Coroner’s budget coronary

The Sacramento County Coroner’s Office could lose its national accreditation due to continuing cuts to its budget. A possible budget cut of $700,000 could also cause the county coroner’s office to eliminate critical staff positions—from medical examiners to those that file death certificates.

“We are on track to conduct at least 1,200 [autopsies] for 2010 and 2011 with only two forensic pathologists,” said Sacramento County Coroner Gregory Wyatt. “This is not sustainable.”

That many is about twice the amount recommended by the accrediting body, the National Association of Medical Examiners. The coroner’s office’s increased workload, once handled by a team of three to four pathologists, has also led to concern the doctors will make more mistakes and miss important clues.

According to Dr. David Fowler, chairman of the NAME accreditation committee, a forensic pathologist should handle no more than 250 cases a year.

“This allows for pathologist to have an eight-hour workday to examine the organs, conduct tests, issue toxicology reports, talk to the funeral home and the police, and type up reports for an autopsy,” Fowler told SN&R, while adding 600 cases per pathologist is excessive.

Wyatt agreed, saying, “We are the point now where we can’t really do any fewer autopsies and still meet our legal mandate to determine manner and cause of death.”

Already, local law-enforcement officials and families of the deceased are facing delays of four- to six-months or even longer in determining a cause of death. Such investigations are vital for families settling insurance claims and for prosecutors handling criminal cases.

Fowler added that NAME’s standards are a way to tell the public and the medical community that the coroner’s office is, at minimum, conducting investigations in the proper way.

“The impact of such lengthy delays is serious for families on an emotional basis as well as financially,” Wyatt said, while adding that current budget constraints allow his office to be open to the public only four hours a day. This year his staff has also been reduced by 50 percent.

The resulting delays in autopsy reports can also lead to legal complications and setbacks.

“If the cause of death hasn’t been determined, it makes it harder for prosecutors to resolve cases and may to lead cases being dismissed or reversed,” Cindy Bessemer, a chief deputy district attorney in Sacramento County, explained to SN&R.

To help balance the workload, Sacramento County does contract with a private company for additional forensic pathologists, but Bessemer stressed this is not the best solution.

“It’s not only important to have an adequately staffed coroner’s office, it is also important they are county officials,” she said, noting recent instances where mistakes by private-sector pathologists led to cases being overturned.

In Sacramento County, the coroner’s office has used the private Forensic Medical Group to help with autopsies. However, a February investigation by the nonprofit news organization, California Watch, found several flaws in FMG’s work. According to California Watch, in some cases FMG dissected the wrong body or provided the wrong court testimony. The doctor used by Sacramento County, FMG president Gregory Reiber, was also cited by California Watch for providing contradictory testimony.

Yolo and Sutter counties also use FMG’s services.

Bessemer hopes such contracting becomes the exception, not the rule. “So far we haven’t had a problem where cases get reversed,” she said.

But with possibility of $700,000 budget gap, such standards may not be possible.