S.A. medical examiner struggles to keep up
SAN ANTONIO — Mass casualties put a strain on an already overburdened Bexar County Medical Examiner’s Office last year amid the COVID-19 pandemic.
But deaths were increasing even before two of San Antonio’s biggest tragedies — the mass shooting in Uvalde and the 53 undocumented immigrants who died after being abandoned in a tractor-trailer.
In 2021, the office certified 3,618 Bexar County deaths, compared with 3,158 the year before and 2,959 in 2019. The annual report was released at the end of 2022 because the office prioritized ongoing cases from the mass tragedies earlier in the year. The big concern now? “Is this the new world that we’re going to live in? Is this the new normal?” Chief Medical Examiner Kimberly Molina said.
Bodies are only handled by the medical examiner’s office in certain circumstances, such as when foul play is suspected or the cause of death is unknown.
Molina said, on average, the caseload increases only 3 to 5 percent each year, which is in line with the county’s population growth.
“In the last three years, we’ve seen 15 years’ worth of growth in the office caseload, which is very, very difficult for us to cope with,” Molina said.
When the pandemic began, everyone who could retire did.
Molina said the main issue is recruiting and retaining forensic pathologists —a career path that takes 13 years of training.
“The issue for us is, because we’re so incredibly specialized, that there aren’t people out there to just be forensic pathologists,” Molina explained. “You have to go to college. You have to go to medical school. You have to train in pathology. Then you have to train in forensic pathology. All of this takes time, right?”
She estimates it could take at least 10 years to replace retired personnel and recruit enough to keep up with growth.
By the numbers
Not all of the growing caseload was from COVID-19 deaths.
The report identified a 25 percent increase in suicides, 20 percent increase in fatal accidents and 19 percent increase in deaths from overdoses.
There were 14 deaths in Bexar County from winter storm Uri in February 2021.
Natural deaths also saw an increase, some of which were an indirect effect of COVID.
“A lot of people weren’t seeking medical care, not just for COVID, but … people who might be having abdominal pain or chest pain — and they would normally go to the hospital for that — weren’t seeking medical care and were then dying at home,” she said.
County officials have done all they can to help. They’ve provided additional cooler space for dignified storage of people’s loved ones so that the increase in deaths from COVID-19 never led to the crowding of bodies seen in other major cities.
They added a family assistance specialist, who can help families with the many questions that arise from having a deceased loved on at the office in the first place.
The county has also provided additional needed medical examiner positions.
But therein lies the challenge, as before: filling the roles.
The United States trains between 30 and 40 forensic pathologists each year. It’s challenging to attract new talent to a place with a high workload when everyone else also needs them.
In one of many partnerships the county has with UT Health, the office serves as a training grown for students studying toxicology and forensic pathology.
But, Molina said, the medical examiner’s office still has to incentivize people to come to Bexar County.
“High caseloads are not really what the physicians are looking for,” she said. “This is not a problem that’s limited to us. It’s pretty much every office in the nation that’s struggling because we need forensic pathologists.”
A dedicated staff
Even with minimal staff, Molina hailed the investigators, who endured not one but two mass fatality incidents a month apart last year.
They had stopped assisting the surrounding counties with death investigations at the start of the pandemic because of the constraints with staffing.
But when 19 children and two teachers were killed on May 24 in Uvalde, the Bexar County Medical Examiner’s Office had the logistics and the capability to investigate their deaths.
The incident was equivalent to a week’s caseload in one day. Although it may seem apparent to others, including law enforcement, how the victims were killed, the medical examiner’s office mandate is to investigate exactly how someone’s loved one died.
“We treat everyone who comes into our office with dignity and respect that they deserve,” Molina said. “We are the last physicians they are ever going to see, and we need to be there as a service to them.”
With this in mind, the investigators who handled the sudden influx volunteered to continue working to bring closure to the victims’ families.
One month later, a tractor-trailer of 53 undocumented immigrants was discovered in Southwest Bexar County. The dead would present the additional challenge of reaching out to loved ones in an entirely different country.
Molina said the office already had a relationship with consulates from their respective countries as they worked to identify other citizens and repatriate them to their countries.
“It probably was easier for us to handle here than, say, if it had been in the Midwest or somewhere where they didn’t already have those relationships in place,” she said.
Molina’s other concern is making sure her staff is able to cope with the stress of working the extra hours and that they’re taking care of themselves, especially considering their drive.
“In those situations, I know they would all volunteer. They would all be here and do what is necessary,” she said. “They would 110 percent put themselves up to it.”