Bodies stacking up, autopsies nixed as Oregon Medical Examiner’s Division facing ‘worsening crisis’

PORTLAND, Ore. (KPTV) - A dozen Oregon counties will soon be expected to step up administrative and investigative duties surrounding deaths in their counties, according to Oregon State Police, who say the change is necessary to handle a “worsening crisis” within the state Medical Examiner’s Division.

OSP leaders say, currently, only a few state pathologists are performing a workload suited for 10 physicians, as the number of death investigations in Oregon have soared in recent years.

The Medical Examiner’s Office has historically “acted” as the county medical examiner for 14 counties, according to OSP spokesman, Kyle Kennedy. The duties include determining cause of death, ordering toxicology reports or autopsies, and signing death certificates.

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Now, those counties will be required to handle the majority of those tasks, and the changes will affect some of Oregon’s most populated counties like Multnomah and Washington counties.

Once manageable, the workload for state pathologists has changed dramatically over the past couple years, and has been overwhelming for staff, according to a memo by OSP Major Alex Gardner to county leaders.

In part of the letter, Gardner wrote, “Our remaining physicians are working weekends, falling behind and expressing concern about heavy workloads adversely affecting performance and quality of life.”

Another major issue: the struggle to hire and retain employees who are turned off by not only the crushing workload, but also low pay.

OSP said, until recently, pathologists and support staff made some of the lowest salaries in the country for their professions.

As forensic pathologists have struggled to meet demand, bodies have stacked up inside the Clackamas morgue, forcing staff to utilize two outdoor coolers that are meant for mass causality situations.

“It certainly has been a challenging time for our office,” said Dr. Sean Hurst, the chief medical examiner for the division.

Hurst told FOX 12 that his work, along with that of his fellow colleagues, has essentially doubled since the start of the pandemic.

Hurst said the surge of cases boils down to the perfect storm of factors leading to more death investigations in recent years: increasing murder in Oregon, many of them tied to Portland’s influx of deadly gun violence; an explosion of drug overdoses in the state, many of them linked to illicit fentanyl; and more autopsy requests from prosecutors, who rely on the evidence to bring stiffer charges for drug dealers linked to deadly overdoses.

Shortcuts have become a band-aid solution.

“In order to manage the caseload, we may perform more limited examinations or an external examination of the body in lieu of a full autopsy,” Hurst said.

Murder cases and suspicious deaths are prioritized, said Hurst, with those autopsies usually performed within 24 to 48 hours. Autopsies are only performed on about a quarter of drug overdose cases.

More frequently these days, pathologists don’t examine bodies at all.

“We do hear from family members sometimes that they are somewhat dismayed that we are not able to take on as many of those cases, as we’d like,” Hurst said.

One family that’s struggled for answers lost a loved one just over a year ago. Jeanette Chumley showed FOX 12 her brother’s death certificate, which says, “Cause of death is pending toxicology and the manner of death is pending investigation.”

“I had a lot of questions; everybody had a lot of questions,” Chumley said.

How exactly the 43-year-old father, brother, and son died was a mystery for his family, who thought Joey Chumley might finally be getting his life on track.

“The hardest part was telling his little 5-year-old girl that her daddy wasn’t coming home,” his sister said.

Chumley told FOX 12 it was no secret her younger brother lived a tough life, riddled with addiction, crime and jail.

“When you have a sibling, who has a 25-year drug problem, you never know when you’re going to get that call, or if you’re going to get that call,” Chumley said.

It was just over a year ago, that her brother was found dead in the Gresham halfway house where he lived. His family thought maybe it was an overdose – but maybe not - as they say Joey had recently been sick, diagnosed with blood clots in his lungs and released from the hospital just a few days before he died.

Chumley said a death investigator then ordered toxicology tests and an autopsy for her brother.

“I’m sure a lot of people think this - but I’m thinking CSI – they’ll know in an hour; they’ll know in a couple of days,” Chumley said.

Instead, it would be five months of waiting for those toxicology results.

“We still haven’t gotten the autopsy report and it’s been a year,” Chumley said.

It’s unclear if the family will ever get an autopsy report, or whether one was ever done. Sensitive information and medical records are rarely public record, outside of law enforcement investigations or prosecutions.

Aside from offering families of loved ones answers, Hurst said there’s an entirely different side to pathologist’s work that is now suffering, as well.

Autopsy data is crucial for tracking and monitoring trends and anomalies related to death, health and wellness for the Oregon health authority and CDC.

“The concern is, that if you’re not performing a lot of autopsies, you may be losing some of that information,” Hurst said.

In the state’s toxicology lab, the backlog is similar.

This past January, OSP told FOX 12 there were more than 2,500 pending toxicology requests, a 240% increase from the same timeframe four years ago.

OSP said it typically takes more than 100 days to send out a toxicology report.

It was this past October, five months after her brother’s death, that Jeanette Chumley finally got some answers.

“They ruled it an accident and said it was an acute fentanyl toxicity,” Chumley said.

An overdose of fentanyl - not entirely unexpected - yet information that still offered some closure, that helped the family move forward with how they choose to remember Joey.

“He was so funny - he had a wicked sense of humor,” Chumley said.

The Oregon Medical Examiner’s Division said a bill designed to help them with staffing failed this legislative session. It would’ve allowed them to explore hiring professionals who aren’t physicians, but rather physician assistants or nurse practitioners.

One bright spot, the ME’s Office said it was able to secure pay raises for employees, which should help with recruiting staff and retention.

Oregon State Police provided FOX 12 with a list of counties that will have to adjust their medical examiner departments, in lieu of the changes, which are coming July 1:

• Clackamas
• Columbia
• Coos
• Curry
• Douglas
• Grant
• Jackson
• Josephine
• Lake
• Lane
• Morrow
• Multnomah
• Washington
• Wheeler

Here is the full memo sent out by OSP Major Alex Gardner:

Good afternoon, friends and colleagues.

I’m writing to update you on a worsening crisis in the SMEO (State Medical Examiner’s Office), probable short-term changes that will significantly impact counties and other partners, and long-term plans to meet community needs.

As most of you know, Oregon’s M.E. system has been small and understaffed for over thirty years. The system has limped along with especially capable people who have prioritized service to public safety partners while being unable to do much of the important public health work (which comprises approximately 95% of our total case volume.)

Over the last five years, rapid population growth, increasing homicide rates, COVID, the opioid epidemic, struggling county systems, and other influences have combined to produce a compounding growth in annual SMEO workload that has exceeded 20% per year. Such a growth rate more than doubles the total workload in less than six years. To put the current burden in a public safety context, our Chief Medical Examiner, who is also responsible for managing the heavy and increasing administrative burdens, recently did seven homicide autopsies in one weekend. Dr. Stanley, our newest physician, has seventeen pending homicide cases, and she’s just getting up to speed in her first year of practice. Our physicians are also signing up to 1000 death certificates per year, each of which requires at least some additional review and, often, research.

The current workload is unsustainable -- and it’s expected to continue increasing. Prior efforts have been insufficient to mitigate the workload, so drastic measures are necessary to restore a manageable balance.

Where we stand today:

1) Workload analysis suggests we need more than ten physicians and a like number of morgue attendants in our Clackamas morgue. We are authorized for about half of that, but the combination of Oregon’s extremely low salaries, low numbers of new physicians specializing in pathology, and extremely high national demand for forensic pathologists has prevented us from keeping even four of our physician positions in Clackamas filled.

2) Increasing caseloads over multi-day call-shifts have produced a growing volume of overnight phone calls, compounding physician fatigue.

3) Two of our four Clackamas physicians have indicated they plan to leave our employment this summer. If this happens, and the physician currently in background accepts our offer, we’ll have only three doctors managing the ten-physician metro workload by fall of 2023.

4) We have only two other state pathologists, one in Springfield and one in Central Point, both of whom are more than thirty years into their careers and managing heavy caseloads. They cannot accept additional work, and we have no viable succession plan if they retire. One of them is scheduled to go on protracted leave within the next few weeks, which will require more work to be shifted north to Clackamas.

5) Our remaining physicians are working weekends, falling behind, and expressing concern about heavy workloads adversely affecting performance and quality of life.

Probable next steps:

1) The SMEO serves as the County Medical Examiner for 14 of Oregon’s 36 counties, including several of Oregon’s most populous counties. That service will likely be discontinued effective July 1, 2023. Effected counties will have to find in-county solutions to manage that workload. This includes signing death certificates in routine cases that can be completed without direct examination by a forensic pathologist.

2) The SMEO will continue to work properly documented suspected homicide cases and infant deaths.

3) Requests for autopsy in potential “Len Bias” cases will be rejected unless accompanied by sufficient documentation establishing a nexus supporting prosecution.

4) Physicians must have the final say in case management and examination decisions.

5) Autopsy attendance by outside agencies should be pared back to the most urgent and/or sensitive cases, such as homicides and pediatric deaths.

State Plan to restore more complete ME services:

1) For the third time in approximately four years, we have petitioned Oregon DAS (Department of Administrative Services) for an adjustment in pathologist compensation that will allow us to compete for experienced forensic pathologists. The State HR system is complex, and the barriers to achieving true market salaries are varied and formidable, particularly for professionals, but the DAS team is collaborative and trying to help, so we remain hopeful.

2) We have notified the Governor’s office of the crisis, and we are requesting immediate authority to add physicians and morgue attendants in Clackamas.

3) We are exploring ways to increase physician workspace and cold storage at the Clackamas morgue.

4) We are evaluating ways to use physicians assistants and nurse practitioners to augment staffing.

5) We are building new morgue facilities in Eugene and Central Point, both of which should be operational before the end of 2026. Assuming we’re able to properly staff those facilities, as much as 20% of the Clackamas load could be shifted south until we find a lasting solution for the metro area workload.

This situation is dynamic, and no plans have been set in stone, but county administrators should be advised that county ME services provided by the state are likely to be suspended on July 1, 2023.

We pledge to keep communication lines open and do our best to ease the transition to reduced state service.

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