Shortage of autopsy doctors is a 'crisis in near future'

The abrupt resignation last month of Chief Medical Examiner-Coroner Dr. Mark Fajardo revealed flaws in Los Angeles County’s system of death investigations, through which some 8,500 autopsies are performed each year.

Delayed medical examinations, overdue toxicology tests and slow response times were becoming an unacceptable norm, Fajardo said, noting he’d not been given the resources to alleviate many of the strains on the department.

But Fajardo, who left L.A. County to take over as Riverside County’s chief forensic pathologist, wasn’t the only one to cite issues that threaten the county’s ability to track how and why people die.

“I can assure you, L.A. is not the only office that’s going through this,” said Dr. David Fowler, president of the National Association of Medical Examiners), an accreditation agency. “Many offices are struggling with resources. It is a problem nationally.”

A shortage of pathologists is affecting counties large and small in Califoia and the United States, many experts said.

Only about 40 forensic pathologists graduate from fellowship programs each year, which is just enough to keep up with the retirement rate, Fowler said.

“I anticipate a bit of a crisis in the near future,” he said.

Delays in cases cause financial and emotional hardships for families who need death certificates to settle their loved ones’ affairs. It is particularly a problem when the dead person is the family’s breadwier.

Delays also have public health implications. For example, if there is a spike in certain drug overdoses, involving a particular drug, medical examiners can report that information to law enforcement, Fowler said.

The strain has departments struggling to maintain accreditation and funding while also holding on to good employees.

For a department to maintain it’s accreditation with NAME, each physician must perform about 250 autopsies per year and 90 percent of a department’s cases must be finalized within 90 days.

While accreditation is not required for coroner’s offices in the United States, it is beneficial to have credentials — especially when medical examiners appear in court to discuss their findings on homicide cases.

The current situation in Los Angeles County puts the coroner’s accreditation at risk.

“The tempo in Los Angeles is brutal; it demands a lot of everybody,” said retired Chief Investigator Craig Harvey, who has recently retued to the department on a part-time basis.

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The medical examiner’s office in Cook County, Illinois, which serves Chicago, achieved full accreditation with NAME last month after its status was downgraded in 2011. The office handles about 5,000 cases a year.

In 2010, an independent audit waed about a potential shortage of physicians if L.A. County did not actively recruit more doctors due to upcoming retirements. Then, the department had 24 doctors on staff. Today, there are 18 forensic pathologists on staff and four vacancies, according to the department.

As he left, Fajardo praised the dedication of the staff upon his departure, especially given the resources they had to work with.

But they were up against not just a backlog, but finances.

“Nobody in this industry is funded at the level that would make every operation optimal,” said Capt. Kevin Lacy, who leads San Beardino County’s coroner division of the sheriff-coroner’s office. “They’re doing the best they can.”

Lacy said the division receives enough funding from the San Beardino County Board of Supervisors, but the department is short two deputy forensic pathologists due to retirements. The department investigated 1,600 cases last year.

The L.A. County proposed budget released last week showed a nearly $2u2009million decrease in funding from this fiscal year’s $35.5 million allocation in the coroner’s budget.

County Chief Executive Officer Sachi Hamai said she had a team from her office working with the department to determine if more funding is needed before the budget process concludes.

In the meantime, strapped resources and staff departures take a toll.

Although investigators arrived within an hour of being dispatched to the scene of a West Hills traffic accident last week that killed a mother and daughter, response times can take several hours depending on workload, traffic and the vastness of Los Angeles County. And, that’s only the begiing of a process that frustrates family members coping with the slow pace of forensic death investigations.

It hasn’t helped that it’s been difficult to hold on to good employees.

The L.A. County coroner’s office is seen as a strong training ground for forensic pathologists, but the department has difficulty enticing those students to stay once they graduate due to the grueling workload and the pay provided by a county agency versus private practice, Harvey said.

John Fudenberg, coroner of Clark County, Nevada, which serves the city of Las Vegas, said his office completed just under 3,000 cases last year. But it’s not easy.

“It’s one of those things when you’re competing for dollars with departments like juvenile justice, family services and social services and police and fire, those are all very important things. And it’s very difficult for a coer or medical examiner’s offices to compete when it comes to those services,” he said.