Medical examiners’ new worry: Staffing
Backlog of cases foreseen if virus makes workforce ill
A sudden surge in coronavirus cases would not only impact health systems, but also medical examiners, who worry that their workforce could become ill, creating a backlog of cases.
“If something happens to me, and then I have to selfquarantine, who runs the office?” said Dr. Joshua Stephany, chief medical examiner for Orange and Osceola counties, who has a staff of almost 30. “And it’s not just me. What if someone else in my office gets sick and then gets the whole office quarantined?”
Medical examiners are already seeing their workload tick up.
In Florida, medical examiners have to sign the death certificates for public health reporting purposes, but they aren’t required to autopsy COVID-19 bodies. The Occupational Safety and Health Administration has also recommended against performing autopsies on COVID-19 bodies, so the majority of the cases go straight to funeral homes.
But medical examiners may have to run COVID-10 tests on the bodies of people who die outside of health-care settings and are at a high risk of having had the disease.
Because of lack of co
ronavirus testing, many families and first responders are starting to suspect COVID-19 as a cause of death for cases that occur at homes or outside of hospitals, flooding medical examiner offices with calls.
“I’ve made it very clear to all my police agencies that we’re not going to start bringing in everybody with a runny nose and sniffles and things like that who die,” said Dr. Stephen Nelson, chief medical examiner in Polk County and chairman of Florida’s Medical Examiners Commission. “They’re going to have to come in with much more credible evidence that this person may be infected before you bring them in.”
That’s not unique to Florida. Dr. Sally Aiken, president of National Association of Medical Examiners and a medical examiner in Spokane, Wash., said many offices across the nation are seeing an increase in the number of calls because of public fear and assumption that every death much be or could be caused by COVID-19.
Even if the medical examiner offices had the staff and capacity to perform a COVID-19 tests on suspected cases, they couldn’t, because like other institutions, they face a severe shortage of testing kits.
“We’ve done three [tests] and we’re already running out of test kits. Soon, if things keep going the way they are, no one’s going to get tested,” said Stephany, who is also the president of Florida Association of Medical Examiners.
He said his office is still doing fine with caseloads. But the surge in cases in other areas provide a glimpse of the impact.
In Boston, where at least 15 people have died from the infection, the state’s chief medical examiner has told the staff to cut their workload to a bare minimum, the Boston Globe reports.
And smaller offices could get hit particularly hard.
The Polk County Medical
Examiner’s office, which has jurisdiction over Polk, Hardee and Highland counties, has only two physicians.
“So you take the two of us here and who’s going to do all these cases? We’re very worried about staffing,” Nelson said.
The pandemic is bringing to light the chronic shortage in the number of medical examiners, and there’s no quick fix for it. There are about 500 working forensic pathologists across the nation, but ideally that number should be about 1,200, said Aiken of Spokane. About 10% of all forensic pathology jobs are unfilled, she said.
It takes about nine years of training, including medical school, to become a forensic pathologist and the pay is low compared with other specialties, so fewer and fewer young doctors are choosing the profession, said Aiken.
The already busy medical examiner offices could be stretched in other ways. If the number of cases escalate here, for instance, medical examiners may be called in to help with body transport and storage.
They also worry that a surge in COVID-19 cases could disrupt the process that starts once an individual dies — from transportation staff who may get sick, to funeral homes, which may have to hold onto bodies if families are quarantined and want to wait until they can hold a viewing.
The funeral homes also worry about the impact of the pandemic on their staff.
They’re scrubbing down their facilities several times a day, having some of their staff work from home and limiting the number of people in the viewings.
“It’s such a hard line to walk, because we obviously see the need for services, because it helps with the grieving process,” said Becky Raph-Bowie, funeral director and location manager at Woodlawn Funeral Home in Gotha, near Windermere. “But we don’t want to get large groups of people together, so we’ve been trying to recommend maybe small intimate family gatherings and then offering a live-streaming option.”
But the large funeral homes in Central Florida said they have ample refrigeration, should there be a surge of bodies due to COVID-19.
“We’ve taken some precautions to reserve some other refrigerated containers should we need them, but at this time, of course we don’t know if we will or not,” said Skip Knopke, president of Baldwin Brothers Funeral & Cremation Society. “We’ve gone through this process in the past, but of course, nothing has ever occurred in any way on a scale like this.”
Got tips about testing woes or PPE shortage? You can reach me at nmiller@orlando sentinel.com; call, text, Signal at 321-710-7947; on Twitter @NaseemMiller and on Facebook.