Dr. Erik Christensen is on track to do 600 death investigations this year, about twice the maximum advised by national medical examiner accreditors.
Christensen, head of the Utah State Medical Examiner’s Office in Salt Lake City, chuckled when asked how far he’s exceeded the recommended annual maximum workload of death cases for a pathologist, 250 to 325.
“I’ve done 520 cases already this year,” Christensen said.
A longstanding backlog in autopsies, toxicology tests and final reports on death investigations may get worse yet, despite efforts by the state to partially catch up this year. Delays of several months often hold back homicide investigations, life insurance payouts, funeral payments and even the viability of tissue donations.
Utah’s high population growth rate and its heavy incidence of suicide and drug overdose deaths are demographic drivers that bind the Medical Examiner’s Office into a workflow situation that Christensen said is almost impossible to accommodate with current staffing.
When Christensen joined the examiner’s office in 2008, the agency handled 1,900 cases. The total will top 3,100 this year.
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The Utah Legislature this year boosted the office’s budget by 25 percent, to $4.3 million, including funding for 2 ½ more forensic pathologists. That puts the authorized pathology staff at eight, but recruitment and retention issues, brought on by the high workload, are making the roster tough to fill.
The Medical Examiner’s Office has lacked national accreditation since 1996 because of the pathologist workload deficit.
“If we do more than 325 a year (per pathologist), we cannot be accredited,” Christensen said.
Another accreditation standard Utah can’t reach: At least 90 percent of cases should be finished within 60 days, and all completed in 90 days. “We are so far beyond that ...” Christensen said.
Homicide investigators around the state have little choice but to try to be stoic about medical examiner delays that keep cases high-centered for months.
“It’s an understood situation,” Dale Ward, Box Elder County chief deputy sheriff, said when asked about the Medical Examiner’s Office. “Those guys are eyes deep in dead bodies, 24 hours a day, seven days a week.”
Box Elder recently closed the books on the death of a jail inmate about 10 months after it happened. The wait was longer than usual, partly because an extra set of tests were requested after the first batch came back.
“Unfortunately, it is what it is,” Ward said. “Very candidly, I’m not going to throw them under the bus. They are encountering exactly the same thing we are encountering in law enforcement — lack of personnel and the wages they pay.”
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Lt. Tim Scott, who leads investigations for the Ogden Police Department, said some unattended deaths can take almost a year to close.
“They can remain open for six, seven, eight months … and when there’s a questionable death, the families want the answers,” Scott said.
Until the state rules on a death, families usually cannot receive insurance payments, mortuary bills cannot be paid and property can’t be sold, Christensen said.
When a family consents to tissue donation — bones, skin, heart valves, for instance — processing agencies require a final report before issuing the tissue. If a report is not done in time, the donor tissue will expire, Christensen said.
With homicides, detectives usually attend the autopsies, Scott said, to get firsthand from the pathologist any immediate conclusions about the cause and manner of death — which can be enough for a prosecutor to justify the filing of charges.
“Now if it’s a case that’s questionable, leaning one way or another, with the ME sometimes you do have to wait for that final report,” he said.
Christensen said his office tries to prioritize, but the daily crush simply prevents rapid service.
“I have multiple homicide files sitting in my desk,” he said. “I just need time to finish the reports.”
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Christensen said his job is meant to be divided between administrative duties and death investigations, but he continues to work a full investigative load.
“The whole point of the caseload limit, and it’s understood by the people who design those criteria, is that if you do too many cases, you’re going to make more mistakes,” he said.
“Mostly where this all plays out is in turnaround time,” he said. “We’re not willing to compromise to do that in a case.”
Christensen said the pathologists do try to give precedence to finishing reports in cases where someone’s liberty is at stake.
Randall Richards, a local defense attorney, said, “We have to put off hearings for several months, and these poor guys or gals (suspects) languish in jail.”
In 2015, an external audit illustrated the ramifications of the backlog. Christensen said the Governor’s Office of Management and Budget’s reaction amounted to a statement that “you do need help, you’re not just whining.”
The lack of accreditation is a red flag that deters recruiting, Christensen said. For a recent opening, eight applicants were interviewed, “who uniformly said ‘You guys do too much work, I’m not coming there,’ ” he said.
Christensen recently hired a pathologist from Kentucky “who was essentially getting paid a pittance wage. He could be overworked here or there, but here at least he’s getting paid.”
After the increase this year, further substantial improvements in the office’s budget aren’t planned by the state for 2017 “even though we obviously need it,” Christensen said.
“People need to understand the crisis we’re in,” he said. If it doesn’t get addressed, people will keep leaving. I will not stay. I have looked, but I have a high school sophomore who doesn’t want to move. That applies to most of the people here.”
The pathologists are medical doctors and must be accredited by the National Association of Medical Examiners.
According to transparent.utah.gov, Christensen and other senior pathologists each make $300,000 or more in total employee compensation, including salary and benefits, under the 2016 state budget. Christensen said the state pathologists make $208,013 salary, in the lower range of the current pay range for such positions in Utah ($175,905 to $333,810). Many pathologists are lured away to more lucrative anatomic and clinical pathology positions elsewhere, he said.
The office may be able to squeak beneath the limit of 325 cases per pathologist if all eight positions can be filled and Christensen continues to work a full caseload, he said. “We probably could use 10 doctors, in my opinion,” he said.
“People that work here ... are incredibly dedicated people, but with the resources we have it is frustrating to us to have to practice this way,” he said.
The Utah State Medical Examiner’s Office investigates:
Sudden deaths when the person was in apparent good health
Deaths that occur under suspicious or unusual circumstances
Poisonings and drug overdoses