More Deaths Go Unchecked as Autopsy Rate Falls to “Miserably Low” Levels

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Watch Post Mortem, FRONTLINE’s exploration of America’s patchwork death investigation system, and The Real CSI, our follow-up film which investigates the science behind forensics.

Nearly 7,000 people die each day in the United States, and according to a new report, there remains a critical shortage of experts trained to determine their cause of death.

The study, conducted by a research group working under the auspices of the Department of Justice, noted a “miserably low” national autopsy rate of 8.5 percent, with only about 4.3 percent of disease-caused deaths resulting in an autopsy. Autopsies are crucial because in instances of natural death, they enhance how medical experts understand disease, and can even help family members discover whether a relative died from an undiagnosed hereditary illness. In instances of homicide, they can provide crucial clues to investigators.

But the undersupply of medical examiners is far from the only challenge. As FRONTLINE’s Lowell Bergman reported last winter in the film Post Mortem, the nation’s approach to death investigation is one plagued by widespread dysfunction. There is no federal oversight of death investigators, and accreditation is voluntary. In more than 1,300 counties across the country, elected politicians are in charge of death investigation.

Such lax standards present serious implications for the criminal justice system, Sen. Patrick Leahy (D-Vt.) said during a July hearing on the state of forensic science.

“In the past several years, we have seen a continuing stream of exonerations of people convicted of serious crimes because of … flawed forensic evidence,” Leahy said.

The new report (PDF) from the Scientific Working Group for Medicolegal Death Investigation (SWGMDI) echoed that concern. Here are highlights from the study as well as several of the group’s recommendations:

Not enough examiners

There are an estimated 500 full-time forensic pathologists conducting death investigations in the U.S. — half as many as experts believe are necessary to provide adequate coverage to the country. In fact, since 1959, the nation has produced a total of 1,400 board-certified forensic pathologists. By comparison, more than 10,000 medical residents train in internal medicine and family practice each year.

Few paths to training

While there are more than 130 medical schools in 45 states and the District of Columbia, there are just 37 accredited forensic pathology training programs across 27 states and Puerto Rico.

Examiner burnout

Only two-thirds of forensic pathology fellowship graduates practice full time, while roughly a fifth end up not practicing at all. “Continued exposure to violence, challenging cases with media exposure and confrontation in court, relatively low pay, and recent government cutbacks” were all cited as factors.

Autopsy “deserts”

Many rural areas lack either a high enough mortality rate or a large enough tax base to justify bringing on a forensic pathologist. In some parts of the nation, the report notes, “if forensic pathologists are available, there is only enough work for a part-time effort and the forensic pathologist must travel or serve multiple areas to make a living.”

Fewer hospital autopsies

The authors note that “many hospitals have basically abandoned the use of … autopsies” to gauge the quality of their medical care, a trend that worsened since 19971, after the Joint Commission on Accreditation of Healthcare Organizations dropped a requirement that hospitals maintain a minimum autopsy rate of 20 percent. Another factor: “Virtually non-existant” funding.

Recommendations

The report’s authors recommend medical schools raise the profile of forensic pathology and death investigation, while offering financial incentives, such as loan forgiveness programs, to attract more students. They also call for salaries, which typically range between $100,000 and $200,000, to be made more competitive with other fields of medicine.

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