N.H. Medical Examiner Seeking More Workers to Handle Heavy Caseload

Dec 5, 2017

The state medical examiner’s office is dealing with a heavy workload amid the opioid crisis and staffing shortages. Its case load has nearly doubled in the last two decades due to population growth and the drug crisis. Former chief medical examiner Dr. Andrew Thomas retired this year, and Dr. Jennie Duval took his place.

Morning Edition Host Rick Ganley spoke with Duval about how the office is coping with these challenges.

(Editor's note: this transcript has been edited lightly for clarity.)

Can you describe for our audience what your job title means? What does the chief medical examiner do?

Well, I’m in charge of the medical examiner’s office. There’s one medical examiner’s office for the state, and we are charged with investigating sudden and unexpected deaths that occur in New Hampshire.

And what are some of the challenges you’ve come across since you’ve taken on the role of examiner?

So it’s all very new in a sense. I have been working here as the deputy chief for 16 years, or almost 16 years. So this is a new position for me in an office that I’ve been working in for some time. But the challenges have been going on for more than the last two months. As you mentioned, we’ve seen a huge increase in the case load here. And so the main challenge is handling that case load with an even shorter staff now that Dr. Andrew [Thomas] has retired.

So there’s been of course a growing trend for population growth in general, but the opioid crisis over the last several years, and now a staffing challenge. I mean, what does that mean for your office day to day?

Well, day to day we’re managing. But we’re managing because we are able to hire contract pathologists to come and spend a few days each month working, taking some of that case load off me. So on average we’ve got a contract doctor working here about 10 days out of every month, which is a break, but it’s not enough. So that’s how we’re managing the case load, but the case load has other effects too. So there’s a lot of increased work for the entire staff here. Fortunately, we’ve also just recently hired another administrative assistant. So once she comes up to speed, I think that will help that end of things quite a bit.

What are the ramifications when your office is overloaded like this?

Well, it means that families, law enforcement, attorneys are going to wait longer for autopsy reports, just because I can’t finalize reports when I’m doing other autopsies. So that’s a big problem right there. It takes longer to finalize reports, which means it takes longer to finalize death certificates, and families need death certificates to settle the affairs of their loved one. And law enforcement needs reports, and attorneys need reports to proceed with whatever criminal charges might be anticipated. So there’s far reaching effects if we can’t generate the reports and get the reports out in a timely fashion.

And how long is the delay now, compared to when you started 15, 16 years ago?

We want the vast majority of our reports to be finalized within 90 days. In fact, that’s a standard that’s been set by the National Association of Medical Examiners. So we need to keep meeting that standard, and I think we’re pushing that at this point.

So right now you’re looking for someone to replace your position at the assistant medical examiner, and you’re also looking for an associate pathologist. That was a position that was approved by the legislature earlier this year. When do you expect those positions to be filled, and will that get you back up to speed you think?

I think it will help tremendously, but getting those positions filled is even more problematic than I anticipated. So it’s not just this office that’s affected by this opioid epidemic, it’s offices in jurisdictions across the country. So everybody is looking for additional staff, and there’s a shortage of forensic pathologists right now. I mean, there has been for some time, but now it’s become critical. So you’ve got a combination of a shortage, this explosion in opioid overdoses, and that combination means every office is short staffed. So we’re all fighting for that same few applicants for these positions.

So how does New Hampshire compete?

Well, fortunately the legislature has increased the salary so we are at least competitive at this point. And that’s about all we can do. I was very hopeful that New Hampshire, and all that it has to offer would attract some applicants, but the applicant pool is very small.