POCASSET — Two years ago the state medical examiner’s office in Pocasset was singled out as “unsanitar dangerous to the public health.”
Since then nothing has been done to correct the problems or any of half a dozen more deficiencies pointed out in an inspection of the office by the National Association of Medical Examiners.
It would only take an estimated $2,000 to repair the stopped-up drains in which body fluids from corpses are disposed and to clean up asbestos – two reasons that the office was considered dirt dangerous.
But if there are plans to correct these problems, no one has told Dr. James Weiner, the lead forensic pathologist at the Pocasset facility.
“We have estimates on repairs. What we lack is a commitment to make them,” Weiner said.
“No one is saying whether there will be money available in the coming year,” he said.
“In the face of this, we do what we’ve always done – keep working.”
The problems plaguing the Pocasset office are symptomatic of greater ills that put the state’s entire medical examiner system at risk of collapse, according to forensic pathologists from around the country who have examined the Massachusetts system.
First came the National Association of Medical Examiners accreditation process, which Massachusetts failed to pass in 2000.
Then, last month, a report by the Florida-based National Forensic Science Technology Center warned that Massachusetts is courting disaster unless it beefs up funding for the medical examiner system, staff and facilities.
The report recommended closing the Pocasset office, located in the former county hospital, because of poor conditions.
The report, commissioned last fall by state Public Safety Secretary James Jajuga, recommends the state immediately inject an additional $1 million to $1.5 million into the medical examiner’s budget, which is currently funded at about $3.7 million.
The Legislature has pledged an additional $500,000 to $700,000 in the coming fiscal year, making the medical examiner’s office one of the few state agencies to see an increase in the budget for 2003.
Experts warn, however, this may not be enough. And the longer the state waits to repair problems in the system, the more expensive those repairs will become, they say.
Situation could lead to errorsThe Florida report warns that the state medical examiner’s system is at “high risk” of making a crucial error in a criminal case because the staff is overburdened and underpaid.
“It is not a question of, will a medical examiner make an error, it is a question of when,” said Peter A. Stefan, a funeral director in Worcester.
“The state system is a shambles. It is shameful,” he said. “I don’t blame the individual medical examiners. They are incredibly hard working. I blame the leadership – or the lack of it.
“We have medical examiners who have worked years without raises – dedicated public servants,” Stefan said. “But they are working under deplorable conditions.”
Salaries for medical examiners range from $40,000 to the $150,000 now earned by Dr. Paul Evans, director of the state Office of the Medical Examiner.
Although most commonly associated with murders or other crime-related deaths, state medical examiners do more. law, they are responsible for conducting autopsies on victims of violent death, including car accidents, suicides and suspected murders. They also perform autopsies on all children who die and on hospital patients who die within 24 hours of admission to a facility.
Additionally, state medical examiners must investigate all unattended deaths – that is, deaths that take place outside medical supervision.
In 2000 – the most recent statistics available – there were 56,591 deaths in Massachusetts.
Of these, state medical examiners investigated 12,901, or just under 23 percent of all deaths in the state. The national figures vary with jurisdiction, but generally, forensic pathologists investigate around 20 percent of deaths in a given population.
Last year, Weiner and his colleague Dr. George Kury conducted an estimated 400 autopsies on people who died on the Cape, islands and in southeastern Massachusetts, the territory covered by their satellite office.
Funeral directors on the Cape have nothing but praise for Weiner and Kury, saying the two men go out of their way to make things easier for families whose loved ones have ended up at the medical examiner’s office for whatever the reason.
Bodies are always returned to funeral homes for identification rather than forcing families to show up at the morgue, which is housed in the basement of the old county hospital in Pocasset, say Cape funeral directors.
Death certificates are “signed as soon as humanly possible,” Weiner said. “We don’t want to do anything that would possibly delay a family getting benefits.”
Lack of equipment problematicBut there are problems Weiner and Kury must contend with.
The Pocasset office does not have a body scale. There is no X-ray machine.
The system used for suctioning fluids from bodies is archaic and the office often runs out of body bags.
Specimen bottles are also in short supply. Weiner admits that he and Kury have often turned to area hospitals for bottles, crucial for taking samples during an autopsy.
Last month the local medical examiner’s office was without a fax machine for two weeks. This meant reports to and from the Boston office had to be dictated by telephone, a time-consuming process.
There is no cleaning service for the Pocasset office, which means clerks, the secretar the two forensic pathologists are responsible for routine cleaning work.
While Weiner says this does not interfere with getting the basics done, it is “demoralizing to work under these circumstances.
“But we know that here on the Cape, we’re not alone. There are problems systemwide.”
According to Stefan, who works at the Graham, Putnam and Mahoney Funeral Parlor in Worcester, the quality of work performed at the Pocasset office is “admirable considering the conditions they are forced to work under.”
Stefan, who has contact with offices around the state, said not all are able to perform as well as the Pocasset office.
“There are instances when a family has had to wait months for a death certificate. It’s terrible. Insurance payments are delayed, social security payments are delayed,” Stefan said.
“The medical examiners can’t be faulted. The system is at fault because the state labs are too backed up. There isn’t enough money to hire and train more lab workers. Consequently, toxicology reports can be delayed for weeks and weeks. There aren’t enough medical examiners, particularly in the Boston office,” Stefan said.
“This is where it hurts the average person. This is the hidden cost of a state that has ignored its medical examiner’s office for too long.”
Origins of the systemThe state medical examiner system that now exists was born in 1983. Prior to that there was a county coroner system. Autopsies were the responsibility of the counties and were conducted in local funeral homes. Most coroners worked on a part-time basis.
In 1982, the state hired Dr. Brian Blackburn to create a statewide system with full-time forensic pathologists.
In 1983, the Legislature budgeted $3.1 million for the newly created system. At that time, all autopsies were done in the Boston office.
Within four years Blackburn had established a satellite system, opening medical examiner offices in Worcester, Agawam and Pocasset. This meant bodies could be autopsied closer to home, making it easier on police who are required to be present at autopsies of questionable deaths and victims of violence.
In 1989, Blackburn resigned and took a job in San Diego, after telling colleagues he was frustrated with the lack of financial support in Massachusetts for a high-quality medical examiner system.
In the 20 years since the state system was created, the annual budget has increased just over $500,000 to the current $3.6 million.
According to the National Association of Medical Examiners, which includes an estimated 450 forensic pathologists nationwide, Massachusetts falls far below the recommended expenditures for medical examiner offices.
An association survey showed wide disparity in what states are willing to spend on investigating causes of death.
“We found that per capita spending among states ranges from a low of 34 cents per capita to a high of $3.20 per capita,” said Dr. Randy Hanzlick, medical examiner in Fulton County, Ga.
“We recommend a state spend $2 per capita,” he said. “That’s a minimum figure.”
Massachusetts spends 50 cents per capita, or 50 cents for each of its 6.6 million residents. National Association of Medical Examiners standards, Massachusetts should be spending more than $13 million a year on medical examiner services.
“Massachusetts is horribly underfunded,” said Dr. Joni McClean, a forensic pathologist in Dallas and National Association of Medical Examiners president.
DNA tests drive up costs “This is a problem not unique to your state,” McClean said. “All across the country medical examiners are underfunded and the problem is getting worse as more and more DNA cases come in.”
Which is exactly the point Cape and Islands Assistant District Attorney Michael O’Keefe has repeatedly tried to make with the Legislature.
The state medical examiner’s office is responsible for collecting body fluid samples for analysis of such things as blood alcohol levels and toxins.
The state police lab, which like the medical examiner’s office is run by the Executive Office Of Public Safety, conducts DNA tests.
The state has not committed money to hire and train new staff to conduct DNA tests, O’Keefe says. This means that evidence in criminal cases takes weeks or even months to reach police. The same is true of blood tests necessary for OUI cases, he said.
Because the system is so backed up, district attorneys are limited to submitting one or two cases a month for DNA analysis.
“This is not the way to run a criminal justice system,” O’Keefe said.
Cape legislators say that, until recently, no one had brought the problem to their attention.
Rep. Demetrius Atsalis, D-Hyannis, said state representatives have recommended an increase in the budget for medical examiners of between $500,000 and $700,000.
“But until Michael O’Keefe called me on this, I was unaware,” Atsalis said.
“No one has ever come knocking on my door looking for money for the medical examiner’s office,” said Sen. Therese Murray, D-Plymouth. “We have only recently been made aware of some of the problems concerning this office.”
Experts around the country say the promised increase does not come close to providing the state’s forensic pathologists with the money needed to do their job efficiently.
“We’re heading for disaster. That’s all I can say,” said Stefan, the Worcester funeral director. “Why has this been allowed to happen?
“Because the dead don’t vote – at least not very often.”