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Medical examiner’s office faces work overload amid opioid crisis

  • Dr. Thomas Andrew, the state’s recently retired medical examiner, talks about his experiences on the job from his office at Concord Hospital in Concord in September. When Andrew took the job of medical examiner in fall 1997, the office’s caseload was about 900 per year. That number has since doubled due to population growth and the drug crisis. Despite the growing demand, the number of medical examiners performing autopsies in New Hampshire has remained static. Elizabeth Frantz / Monitor file



Monitor staff
Saturday, November 25, 2017

At the New Hampshire Medical Examiner’s Office in Concord, good help is hard to find.

As Dr. Jennie Duval takes the helm as chief medical examiner, her former position as deputy chief could remain unfilled for months. The search is also still underway to find an associate pathologist, a new position approved by the Legislature this year.

“There are very few candidates for very many open positions throughout the country,” said Dr. Thomas Andrew, the state’s newly retired medical examiner.

Andrew told the Monitor the timing of his retirement “couldn’t be worse.” The state office’s workload has exploded because of the opioid crisis, forcing medical examiners to drop a long-standing policy of performing an autopsy on every suspected drug death in the state.

When Andrew took the job of medical examiner in fall 1997, the office’s caseload was about 900 per year. That number has since doubled due to population growth and the drug crisis. Despite the growing demand, the number of medical examiners performing autopsies in New Hampshire has remained static.

The story is the same across the country.

“We are now competing with many other jurisdictions who are all facing the same problem,” Andrew said.

Andrew spent the first few years of his tenure working toward the state office’s accreditation, which is good for five years absent any violations. The office was reaccredited for a third time in December 2016, but that status could be in jeopardy.

Staffing shortages increase the risk that a medical examiner will be forced to perform more autopsies than the industry standard allows. The magic number is 250.

“Reach 325 and that’s an automatic death sentence,” Andrew said.

A total of 546 autopsies were performed in New Hampshire in 2016. Duval performed 302 autopsies, Andrew 225 and contractors 19.

The office hired contracted pathologists in March of this year to cover autopsies for one week a month to alleviate some of the case load, and to give Andrew and Duval time to finalize autopsy reports. But the arrangement is not a permanent fix to the problem, Duval said.

“Since Dr. Andrew retired, we have hired additional contractors to cover autopsies for approximately 10 days each month,” she said. “This is a temporary and unsustainable response to our staffing shortage.”

Andrew echoed that point, noting the addition of a third position is essential to the office maintaining its accreditation. An inspector with the National Association of Medical Examiner was informed of the plan and will follow up annually to ensure the office is following through, he said.

Loss of accreditation can undermine public confidence and lead to challenges in court over a medical examiner’s findings. That’s especially true if the medical examiner is called to testify as an expert witness, which is commonly the case.

The state’s medical examiners work under the umbrella of the attorney general’s office, which in late 2016 strongly pushed for funding for a third pathologist, in addition to pay increases for the chief and deputy chief. Salaries for the chief and deputy medical examiners were roughly $40,000 below the market rate when compared to their counterparts in other states, Attorney General Gordon MacDonald told leaders in state government.

Those salaries are now more on par with other states. The chief medical examiner makes a minimum of $210,000 annually, and the deputy chief $200,000.

But New Hampshire still faces many challenges moving forward.

Duval said she learned from a medical examiner in another jurisdiction that it often takes 18 months to hire a forensic pathologist. While she hopes to fill the deputy position by early next year, an associate pathologist may not be on staff until summer 2018 or later, she said.

Once the office is fully staffed, Duval will resume the practice of performing autopsies in all suspected drug cases. Until then, an autopsy will be performed if necessary to determine cause of death, or if necessary from a criminal justice or public health standpoint, she said.

Last month, Andrew led recruitment efforts in Scottsdale, Ariz., at the National Association of Medical Examiners annual meeting. Specifically, he was looking for someone recently trained to fill the position of associate pathologist. That person’s sole responsibility will be to perform autopsies; they will have no administrative responsibilities, he said.

“I’ve been talking up New Hampshire,” Andrew said in a phone interview from the conference. “I am killing two birds with one stone – continuing my education and trying to recruit for the state.”

The entry-level position has a starting salary of $160,000 annually, which does not compete with similar jobs outside New England, Andrew said. But, he added, New Hampshire has many other selling points to draw in candidates.

“I’m trying to emphasize quality of life issues,” he said. “If I can attract someone who can fall in love with New Hampshire, then we’re in pretty good shape.”

(Alyssa Dandrea can be reached at 369-3319, adandrea@cmonitor.com or on Twitter @_ADandrea.)Editor’s note: This stroy has been changed to correct references to Dr. Thomas Andrew.