Oliver said.
Autopsies include not only the examination but also further microscopic investigation, medical record and police report review, consultations with other specialities and research, especially in unusual cases, he said. Then, autopsy reports must be written and edited.
“The longest I’ve ever spent in the autopsy suite was 14 hours, which made it about an 18-hour autopsy, and that was a multiple gunshot wounds case,” Oliver said. For a “straightforward autopsy,” the process takes about eight to 10 hours, Oliver said, but complex autopsies can reach 30 to 40 hours.
More cases in Raleigh mean the pathologists can expect increased court preparation and testimony time, he said, resulting in even more delays.
‘They’ll get it done’
Although the OCME has been doing “more and more with less and less” in the past 20 years, Oliver believes errors have been few or none.
“But we’re at the point in the state system where mistakes will become more likely unless some sort of solution is found for the under-funding, not only at ECU, but at Wake Forest and the OCME and Mecklenberg County,” Oliver said.
The pathologists “will just take on whatever additional caseload that has to be managed and do the best they can,” Henry said. “I think it’s amazing the volume of work the staff get done. If they have to do it, they’ll get it done.
“I know Dr. Radisch,” she said. “I know her commitment to doing the job … so I wouldn’t want to speculate on any decrease in accuracy or the quality of the work they do.”
Oliver said Radisch is “doing a very good job in a difficult situation,” but “it doesn’t really matter what your commitment is, because if you have to do that amount of work, you do not have the time or resources or energy not to make a mistake.”
ECU and Vidant have provided the local office the opportunity, he said, “to step back and say, ‘Look, we can’t cut back anymore without making these mistakes, so we’re just not going to do it.’ Unfortunately, the Office of the Chief Medical Examiner may not have that option.”
Contact Kristin Zachary at firstname.lastname@example.org and 252-329-9566. Follow her on Twitter @kzacharygdr.
via The Daily Reflector.