Tuesday, May 10, 2022
WASHINGTON – Dr. Gregory Hess says he has
enough forensic pathologists on staff for the Pima County Medical Examiner’s
Office to keep pace with the office’s caseload, but they are still stretched
thin.
And his office is one of the lucky ones.
As the nation enters a third year under the
threat of COVID-19, Arizona medical examiners say they are struggling to keep
up with rising caseloads driven largely by rising deaths from the virus at a
time when there is a shortage in forensic pathologists.
It’s not just Arizona: In states across the
U.S., medical examiners are reporting sharp increases in their caseloads as
COVID-19 and related increases in overdose and other deaths strain their
resources.
“We are fully staffed right now but we’re kind
of in the minority,” Hess said. “A lot of places in the United States don’t
have enough staff to keep up with the increased caseload, never mind … the load
that they had prior to the pandemic, prior to this recent wave of overdose
deaths that you see across the country.”
The Maricopa County Medical Examiner’s Office
reported a 26% increase in deaths from 2019 to 2020.
While deaths can be expected to rise along with an increase in population,
Maricopa County’s population grew just 1.9% in 2020.
Dr. Jeff Johnson, chief medical examiner in
Maricopa County, said the death rate for the county has stayed high through
2021 and early 2022, creating large caseloads for an office that is already
facing a shortage of forensic pathologists.
“One of the struggles that we experience is
that because there’s so few (pathologists) that train every year, and so few
that are available, it takes us a really long time to get somebody to join us
when we have a vacancy,” Johnson said.
“So while you wait for that, you’ve got all
the rest of your physicians who are struggling and if you have two or three
vacancies at the same time, then that just magnifies everything,” he said.
Johnson said the National Association for
Medical Examiners, the accrediting body for forensic pathologists and medical
examiner’s offices, recommends that one
physician do no more than 325 “autopsy equivalents” per year. The three
Arizona counties accredited by
the association – Coconino, Maricopa and Pima counties – all meet that standard.
But that comes as the total number of deaths
in the state jumped a remarkable 25% from 2019 to 2020, a year when some
smaller counties saw deaths rise almost 50% year
over year. Deaths continued to rise in 2021, according to data from the Arizona
Department of Health Services, from 75,700 to 80,733 – a more modest rise of
6.7% but still well over the population growth of 1.7% that year.
Pima County faces high caseloads in
part because it handles deaths from Cochise, Graham, La Paz and Santa Cruz
counties. But it has been able to cope because it has remained fully staffed
throughout the pandemic.
Hess attributes his office’s ability to avoid
the forensic pathologist shortage to the availability of the University of
Arizona’s pathology residency program.
Johnson also noted that the increased
caseloads have been driven by the fentanyl crisis, which was made worse by the
pandemic.
“We’ve seen a really strong upward trajectory
in Maricopa County since 2015, the number of fentanyl deaths that we’ve seen
between then and 2021 is nearly doubled every year,” Johnson said.
Both Johnson and Hess said that even though
their offices are stressed, they have been able to keep up with the caseload.
Hess said it’s impossible to predict how the death rate will fluctuate or if it
will return to pre-pandemic levels.
“I think everyone thought that the pandemic
was going to kind of come and go, but it lingers,” he said. “We may have more
waves of different variants and the mortality may stay high.”
Both Hess and Johnson agree the best way to
combat the high caseloads is to increase education and opportunities for
forensic pathology. The UArizona pathology residency is the only one of its
kind in the state, according to Hess, making it more difficult for students to
enter the field and take their expertise to other areas of the state.
It’s also not a field that many students are
interested in, Johnson said, but if they recognized the importance of the work,
it could help ease the strain on medical examiner’s offices.
“I think that the pandemic has highlighted how
important medical death investigation systems are for communities and … for
those public health datasets that allow policymakers and public health
officials and public safety officials to design interventions to improve the
situation,” Johnson said.
“We wouldn’t know about the opioid crisis if
it wasn’t for medical examiner’s offices doing this work and highlighting these
things,” he said.
For more stories from Cronkite News, visit cronkitenews.azpbs.org.