More people in Erie County are dying outside of hospitals and nursing homes. Instead, they are dying at home or at job sites, in rivers, fields, cars, restaurants and jails. And that has overwhelmed the doctors responsible for determining their causes of death.
The backlog at the Medical Examiner's Office has grown so big – more than 300 cases were open at one point – that the county has brought in specialists from New York City and elsewhere to do exam and autopsy work. The office has farmed out more than a fourth of all cases this year to non-staff pathologists.
The opioid epidemic has contributed to the growing body count. But suicides, homicides, other drug-related deaths and natural deaths from those not under a doctor's care have added stress to a department currently staffed by only two pathologists. A third pathologist left mid-year.
Medical Examiner's Office pathologists examined and dissected 677 corpses six years ago to determine how each person died. So far this year, the office has handled twice as many cases.
So the office wants money to hire more people to conduct exams and complete paperwork.
"We're constantly short-staffed," said Janinne Blank, director of the Medical Examiner's Office.
The county has budgeted $468,000 this year to cover the cost of outside professional services – $200,000 more than was spent last year.
"You can't do that long term," Blank said.
To bring down that cost, the Medical Examiner's Office wants to add two more positions – an examiner and an autopsy technician – at a cost of $159,000 excluding benefits.
The office also wants to hire an anthropologist to assist with cases involving unidentified remains and those involving skeletal trauma and abuse. The anthropologist already works for the county as a consultant. The office's request also includes a pay raise for the chief medical examiner.
The Medical Examiner's Office has previously added staff since the office began seeing more cases during the opioid epidemic.
The office successfully lobbied for more positions two years ago to assist in its Toxicology Lab. A few months ago, the county also earmarked money from its reserves to hire more lab personnel – who identify things like narcotic drugs in the bloodstream – and an investigator and autopsy technician.
The Toxicology Lab hires have helped reduce the county's turnaround time for toxicology reports, which are often critical to prosecuting criminal cases. Two years ago, barely a third of toxicology cases were completed within 60 days. Now, twice as many cases are.
But the turnaround time for completed autopsies, including death scene investigations and other paperwork, has grown. In 2015, it took an average of 74 days to complete an autopsy report. The average time to complete an autopsy this year is 85 days.
While examining each body is still done quickly, it's the paperwork and other analyses that take so long to finish.
Erie County Health Commissioner Gale Burstein said the caseloads for its examiners must come down for there to be any hope the Medical Examiner's Office can gain accreditation from the National Association of Medical Examiners.
Each medical examiner should ideally handle no more 250 cases to gain accreditation. That would require the office to employ at least four medical examiners. Now, the office's budget has money for three, and currently only two are employed.
The two each handle about 300 cases, so they work a lot of overtime, said Chief Medical Examiner Tara Mahar. Couple that with the fact that the county pays less than market rate for forensic pathologists and you wind up with high turnover in the job, she said.
The county's associate medical examiners each earn $121,415. National salary data suggest private sector pathologists earn far more.
"We want to retain the doctors we have," she said. "We have to. And there's the issue of burnout."
The Erie County Legislature will consider hiring more pathologists as it considers County Executive Mark C. Poloncarz's proposed $1.48 billion budget for next year. A vote is expected Thursday.