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So many drug OD deaths, medical examiner can’t keep up with load


The skyrocketing number of overdose deaths is causing the Palm Beach County Medical Examiner’s Office to stop performing autopsies on some people who commit suicide, die in car crashes or die in hospitals.

Click to read the special report

“We just don’t have the manpower,” Chief Medical Examiner Michael Bell said. “We’re just being overwhelmed.”

Last year, the office investigated 332 drug overdoses, 216 of which were heroin-related, The Palm Beach Post found. In a 12-page special section, “Heroin: Killer of a generation,” Post reporters profiled on the web each of the 216 people who died and their photos dominated the front page of Sunday’s paper.

>>Heroin epidemic, hidden in shame, draws little action to stop the dying

>>Interactive Calendar: All the lives lost

This year, the number of dead from heroin-related overdoses is expected to jump by more than 30 percent, Bell said.

The office’s four pathologists, including Bell, perform autopsies on far more than just those who overdose, of course. But the number of overdose deaths has forced Bell to give up autopsies of some other cases rather than risk the office’s credibility and accreditation.

Its accreditation already might be in jeopardy, however.

Both Florida and the National Association of Medical Examiners say each pathologist should perform no more than 250 autopsies per year. Anything more than that, and it invites mistakes. At 275, the office could lose its certification.

The Palm Beach County office is already there. So far this year, each doctor has performed an average of 274.75 autopsies, Bell said.

The only solution, he said, is to hire more doctors.

“For the years that the economy was poor, I have not asked (for more doctors) because our caseload has stayed fairly consistent. I was being a good soldier,” he said. “With the drug cases, it’s clearly overwhelming us.”

Most people will never encounter one of the office’s staff or its pathologists, who perform autopsies on people who die of unnatural or unknown causes. Its budget from the county is relatively small, at less than $3 million per year.

>>Full Coverage: Generation Heroin

The importance of the office cannot be overstated, however. Murder investigations hinge on its findings. Insurance companies use their results to decide whether to pay out on life insurance policies. Families can learn of genetic illnesses from autopsy results. And tracking drug overdose deaths can help guide response to the growing opioid epidemic.

Nationwide problem

Across the country, pathologists have been overwhelmed by the opioid crisis, said Dr. David Fowler, president of the National Association of Medical Examiners and Maryland’s chief medical examiner.

Los Angeles County’s coroner quit this year partly because of understaffing. Connecticut’s office has been told it will lose its accreditation unless it hires more doctors.

“We have the same dilemma in Maryland, and Maryland’s solution was to give me two more medical examiners,” Fowler said.

>>Heroin scourge: 'Not a thing being done about it'

Palm Beach County this year allowed the hiring of another doctor and provided $85,000 for toxicology testing. The doctor will start in January. But that’s not enough, Bell said. He’ll be asking for another doctor and another investigator next year.

Hiring doctors can be a tough sell for county administrators, though. Bell’s latest hire will make $195,000, not including benefits, making the new hire among the highest paid county employees. But Fowler said pathologists are in high demand because they easily can make twice that in private practice. The Lubbock, Texas, medical examiner makes more than $500,000.

To limit the workload, Bell, who makes $270,000, and his doctors have not been performing autopsies on “obvious” suicides, fatal traffic crashes that won’t result in charges, people who are injured and die in a hospital, people who suddenly die in the hospital, people who die under anesthesia and people who die under hospice care.

>>Opiate, opioid, Narcan? Words to know about the heroin epidemic

There are exceptions to those cases, including incidents in which children die.

But the office is cutting back in other ways. Although it’s performing autopsies on people who die of drug overdoses, it is not sending investigators to the scenes, where they could uncover important evidence. In addition to their own medical findings, doctors use investigators’ reports before ruling on how someone died.

Fowler sympathized with Bell, calling the situation being stuck between “a rock and a hard place.” He said the choice threatens the office’s mission.

“The law says we have to investigate these deaths and certify them within a reasonable degree of certainty,” he said. “If you stop doing autopsies, then are you satisfying the law?”

 >>How to recognize an overdose and save a life

Drug deaths slow

There is a reason the industry recommends doctors not perform more than 250 autopsies per year, about one per workday. A typical death case requires an autopsy, which takes between one and three hours. Then doctors have to spend time writing reports, poring over samples under a microscope, analyzing toxicology results and potentially testifying on the case in court. One death investigation can easily take a day.

With more cases, the chances for mistakes rise, Fowler said. If the office loses its accreditation, it could risk its credibility in court.

>>‘It was a tidal wave I saw coming early on that I could not stop’

To combat the heroin crisis, Bell has asked the county for software to analyze his cases. Right now, he doesn’t have the ability to do even simple analysis, such as producing a list of everyone who died from heroin last year.

If there’s any bright spot, it’s that the county has seen fewer overdose deaths in the past couple of weeks, Bell said. He believes that drug dealers are starting to make less-lethal doses of their drugs.

“I think the dealers are realizing, ‘Hey, if we kill everybody, we don’t have anybody to buy the drugs,’” Bell said.



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