Summit County is no longer conducting autopsies for three other counties as it grapples with a staffing shortage and a spike in drug-related deaths.
The county — which did 755 full autopsies last year compared with 614 five years ago — has stopped handling cases for Columbiana, Richland and Wayne counties.
The move was made because the workload has gotten too great and there is a worry about making a mistake in a delicate case, county medical examiner Dr. Lisa Kohler said.
Summit lost a deputy medical examiner who left for a job elsewhere late last year. The county has had difficulty finding a replacement, so the work that’s been handled by three doctors is being done by two.
“We’re just reaching a point of exhaustion,” Kohler said.
Overall, 3,757 deaths were reported to the medical examiner last year. The office ended up handling 729 cases from Summit — everything from drug overdoses to car accidents. It also conducted 212 autopsies for other counties.
Summit is continuing to do autopsies for Portage County.
“While we can’t necessarily control the number of cases that come through within Summit County, … we can trim out some of the extra cases by turning away several of the counties that we normally do business with,” Kohler said.
National problem
Summit County isn’t alone when it comes to dealing with an increased workload and having trouble attracting a new pathologist.
Coroners and medical examiners across the country are coping with a rise in the number of drug-related deaths due to the opiate epidemic, including heroin and fentanyl, and a shortage of forensic pathologists.
“It’s a chronic problem across the nation and not just here that forensic pathologists are in high demand,” Montgomery County Coroner Kent Harshbarger said. “There are very few.”
The National Association of Medical Examiners has estimated that only about 40 forensic pathologists graduate from fellowship programs each year, essentially matching the number retiring.
“If we’re not at crisis now, we’re going to be at one very, very soon,” association President and Maryland Chief Medical Examiner Dr. David Fowler said.
He estimated that there are about 600 forensic pathologists operating nationwide now, while there is a need for 900 to 1,000.
The role that those pathologists play in death investigations is critical when dealing with grieving families, delivering timely reports and even handling insurance settlements.
The more work, the longer it takes to close cases. Overworked doctors also are more susceptible to making an error.
“You want the cause of death on a death certificate to be accurate,” Fowler said. “It really comes down to quality and accuracy and reasonable speed.”
The national standard says a forensic pathologist can conduct about 250 autopsies a year, and no more than 325 before an organization risks losing its accreditation.
If accreditation is lost, pathologists have their credibility attacked in court cases.
In some areas of the country, examinations are not being conducted by forensic pathologists because of the shortage.
“If you needed a heart transplant, would you get a gastrointestinal surgeon to do it?” Fowler asked. “The medical world has become super specialized.”
Money issue
The problem is particularly pronounced in Ohio, where urban counties operating regional autopsy centers have difficulty matching wages being offered elsewhere.
The open Summit County job will pay anywhere from $135,000 to $145,000.
That salary is low, not taking into account the cost of living, compared to other government job postings on the National Association of Medical Examiners Association website.
San Bernardino County, Calif., is looking for a forensic pathologist and is willing to pay $186,680 to $244,940.
The Utah Department of Health is offering $138,860 to $220,188 for an assistant medical examiner.
The starting salary for an associate medical examiner in St. Johns County, Fla., is $160,000.
And the Virginia Office of the Chief Medical Examiner in Richmond, Va., will pay $170,000 to $180,000 for an assistant chief medical examiner.
Forensic pathologists in private practice earn even more.
It’s difficult to compete with communities that offer more money and a picturesque view of an ocean, Harshbarger said.
Montgomery, which handles autopsies for about 25 counties and is on pace to do about 2,000 autopsies this year, runs a training program as a way to recruit and retain pathologists.
“I have been fortunate,” Harshbarger said.
Smaller counties, those unable to pay for their own forensic pathologists, contract with larger counties such as Montgomery, Lucas, Cuyahoga, Franklin and Hamilton for autopsies.
Montgomery has seven forensic pathologists, with their salaries paid for by the autopsy fees charged to other counties.
Montgomery charges $1,500 for out-of-county cases. It handles more than 1,000 of those autopsies a year.
Summit situation
Jason Dodson, chief of staff for Summit County Executive Russ Pry, acknowledged that pay is an issue for the county’s open job.
One candidate turned down the position because she wanted $170,000.
The county has identified a potential candidate who will be trained but won’t be certified for months. In the meantime, Kohler and Chief Deputy Medical Examiner Dr. George Sterbenz will continue to handle the cases by themselves.
At the same time, they have to deal with a sharp rise in accidental drug overdoses, which ballooned from 69 five years ago to 200 last year.
No longer doing autopsies for Columbiana, Richland and Wayne should ease the workload. Those counties are now seeking other contracts.
But Summit also is losing out on revenue by not handling the additional cases.
Summit charges $1,283 per out-of-county autopsy — money it uses for supplies and equipment.
The 212 out-of-county autopsies brought in nearly $272,000 last year. Summit wants to do autopsies for those other counties again when it hires a new full-time pathologist.
“We’re not looking to have any relief here before August,” Kohler said. “We’re just trying to manage our resources and make sure we can continue to serve the citizens of Summit County appropriately without fearing that we’re going to be making a mistake that will be detrimental to a case.”
Rick Armon can be reached at 330-996-3569 or rarmon@thebeaconjournal.com. Follow him on Twitter at @armonrickABJ.