Originally posted at California Health Report.
By Chris Richard.
In a refrigerated crypt at the Los Angeles County Coroner-Medical Examiner’s headquarters, the bodies lie awaiting examination on the shelves of metal racks, similar to what you might find in a Home Depot.
The coroner’s office is responsible for investigating violent and unusual death. With up to 80,000 deaths in Los Angeles County annually, about 20,000 are reported each year to the medical examiner’s office. The department examines from 8,000 to 9,000 bodies a year, records show.
Walking past the crypt’s steel shelves, you glimpse a bullet-pocked leg. There, the distended, bruised-looking belly of a corpse that lay out in the sun too long. And so on, dead person after dead person, a 160-corpse backlog.
In a laboratory upstairs, jars of blood are stacked in cartons.
“That blood backing up, for one thing, is so frightening to me, and so frustrating,” said Mark Fajardo, who quit as county coroner in April, saying he had not received the funding or staff he needed to carry out his duties.
As an example, Fajardo cites the need to investigate a surge in overdoses of the synthetic opiate fentanyl, the same drug that recently killed music icon Prince.
“(Public health officials) were asking coroners throughout California, ‘Hey, are you guys seeing a spike in fentanyl?’ To which I could not respond, because at the time of my resignation, we were nine months behind on toxicology tests,” Fajardo said.
His decision to leave the nation’s busiest coroner’s department points to a strain on public funding for death investigations that is especially severe in Los Angeles, but a growing problem throughout the state, experts say.
The shortage of resources has serious public health implications, such as delaying health alerts to ambulance crews and emergency room doctors when there’s a spike in overdoses such as those occurring now with fentanyl and other opioids. Likewise, we rely on pathologists’ reports to head off disease such as the tuberculosis epidemic that broke out a couple years ago on LA’s Skid Row. Findings by coroners’ departments help to identify trends in another public health issue, violent crime.
Finally, slowness in investigating questionable deaths causes additional anguish and sometimes financial hardship to friends and relatives of the deceased. Slowness in processing death certificates can substantially delay processing of life insurance policies, for example.
David Fowler, president of the National Association of Medical Examiners, or NAME, said many coroner’s offices nationwide are short on staff. He said some 40 forensic pathologists graduate from fellowship programs across the country annually, barely enough to keep up with retirements.
“This has been a slow, creeping problem, worsening over time,” Fowler said. “There was no trigger, no measurable point where you suddenly said, ‘Oh, dear!’”
While training programs for other specialties generally receive federal subsidies throughout their duration, the final year of a forensic pathologist’s education commonly does without such support, Fowler said.
Less demanding general pathology positions typically pay much better than does government work, adding to the shortage of specialists willing to work in the public sector, Fowler said.
Glenn Wagner, chief medical examiner for San Diego County, called staffing shortages a chronic problem.
With 57 employees, the San Diego medical examiner’s office evaluates some 900 deaths per month, Wagner said. Of those, from 200 to 300 bodies are unidentified. Wagner said ideally, he’d have his own DNA laboratory to help find out who these people are, but to avoid that expense his county depends on state laboratories.
Wagner said such a state check can take several months, during which time the body must be stored at county expense.
The county also struggles to keep up with requests for toxicological investigations. With 10 pathologists working around the clock, Wagner said it can take up to three months to complete test results on a case.
Still, Los Angeles County’s difficulties remain by far the most severe. In April, a civil grand jury report focused on chronic underfunding.
The report concluded that the Department of the Medical Examiner-Coroner “is significantly understaffed” in both coroner investigator and laboratory positions and has a “sobering backlog” in toxicology testing. The grand jury warned that the department is likely to lose its NAME accreditation if those issues are not addressed.
That “may subject Los Angeles County and (coroner’s office) to attacks on their credibility in criminal cases,” the report states.
Retired coroner’s investigator Vidal Herrera said the funding shortfalls go back decades. He remembers showing up at work to find no gloves available to protect workers’ hands during autopsies. Sometimes, he and his colleagues had time to buy heavy-duty dishwashing gloves at local stores, but often they did without, Herrera said.
“The bodies just kept coming in and coming in,” he said. “The work had to get done.”
As for staffing, in his last year at the head of the department, Fajardo requested funding for 80 new positions. When the draft county budget was released in April, it provided money for two.
Joel Sappell, a spokesman for county Chief Executive Officer Sachi Hamai, wrote in an email that Fajardo had failed to provide a sufficiently detailed justification for his request.
More recently, the CEO has authorized 24 temporary positions, while distributing some of the coroner’s workload to other departments, the email states. A study is underway to evaluate the coroner’s management issues, staffing requirements and technological needs, Sappell writes.
Fajardo said he believes that by resigning and speaking out, he helped to draw the attention of the county Board of Supervisors and the general public to his department’s plight. He’s encouraged by the temporary hires.
As for a broader solution, county supervisors are legally required to respond to the grand jury report within another month, Fajardo noted.