Yakima County weighs options as it copes with medical examiner shortage

YAKIMA – Dr. Jeffrey Reynolds did what he thought was his last autopsy for Yakima County in 2021.

But Reynolds, who was the medical examiner for Yakima since 1989, as well as seven other counties in Washington and Idaho, is back at work performing autopsies on homicide victims and infants.

It wasn’t that Reynolds missed the work.

He returned because he saw he was needed to ensure justice worked in the face of a shortage of forensic pathologists.

“It was taking as long as a dozen days to get an autopsy,” Reynolds said in a phone interview. “It is one thing that I can do. For homicides in Yakima County, it is one thing that I will do.”

Prior to Reynolds’ return, Yakima County was sending bodies for autopsies as far away as Seattle, Spokane and Longview, Washington, as well as bringing in qualified doctors to Yakima to perform autopsies.

Yakima County Coroner Jim Curtice and Prosecuting Attorney Joe Brusic said having Reynolds back on a limited basis is a welcome, but a stopgap, solution for a problem that is plaguing communities not just in Washington but around the country – a shortage of forensic pathologists.

Yakima County is weighing options for a more permanent solution, including going in with other counties to hire a medical examiner.

Under state law, coroners have jurisdiction when someone dies under suspicious circumstances, homicides or in jail or prison. In many of these cases, an autopsy is performed to determine the cause and manner of death.

While elected coroners do not have to have medical training, the medical examiners who perform the autopsies must be certified forensic pathologists, a certification that takes years to achieve.

Becoming a medical examiner

Along with being able to determine how a person died, medical examiners have to know how to document their findings, preserve evidence for use in a trial and testify before a jury as to how they reached their conclusion.

Reynolds said the path to becoming a forensic pathologist starts with graduating medical school as a physician and doing a residency in pathology, the study of disease, which takes about four years. Then, the doctor has to participate in a fellowship that can last from one to two years, after which they can apply to take the test to become board certified.

Nationally, there are 1,000 positions for forensic pathologists, Reynolds said, but there are only 500 working in the field.

Part of the reason for the shortage is the pay, which Reynolds said is improving. More than a decade ago, a certified medical examiner could make $100,000 a year, about half to a third of what a doctor going into surgical pathology would make, he said.

Plus, the job can be stressful, with pathologists being regularly and intimately exposed to traumatic deaths.

The shortage has legal ramifications. Without an autopsy report declaring from a legally certified expert that someone was a homicide victim, prosecutors have a harder time filing charges, let alone going to court.

“It delays our decision-making process,” Brusic said.

While it is possible to file a murder charge while presuming someone’s death was a homicide, Brusic said an autopsy report certifying that manner of death is legally safer.

Time and money

In light of a recent appellate court ruling that threw out a rape conviction in Yakima County because prosecutors did not get lab results back in a timely manner, Brusic said prosecutors have to carefully explain in court anything that delays a case moving forward and what was done to expedite it.

To cope with the lack of a medical examiner, Yakima County initially brought in medical examiners from other parts of the state, usually paying about $1,600 to $1,700 per autopsy.

The county also took bodies to the King County Medical Examiner’s Office for autopsies, starting at a cost of $1,100 per examination, with an additional fee for collecting evidence.

And those do not count the costs of bringing the examiner into court if a case goes to trial.

In comparison, Reynolds’ previous contract with the county was $1,000 per autopsy, and he usually tackled cases within a day or two.

Curtice said going outside the county is putting a strain on his budget, estimating he’s been spending $100,000 a year. While the state reimburses the county for 40% of autopsy costs, he said it’s still a significant expense.

The county averages between 70-80 autopsies a year, Curtice said, including homicides, drug overdoses and other cases where an autopsy is required.

Drug-overdose and nonhomicide cases are still being sent outside Yakima County for autopsies.

There’s also a personnel cost, as Chief Deputy Coroner Marshall Slight or one of the deputy coroners has to drive the body to the medical examiner’s office and then return it to Yakima County when the procedure is done.

Statewide issue

Curtice is not alone in this problem, nor is it new to Washington.

Hayley Thompson, Skagit County Coroner and president of the Washington Association of Coroners and Medical Examiners, said the shortage of forensic pathologists has been going on for a decade, and it has not improved.

She said there are 18 forensic pathologists in the state, with most of them reaching retirement age. The demand for autopsies is increasing as the population ages and drug deaths, suicides and homicides increase.

An individual pathologist is limited to 325 cases a year, which Thompson said contributes to the backlog as the number of medical examiners shrinks.

King and Snohomish counties have taken on autopsies from other counties, but have started to turn away cases because of the workload, she said.

Thirty to 40 people complete certification as medical examiners every year, Thompson said.

But with retirements, Reynolds said that works out to roughly a net increase of 25 per year, which means the shortage won’t be over soon.

Thompson said some of the solutions being discussed are better advertising positions, increasing salaries to competitive levels and offering to pay back student loans for new hires. But she said it can also be a hard sell to get someone to come to work in a rural community compared to one of the major metropolitan areas.

Reynolds’ decision to come out of retirement is welcome, but Brusic said it’s not a permanent solution.

“It’s a stopgap solution, but we’ll take it for now,” Brusic said. “We are the eighth-largest county in the state. We need a medical examiner.”

Finding funding

Yakima County is considering a couple of strategies to deal with the situation.

County commissioners are looking at a way to use part of the three-tenths sales tax to bolster the coroner’s budget. Since it was implemented in 2004, it has provided funding for law and justice services, but the coroner’s office was not included, Commissioner Amanda McKinney said.

She said the county is thinking about asking the entities that receive the tax to give a small portion of their share to the coroner’s office.

Another plan is to partner with neighboring counties, such as Benton and Kittitas, and hire a shared medical examiner, with the counties sharing the costs.

“Part of something is better than all of nothing,” McKinney said.