BALTIMORE – Dr. David Fowler’s staff is scrambling to keep up with the surging stream of corpses flowing through the doors.
In his 15 years as Maryland’s chief medical examiner, Fowler has seen natural disasters, train crashes and mass shootings. Heroin- and cocaine-related homicides have plagued this city for decades. But he says he’s never seen anything that compares to the opioid epidemic’s spiraling death toll. As fentanyl, carfentanil and other deadly synthetic opioids seep into the illicit drug supply, it’s only getting worse.
The recent surge in drug overdose deaths has created an unprecedented nationwide demand for autopsies and toxicology examinations, said Brian Peterson, president of the National Association of Medical Examiners, which accredits the forensic pathologists who perform death investigations.
Many medical examiners are working overtime and, in some places, they’re running out of refrigerated storage for bodies. When that happens, local officials typically borrow additional space at local funeral homes and hospitals, and in some cases, rent refrigerated trucks, he said. “Virtually every medical examiner’s office and toxicology laboratory in the U.S. has felt the impact of the opioid tsunami.”
In Maryland, homicides and fatal car crashes also are on the rise, creating far bigger caseloads for medical examiners than recommended by the national association. The concern is that performing more than the recommended limit of 325 autopsies in a year, in addition to other duties such as testifying in court, could result in errors.
“People are using drugs every day, but they died today instead of yesterday. Why? They might have had a heart attack, pneumonia or a stroke. Drugs are there but they may not be the cause of death,” Fowler said.
Over-reporting drug deaths could be just as harmful as under-reporting them, he said. “We could be missing something else that’s killing people.”
In April, Republican Gov. Larry Hogan approved the Maryland medical examiner’s request for three new forensic pathologists to help handle the additional workload. But after more than 2 months of searching for qualified candidates, none have emerged.
There are job openings all over the country and not enough forensic pathologists to fill them, Fowler said. “The sad thing is that when we find someone, we’ll probably be stealing them from somewhere else.”
Nationwide, the drug overdose epidemic is now claiming more lives than both homicides and automobile accidents combined, and there were more fatalities from drug overdoses in 2015 than AIDS-related deaths during that epidemic’s peak in the 1990s. Drugs are the No. 1 killer of people under 50, and they are shortening the average American life expectancy.
The Centers for Disease Control and Prevention’s most recent count of drug overdose deaths was more than 52,000 in 2015, with at least 33,000 due to heroin, fentanyl, prescription painkillers and other opioids.
Drug overdoses, typically classified as drug intoxication deaths by medical examiners, are considered accidental deaths and in most jurisdictions require an autopsy and toxicology examination. In this opioid epidemic, however, that rule is being debated within the profession because of the shortage of forensic pathologists available to perform autopsies.
Nationwide, only about 500 trained medical examiners are at work, and a disproportionate number are nearing retirement age, the national association’s Peterson said. The job requires 13 years of training after high school including 4 years of college, 4 years of medical school, 4 years of residency in general pathology, and another year of forensic pathology.
More than a hundred jobs are open right now and more are opening up every month, Peterson said. The number of forensic pathologists nationwide is half of what is needed to handle the current volume of deaths, according to Peterson, and evidence suggests the number of drug deaths will keep growing.
But only 30 to 40 forensic pathologists are minted each year, and because salaries for medical examiners, which are mostly public employees, are so much lower than for general pathologists, many quit mid-career for more lucrative jobs in hospitals. “The situation in forensic pathology is truly dire,” Peterson said.