Bodies Pile Up as Detroit Morgue Outsources to Reduce Costs

Deal Would Hand Detroit Autopsies to University
Bodies lie on gurneys in the autopsy room at the Wayne County Medical Examiner's office in Detroit, on Sept. 7, 2011. Photographer: Jeff Kowalsky/Bloomberg

The bodies line up in the morning at Wayne County’s Detroit morgue, each bagged on a cold steel gurney awaiting an autopsy by one of five pathologists, three fewer than the county could afford a year ago.

It’s not dissecting 2,400 corpses a year that causes strain, said Chief Medical Examiner Carl Schmidt.

“The paperwork is astounding,” he said, shaking his head. The morgue’s workload disqualifies it from national accreditation, Schmidt said, although “we are very good at what we do.”

As local governments struggle to fund services -- half of 500 U.S. counties in a February survey reported fewer employees than in 2010 -- Wayne County is turning to academia to deal with the dead. In a contract approved today by the county commission, Wayne, which has faced budget gaps for the past three years, will pay the University of Michigan to do autopsies, saving $1.5 million over three years.

It is the busiest morgue operation to transplant its primary function to a university medical school, Schmidt said. Autopsies will still take place at Wayne County’s 50,000-square-foot morgue on Detroit’s east side, though the pathologists will work for the school.

“The old ways aren’t going to work anymore,” said Wayne County Executive Robert Ficano. “The bottom line is, over three years we save $1.5 million, and at the same time we have a prestigious medical institution that’s become a partner and allows us to be more efficient and effective.”

Work Piling Up

The morgue budget has been cut to $6.2 million from $8.1 million in 2007, and its staff reduced to 31 from 52, said Dennis Niemiec, a spokesman for the state’s largest county. The deal will bring it down to $5.7 million, he said.

The morgue drew national attention in 2009 and 2010 when it stacked unclaimed bodies -- at one point more than 100 -- in a refrigerator and temporary trailer. The backlog was caused by red tape and relatives who couldn’t afford to bury or cremate loved ones, Schmidt said.

No longer do staff photographers document the faces and damaged bodies that flow through. Required photos are taken by technicians or a dwindling number of investigators who do double duty in the naturally lit examination area.

“People say they’re surprised how light it is in here,” said chief investigator Albert Samuels. Of the musty odor: “You get used to it.”

Looking for Respect

Under the contract with the Ann Arbor university, morgue pathologists will become medical-school faculty. The county will pay the school $7.5 million over three years for services, said Niemiec. The morgue will escape paying pathologists’ salaries and benefits, and five other positions will be eliminated, according to a news release. The school will have access to a facility to teach forensic pathology.

The University of Michigan will boost pay to $160,000 a year for the forensic pathologists, whose salaries now top out at $120,000, Schmidt said. He said the university doesn’t offer benefits as generous as does the county, which has a 401(k) plan with a 5-to-1 match in contributions.

Schmidt, 54, said he hopes the new arrangement gains the morgue accreditation by the National Association of Medical Examiners. The organization recommends no more than 250 autopsies per year for morgue pathologists, and 325 maximum. Without the university, Wayne County’s pathologists each would face almost 500 autopsies a year, twice the recommended limit.

The switch will occur Oct. 1, Niemiec said.

Corpses to Colleges

Wayne County’s morgue is not the first to link with higher education. The University of New Mexico has run its state’s medical examiner’s office since 1978 and performs about 2,000 autopsies a year with nine forensic pathologists, said Operations Director Amy Boule.

The University of North Carolina is home to the state chief medical examiner’s office, where state-paid pathologists teach and perform about 1,500 autopsies a year, about one-third of the state’s total, said Patricia Barnes, administrator for the office. Others are done at facilities around the state, including two affiliated with two other medical schools.

The relationship between the medical examiner’s office and the school provides resources for investigations, and also offers fellowships for students who want to pursue forensic pathology, she said.

“There are few resources for training in pathology, and the medical examiner’s office provides that training,” Barnes said.

Burnout and Mistakes

Besides saving Wayne County money, the University of Michigan affiliation may attract people to a field that needs them, Schmidt said. Last year, about 40 U.S. medical students became forensic pathologists.

“We need two or three times that many,” said Mary Ann Sens, 62, chairman of pathology at the University of North Dakota in Grand Forks and medical examiner for Grand Forks County. She is president of the national association.

The U.S. has about 500 certified forensic pathologists and needs at least 1,000 more, according to a 2009 report by the National Academy of Sciences.

Meanwhile, morgues are absorbing budget cuts.

Iowa Chief Medical Examiner Julia Goodin, 54, said her office lost four positions, including one of five forensic pathologists. Her state appropriation was cut to $852,000 from $1.1 million this year for a facility that conducts more than 700 autopsies a year, she said.

“Everybody is feeling the pain,” said Goodin. “We’re concerned about burnout, concerned about making mistakes and keeping the facility open.”

Death and Revenue

In Florida, the Miami-Dade Medical Examiner department cut 18 positions, or 25 percent of its staff, in the past four years, according to a document provided by the department. The office’s general fund budget has fallen 8.4 percent since 2009.

The toxicology laboratory has gone from closing 90 percent of its cases within 90 days in 2009 to closing 60 percent, said Larry Cameron, director of operations.

The Los Angeles County coroner’s $23 million budget was cut 10 percent this year without hurting services, Ed Winter, assistant chief of operations, said in a telephone interview.

Death Never Rests

Wayne County’s morgue is a busy operation. The Detroit-Livonia-Dearborn metropolitan area ranks No. 2 in the nation for murder and negligent manslaughter, at 18.2 deaths per 100,000 residents, according to the FBI’s 2010 Uniform Crime Report. It trails only the New Orleans area’s 20.8.

Of the 3,200 bodies taken to the morgue each year, about 2,400 undergo autopsies. Of those, about 400 are homicides, Schmidt said. Last year, the county spent $3.2 million on upgrades, which included adding a refrigerator to expand its capacity to 300 bodies.

Without the university agreement, Wayne County would have to spend more than $800,000 to improve lab equipment, Schmidt said. Instead, the university will take over blood, tissue and toxicology tests.

Schmidt said homicides are among the least-challenging cases. The job, he said, transcends identifying causes of death to solving medical mysteries that help the living.

He’s found advanced coronary disease in gunshot victims in their 30s. He warned relatives to get their cholesterol checked.

With the university, “we will have access to resources,” Schmidt said. “If we find something strange we can ask them, ‘Can you find what this is?’ It might be important to that family.”

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