A surge in fatal drug overdoses coupled with staffing vacancies has created a backlog of hundreds of cases in the San Diego County Medical Examiner’s Office — delaying prosecutions of some homicides and leaving some family members without answers when loved ones die unexpectedly.
County officials, who initially described the unprecedented backlog’s impact on the public as minimal, say they will be hiring an outside laboratory to analyze samples. Last week during a Board of Supervisors meeting, the sister of a man who died told leaders how painful it is to wait months for answers.
The combination of too many cases and not enough staff prompted the county to post a warning on its website that it could take up to six months for causes of death to be determined or cases to be closed.
As of last week, seven jobs in the department remained vacant — including the No. 2 spot in the office — although five were in the process of being filled. Officials say a national pathologist shortage has worsened the problem.
Help may be on the way: Chief Medical Examiner Steven Campman has asked the Board of Supervisors to approve a 10 percent increase in staffing in the coming year, which would add six positions to the 66-person office. In addition, pay raises are being proposed to try to make jobs more attractive to applicants.
The county also is finalizing a contract for an outside lab to analyze “several hundred” of its oldest cases in which presumptive tests indicated the dead person had fentanyl in their system.
County officials would not reveal the cost of the contract, what company it was going to or the scope of work it would include, saying the details are still being worked out. It is unlikely to require Board of Supervisors approval because it is expected to be under a $100,000 threshold, medical examiner spokesperson Chuck Westerheide said. Funding for the outside testing will come from the medical examiner’s budget.
The office does almost all of its testing at its in-house toxicology lab.
Delays are gumming up the court system because prosecutors — and defense attorneys — rely on autopsy reports and toxicology reports to prepare for homicide cases. The county public defender said the delays are creating problems.
“It takes at least six months to get medical examiner reports. Which makes investigating and negotiating homicides almost impossible within that time period,” Public Defender Randy Mize said in a text message.
Mize said court delays caused by COVID-19 and delays in obtaining reports from the medical examiner mean that “our homicide caseload has bloomed above 250, over twice the amount it has historically been.”
A spokesperson for the District Attorney’s Office said the Medical Examiner’s Office had been “working tirelessly” with the increased volume of cases and had been “timely with cases that have a court deadline.”
“In some cases, where the cause of death is complex or at issue, it can take several months to get the medical examiner’s report,” the District Attorney’s Office said in a statement. “Their work is a critical part of homicide cases. Against all odds, they have been timely with cases that have a court deadline. It is important not only for the justice system, but also to the families and loved ones affected, that they are fully supported and staffed.”
Westerheide initially said the backlog wasn’t affecting those waiting for reports because medical examiner staff was sharing presumptive test results with law enforcement, prosecutors, defense attorneys and family members of persons who died. He later acknowledged the delays were slowing criminal cases and could affect prompt payment of some life insurance benefits.
In cases where toxicology tests and autopsy reports aren’t completed, death certificates are issued with the cause of death listed as “pending” — a detail that could cause delays if the insurance policy has a clause denying payment if the insured person dies from suicide within a certain time frame.
Campman declined requests to be interviewed but replied to questions submitted over several weeks.
“Every day, the investigators must respond to the new deaths and the pathologists do their best to handle the bodies as they come in,” he wrote. “We try for examination within 24-48 hours, but depending on the daily caseload and limited numbers of pathologists, we have had bodies wait for five days to be examined.
“With the pathologists having to spend four to six hours in the autopsy room every day examining new cases, there aren’t many hours in the day left to work on existing reports.”
When pathologists have to testify in criminal or civil matters, he said, they also aren’t able to examine bodies — which leaves more for the next day and “less time to complete reports.”
Some cases don’t face long delays. Campman noted that in more than 63 percent of cases, his office provided a cause of death within the first week of receiving the body. Most of the waiting happens with suspected drug overdose cases that require confirmation testing.
The delays come as accidental fentanyl overdose deaths have jumped more than 400 percent over the past two years. In 2019, there were 151 unintentional fentanyl deaths recorded; by the end of 2021, there were more than 800. That number has yet to be finalized because of the backlog.
Those left waiting for answers include Kellie Gray, who learned of her 45-year-old brother’s December death when a Medical Examiner’s Office investigator called her.
He had been installing floors for a glass-blowing shop he planned to manage when a coworker found him collapsed in a bathroom. His sister found out later that paramedics administered doses of naloxone, which can counter the effects of a possible opioid overdose. He was rushed to a hospital in Chula Vista but could not be revived.
Several days after his death, Gray called the investigator to try to find out exactly what killed her brother. She was told to call back in April. She did — and she’s still waiting.
On her own, Gray reached out to the pathologist who conducted her brother’s autopsy and was told he had an enlarged heart, and that a presumptive test indicated fentanyl in his system. Toxicology tests should detail what else was in his system and in what amounts.
Last week, Gray spoke at the county Board of Supervisors meeting during the public comment period to voice her frustration.
“Today, over five months after his death, we still don’t know the cause of his death,” Gray said during Wednesday’s session. “As you can imagine, it is very difficult, if not impossible, to begin the process of closure when we still don’t know how he died. … My brother’s autopsy was completed within 72 hours after his death. His toxicology labs have still not been processed.
“Losing a loved one is hard enough and people do not deserve to have their suffering compounded by the inhumane delays of the Medical Examiner’s Office.”
Gray said her brother had used opioids in the past but had told family members he had stopped using. Days before he died, he’d had a skateboarding accident, and she wonders if maybe he illicitly bought a painkiller that — unknown to him — might have been laced with fentanyl.
Her family has not yet held a service or celebration of life for her brother. She’s waiting to tell some family members about the fentanyl in his system until she gets the answers that only still-pending toxicology tests can provide.
Two days after Gray spoke to the board, she got an email: Final toxicology results in her brother’s case should be available in a week, maybe two. The message made her realize she’s put her grief on hold.
“I am not looking forward to re-heartbreak,” she said, “but I am looking forward to ending the aftershocks that have been present in the waiting place.”