A critical shortage of forensic pathologists may be undermining efforts to advance criminal justice and public health across the country, as officials don’t always have the resources they need to effectively determine how people died.
The issue of forensic pathology is back in the news thanks to the ongoing outrage surrounding the death of Mike Brown, an unarmed teen who was shot multiple times by a police officer in Ferguson, MO. Since the details about Brown’s death and the police officer’s conduct are in dispute, a lot of attention has been focused on the physical evidence. An independent autopsy — prepared by a well-known medical examiner who also examined the bodies of President John F. Kennedy and Dr. Martin Luther King Jr. — was released on Sunday, revealing that Brown was struck at least six times. A county autopsy has also been conducted, while a federal autopsy remains ongoing.
It’s not unusual to expedite autopsies for public figures, or to hire independent pathologists to conduct additional investigations in cases that are fraught with controversy. But for everyday Americans, autopsies are becoming increasingly rare.
The national autopsy rate is at about 8.5 percent of deaths, a rate that experts in the field consider to be “miserably low.” While autopsies used to be performed on about half of the people who died in hospitals, data from the Centers for Disease Control and Prevention (CDC) shows they’re conducted on fewer than five percent of those patients today. According to an extensive ProPublica and NPR investigation into death records, hospitals are shying away from these types of reports because they’re worried about malpractice suits.
That leaves the process of conducting autopsies to medical examiners who are certified as forensic pathologists. But, according a recent report from a scientific working group under the Justice Department, there simply aren’t enough forensic pathologists to keep up with the demand. The report estimated that the United States needs about 1,000 pathologists across the country — but we currently only have about 500 practicing full-time. That leaves some parts of the country, and particularly rural areas, without a nearby expert who can examine a dead body.
“The question then is, how far do they have to transport those bodies?” Dr. Randy Hanzlick, the chief medical examiner in Fulton County, GA and the vice chairman of the group that prepared the report, told ThinkProgress in an interview. “And are they making decisions based on body transport costs, and not sending out cases that need to be autopsied?”
Plus, the shortage of forensic examiners means that the people who do work in the field are overextended. State medical examiner’s offices are already plagued with massive backlogs for death certificates, and they may simply not have time to do many autopsies. The huge number of cases also makes it hard to attract potential employees who could help handle some of the work.
According to Hanzlick, there isn’t much data about the scope of the missed opportunities that arise from failing to do an autopsy. But there are several anecdotal cases illustrating what can happen when resources are stretched too thin.
In Maricopa County, AZ, a judge was forced to drop charges against a couple indicted in the death of a two-year-old girl because the medical examiner’s office couldn’t provide the forensic evidence by the statutory deadline. In Mountain Mesa, CA, a 76-year-man appeared to have died of natural causes, but a re-examination of his case revealed his death was actually brought on by mismanaged care and particularly strong antipsychotic drugs that can be dangerous in seniors. The New Orleans police department has been plagued with issues arising from incomplete autopsies, even in cases where there there was clearly foul play. And Hanzlick recalls a drowning case in his home state of Georgia from a couple of years back; no autopsy was conducted because the coroner thought the case looked like a routine accident, but the parents of the victim eventually came forward with some evidence that suggested otherwise.
“Sometimes it’s not so much a matter of determining only the cause and manner of death, but also trying to clarify the circumstances of death,” Hanzlick said. “Say, for example, you have someone that looks like they overdosed on their medications, and all you do is draw toxicology and do an external exam. You get their toxicology back and find out that they died of valium poisoning. But it would help confirm it was a suicide if you also did an autoposy and found 25 pills in the stomach.”
“People will take things at face value — this looks like a drug overdose, or a gunshot wound, or a suicide — and just do a basic routine that doesn’t really answer some of these other questions that come up,” he continued.
Although most Americans may associate forensic pathology with the crime labs on shows like CSI, autopsies aren’t only used to solve murders. There are several public health reasons why it may make sense to figure out more information about how someone died. Autopsies can provide families with more information about their loved ones’ health and potentially alert them to conditions that may be hereditary. They can help determine whether dangerous consumer products are causing deaths, or how communicable diseases are spreading. Plus, they can ultimately lead to better medicine by helping hospitals figure out whether they performed procedures accurately.
“The only place to get information about diseases and conditions that are running around in the public, causing morbidity or mortality, is basically through the medical examiner and coroner system,” Hanzlick noted. “It does provide information that can help assess the health of the population.”
Some federal groups have taken up the issue of the forensic pathologist shortage. The National Commission on Forensic Science was formed in 2013 to work on improving the issues in this field. The forensic community already has some recommendations: making forensic pathology more visible in medical schools, increasing salaries to make them more competitive with the rest of the medical field, and creating more training programs across the country.