The US state of Massachusetts has over recent years increasingly switched to “autopsies” using photographs and medical records rather than the actual bodies to reduce escalating caseloads, reports the Boston Globe.
The state’s chief medical examiner’s office has slashed its frequency of autopsies in recent years, opting instead for faster, less-intensive examinations, driving autopsy rates here to one of the nation’s lowest levels among similar offices.
Experts warn that doing fewer autopsies inherently risks missing causes of death that other methods can’t rule out, particularly among suspected overdoses. The primary charge of the office is to investigate the causes of violent, suspicious, or unexplained deaths, and to provide information to grief-stricken families.
Nearly 1,200 times last fiscal year — or in roughly one of every seven cases investigated by the Office of the Chief Medical Examiner — there was no physical body examined before a cause and manner of death were identified. Instead, the office relied on medical records and photographs taken by staff, according to a newly released report.
This nearly doubled the number of so-called chart reviews from the previous year, and it was an eight-fold increase from just four years earlier. That growth under chief medical examiner Dr Mindy Hull far exceeds the pace at which cases are increasing overall and adds another dimension to a quicker approach embraced by the office in determining how people are dying in Massachusetts.
For the past three years, the medical examiner’s office performed autopsies in 26% to 27% of cases, trailing its counterparts in other states who, on average, performed them 38% of the time. Through the first half of this fiscal year, autopsies accounted for slightly less than one quarter of the office’s caseload.
Instead, examiners are opting to examine the surface of bodies, while conducting toxicology or minimally invasive testing, in more than 50% of cases last year, including drug overdoses and traumatic accidents. Chart reviews, once infrequent, accounted for another 15%.
It’s a departure from just five years ago. In 2017, the last full year under Hull’s predecessor, the agency performed autopsies in 44% of all cases, completing 3,192 in total. In Hull’s first year, the number dropped to 2,755; last year, it reported doing 2,177.
The decline is not limited to Massachusetts, as growing caseloads wrack an industry starving for medical examiners. Hull’s office also said it’s confident its examiners are turning to them when needed — including as cases reached nearly 8,000 last year — and utilising chart reviews to spare the delay of transporting a body to the medical examiner’s office for other “well-documented” deaths.
State officials said they still conduct autopsies in deaths believed to be suspicious or a homicide, in unexplained deaths of infants and children, and in other cases likely to involve legal proceedings or a request from prosecutors.
The shift away from autopsies, experts say, also reflects the challenges medical examiner’s offices are facing nationwide. More bodies are flowing into exam rooms because of drug overdoses or homicides, taxing many offices that are regularly seeking new medical examiners, reports the Boston Globe.
In Maryland, whose chief medical examiner recently resigned, there’s a backlog of more than 200 cases, forcing the agency last month to turn a garage into a makeshift morgue.
In Massachusetts, several of the contracted physicians on whom Hull’s office relied to examine bodies at hospitals or in funeral homes are “ageing out”, state officials said. There are now just four so-called district examiners statewide, pushing hundreds of more deaths to the state’s 16 full-time and three part-time medical examiners in recent years.
Many are now being handled as chart reviews, cases in which staff investigators, who are not doctors, will typically examine and photograph bodies and a medical examiner will review the evidence.
But in a “small number” of cases, state officials said, they’re also used in suspected overdoses — cases the national association still recommends be autopsied. There have been more than 2,000 opioid-related deaths every year over the last half-decade in Massachusetts.
Other states that have continued to perform autopsies in most cases include Connecticut, which, like Massachusetts, has seen dramatic increases in fatal overdoses but where the medical examiner’s office performed more than 3,200 autopsies overall last year.
“We’ve all seen cases that come in and look like a straightforward drug overdose. And then you do an autopsy and find out this person was strangled,” said Dr James Gill, Connecticut’s chief medical examiner and a past National Association of Medical Examiners (NAME) president. “That’s the nightmare scenario. That’s what you don’t want to miss.”
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