New York City is losing medical examiners faster than it can replace them, and those who remain say they have to make difficult decisions about which bodies will get autopsied.
The city’s medical examiners described the situation as a “crisis” in a letter to Mayor Eric Adams Thursday. The doctors, who are in the midst of negotiations over a new contract, said better pay and benefits are needed to recruit and retain staff to the medical examiner’s office amid national staffing shortages.
In 2021, the city employed 32 full-time medical examiners, according to the letter, signed by the full staff of unionized physicians in the office. But now there are just 20 full-time examiners to investigate violent or suspicious deaths and testify in homicide cases — and additional staff are expected to leave in the coming months, the letter says.
Multiple medical examiners also told Gothamist that because of the tight staffing, they’re no longer performing autopsies for certain suspected overdose deaths, which could lead to less accurate assessments of how some New Yorkers died. The letter warns that to cope with the staffing shortage, the city could have to further cut the number of autopsies it performs every year, and consolidate some operations in ways that would have a “dramatic impact on families of the deceased, funeral homes, and religious communities” as well as police investigations.
Forensic experts say there is debate within the medical community about whether an autopsy is needed in every apparent overdose case, and that changes to practices aren’t uncommon when staff is short. But the changes come at a time when fentanyl dealers can face lengthy prison sentences if their customers die of overdoses, creating higher stakes for getting the cause of death right, noted Dr. Susan Ely, a former senior medical examiner for the city.
The city has “populated its [medical examiner’s] office with very well-trained, highly competent and dedicated professionals who are killing themselves to keep the ship afloat,” said Ely, who retired last summer. “And they have, but at some point the veneer cracks.”
Both the mayor’s office and medical examiner’s office declined to comment on ongoing contract negotiations. The medical examiner’s office also did not respond to questions about how many vacancies it has.
Ely said she retired earlier than planned because of how many of her colleagues were leaving, the growing workload, and “the significant, worsening and sustained pay shortfall.” In their letter, the medical examiners say they are concerned about their capacity to do their work and train new doctors coming in.
As staff have left in recent years, a growing number of opioid deaths has contributed to a larger number of cases for medical examiners to investigate, according to the latest Mayor’s Management Report.
Amid the growing caseload and declining staff, the median time it took to complete an autopsy report increased from 110 days in the first four months of fiscal year 2023 to 133 days in the same period of fiscal year 2024. Both those figures missed the city’s target of 90 days, the report found. However, the medical examiners still generally perform autopsy procedures and release bodies back to funeral homes within about 10 hours.
Julie Bolcer, a spokesperson for the Office of the Chief Medical Examiner said that, combined with ongoing recruitment efforts, the office, “remains flexible to adapt to [staffing] challenges while upholding quality and accuracy in the forensic science services we provide to families and communities during times of profound need.”
Fewer examiners, fewer autopsies
When medical examiners investigate how someone died, they generally have the same discretion as other types of doctors to decide whether a given test or procedure is needed — including an autopsy.
But until recently, city medical examiners generally followed the National Association of Medical Examiners’ recommendation that everyone who dies of a suspected overdose should be autopsied, in addition to being tested to find out what substances are in their systems, in order to rule out any other potential cause of death, according to multiple medical examiners who spoke to Gothamist. They asked not to be identified because they were not authorized to speak to the media.
Two employees said that in late June, the office issued an email with new guidance saying medical examiners should no longer perform autopsies in some cases where there had been an apparent drug overdose. They said the email came from Dr. Michele Slone, the first deputy chief medical examiner, though they declined to provide the email directly to Gothamist.
They said the new guidance is to forgo autopsies on people over 55 who have medical histories that could potentially explain their deaths if their toxicology reports come back negative. They said they were told that other categories of deaths could be affected in the future.
Bolcer acknowledged the employees were sent new guidance, but described it as temporary, and said medical examiners can still use their discretion to determine when an autopsy is necessary. She did not say how long the guidance would remain in place, or confirm the specific details.
It’s not uncommon for medical examiner offices across the country to forgo autopsies because of similar staffing shortages, according to Dr. Gregory Davis, the chief coroner and medical examiner for Jefferson County in Alabama, who was one of the experts consulted on the National Association of Medical Examiners’ recommendations. In most cases, suspected overdose deaths “are, in fact, what they appear to be,” but not always, Davis said.
“When places have to cut back [on autopsies], then one of the effects is that there will be a little bit less specific information about why people died, or perhaps even erroneous information,” Davis said.
Worries over delaying funerals
Despite the staffing challenges, four funeral directors who spoke to Gothamist said they haven’t been feeling the effects of the medical examiner shortage so far, and are happy with the way the office operates and the turnaround time for bodies that are getting autopsied.
“The current relationship between the [medical examiner] office and the funeral directors has probably never been better in the 30 years I’ve been doing this,” said Patrick Kearns, director of the Leo F. Kearns Funeral Home in Queens and the secretary and treasurer of the Metropolitan Funeral Directors Association.
But the medical examiners who spoke to Gothamist said there are also changes being discussed that could potentially delay funerals.
The medical examiners said they attended a meeting in May where Chief Medical Examiner Dr. Jason Graham told them the agency might address the staffing shortage by concentrating autopsies at fewer locations across the city. The move would be intended to distribute the workload more evenly, since there are currently days when some of the city’s three medical examiner’s offices are busier than others, the doctors said.
But funeral directors, including Kearns, said they worried that such a move could increase the time it takes them to travel to pick up a body for a funeral — especially if it meant traveling into Manhattan. Currently, autopsies are conducted at the medical examiner’s offices in Manhattan, Brooklyn and Queens.
Bolcer said there’s currently no plan to reorganize the office’s autopsy operations.
The letter from medical examiners to Adams says the city took steps to address staffing issues in the medical examiner’s office 2018 with an agreement that increased salaries across the board and offered longevity bonuses that incentivized people to stay longer. But that agreement was not renewed after it expired in 2021 and retention bonuses were not extended, leading more people to leave, according to the medical examiners.
Current base salaries for city medical examiners range from $156,088 to $238,942, according to the Doctors Council, the union that represents medical examiners. The union says salaries lag behind those of some other cities, especially when taking the cost of living in New York into account.
Now, the union is working to get medical examiners better benefits and higher pay through contract negotiations with the city’s Office of Labor Relations, and argues that’s the best way to address the staffing shortage.