ME's office has 800-case backlog, some older than a year
BY ZIVA BRANSTETTER World Enterprise Editor & CASEY SMITH World Staff Writer
Sunday, August 05, 2012
8/05/12 at 7:56 AM
Read the 2010 annual report of Oklahoma’s Office of Chief Medical Examiner.
View a list of cases that were listed as pending and in which a death certificate had not been finalized with the state Medical Examiner’s Office as of July 26.
More than 800 death investigations are pending with the state Medical Examiner's Office, some more than a year old, hampering police investigations and depriving survivors of life insurance payments and other benefits, a Tulsa World investigation has found.
The agency is working to eliminate the backlog of cases in which a death certificate has not been finalized, said Chief Medical Examiner Eric Pfeifer. The agency just hired a new pathologist for its Oklahoma City office and has several candidates interested in working as pathologists in Tulsa, Pfeifer said.
Kathy O'Connell is among those affected by the backlog at the agency.
Her husband, a decorated Vietnam War veteran with three tours of duty as a combat medic, died three months ago. His death left O'Connell, 58, of Sand Springs, with no income because she is disabled and cannot work.
The couple, married 33 years, depended on her husband's veterans benefits, which stopped when he died from a stroke April 26. Since then, she said she has been living on their dwindling savings.
The medical examiner's office had to sign off on the death certificate because Larry O'Connell was cremated and all cremations require a certificate. Without a completed death certificate, O'Connell could not collect on her husband's life insurance policy.
The medical examiner's office receives about 18,000 referrals each year and of those, less than one-third involve a full autopsy or an external analysis of the body. In the remaining cases, the agency either has no jurisdiction or pathologists review medical records in cases where the body will be cremated, sent out of state or will not be available for autopsy.
Kathy O'Connell said she unsuccessfully sought help from the office of U.S. Sen. Jim Inhofe, R-Okla., and the funeral home that handled her husband's services. She said she was unaware she needed to call the medical examiner's office.
O'Connell said the red tape involved with getting her husband's death certificate finalized is "ludicrous."
"It's appalling, to just leave people hanging and not even give two bits about whether anybody can survive," O'Connell said.
Pfeifer said he is well aware of the difficulties a manpower shortage at the agency has caused the public and agencies that depend on the death investigations. While national standards call for a case-load of several hundred cases per pathologist, the seven pathologists at the state medical examiner's office handle more than twice that amount.
"It's a simple ratio: workload vs. qualified people to do the job," Pfeifer said. "This isn't television-show fantasy. Every single case takes an amount of time. Multiply that by approximately 18,000 referrals per year and divide by a few pathologists."
Outdated equipment only adds to the delay, though an appropriation by the Legislature this year should alleviate some of those issues, he said.
"The delay adversely compromises everyone: families, law enforcement, judiciary, insurance companies. There are other agencies that need our reports, like the FAA, fire departments, the child death review board. ... We are not just a repository of the deceased; we are actually providing information that helps all these people."
Many types of benefits, such as Social Security survivors benefits and life insurance, require a completed death certificate before funds are paid to survivors.
After checking into O'Connell's case, Pfeifer said records show Larry O'Connell's cremation permit was signed a few days after his death. However, the updated information was not entered into the "ROVER" computer system. The medical examiner's office, state Health Department and funeral homes share that system to enter information for death certificates.
Larry O'Connell's death certificate remained listed as pending until the World inquired about the case last week. Pfeifer said O'Connell's death certificate would be certified by Friday.
"I'm sorry the family has had to wait so long. Adopting the ROVER process is a very recent thing for the Tulsa office. A bright and highly efficient person has been recently placed in Tulsa to bring those records up to speed," Pfeifer said.
The same reason caused a lengthy delay in the oldest pending case in the Tulsa office, involving the death of Ula Bob Parsons. Records show the 25-year-old Idabel man died July 3, 2011, following an accident at his home.
Parsons' body was viewed by a pathologist the day after his death and toxicology tests on his blood were returned nine days later, records show. However, the report on his death wasn't complete until May 10, 2012, and his death certificate was listed as pending when the World requested a list of pending cases in late July.
"We recently discovered there has never been in this agency a consistent protocol for the finalization of cases in the computer, so cases where the autopsy is complete (as in Mr. Parsons' case) may not appear finalized in the database. We are fixing that," Pfeifer said in an email.
Pfeifer noted that the delay does not impact the family's ability to bury their loved one.
"The delay is inherent in the analysis and paperwork of a massive caseload only - bodies are released within a day or two of receipt in the vast majority of cases ... and do not linger in our facility."
Among the 800 pending cases, on average, about three months have passed since the date of death for each deceased, a Tulsa World analysis shows. Most of the pending cases are in Tulsa and Oklahoma City.
The oldest pending case involves an unidentified male who died Feb. 9, 2011. Pfeifer said investigations in such cases cannot be completed until identities are established.
A case pending 433 days involves a 30-year-old Texas man, Dax Buck Anthony Manor, fatally shot by police in Moore, Okla.
It is unclear why the case remains pending because a pathologist viewed his body and toxicity test results on his blood were done within the week after his death, May 20, 2011, records show.
For the approximately 450 cases pending in the Tulsa office, an average of almost 103 days passed between recorded dates of death and July 26, the day the World analyzed the data. That average lags more than two weeks behind the 300 cases pending in the Oklahoma City office.
On average, a shorter amount of time - just over two months - had passed since the date of death for pending cases in which a medical examiner only needed to perform an external exam, as opposed to a full autopsy.
For the nearly 210 pending cases in Tulsa requiring an external exam, an average of 69 days passed between the date of death and July 26. An average of almost 52 days passed for the pending external examination cases in Oklahoma City.
Autopsy cases, which involve an internal exam, can take five to 10 times longer to process than cases requiring only external exams, Pfeifer said.
As of July 26, approximately 500 autopsy cases were pending statewide and an average of nearly 115 days had passed since recorded dates of death.
The difference between the delay in cases assigned to the Tulsa and Oklahoma City offices grows when considering pending autopsy cases only.
An average of almost 131 days passed between dates of death and July 26 for the almost 250 pending autopsy cases in Tulsa. The average is just over a month longer than in Oklahoma City, where an average of almost 99 days passed for the 254 pending autopsy cases.
Pfeifer said he just hired an experienced forensic pathologist from another state to work in the Oklahoma City office, bringing the total pathologists there to six. There is one pathologist in the Tulsa office and two vacant positions.
"And, we have three promising outside candidates interviewing soon for the Tulsa positions," Pfeifer said.
More than a year into the job, Pfeifer said reforming the troubled agency "has been way, way, way more difficult than I thought and we're not done here. The operational problems were deep-seated ones."
He said he is proud of several achievements: establishing an open dialogue with lawmakers, organizing the Tulsa and Oklahoma City offices into a cohesive unit, "leading a group of really good people toward a culture dedicated to the mission of the agency and finding a little time to myself to practice forensic medicine."
Medical Examiner's Office cases
The Office of the Chief Medical Examiner receives about 18,000 cases per year, and less than one-third of those are cases in which a pathologist performs an external review of the body or a full autopsy. In the vast majority of cases, the agency is either signing a permit to cremate a body or determining whether it has jurisdiction to get involved.
According to state law, the agency has jurisdiction in the following cases:
1. Violent deaths, including apparent homicides, suicides or accidents. This category includes deaths from any type of burn, as well as "deaths due to criminal abortions, whether self-induced or not."
2. Deaths caused by "suspicious, unusual or unnatural means."
3. Deaths related to disease that could pose a threat to public health.
4. Deaths unattended by a licensed medical or osteopathic physician for fatal or potentially fatal illness.
5. Deaths of persons after unexplained coma.
6. Deaths that are medically unexpected and that occur during a therapeutic procedure.
7. Deaths of any inmate occurring in any place of penal incarceration.
8. Deaths of persons whose bodies are to be cremated, buried at sea, transported out of state or otherwise made ultimately unavailable for pathological study.
Source: Office of the Chief Medical Examiner
By the numbers
Here are selected numbers from the Oklahoma Office of the Chief Medical Examiner's 2010 annual report (the most recent available):
35,697: Number of all deaths reported in the state of Oklahoma in 2010.
20,052: Reported to the medical examiner by medical and law enforcement personnel.
16,293: Cases in which the agency assumed jurisdiction of the reported death.
13,678: Cases investigated because the body was going to be cremated, shipped out of state or ultimately made unavailable for pathological study.
5,255: Total cases selected for a complete investigation and examination.
1,645: Cases selected for autopsy. Autopsies were not performed in deaths "where scene investigation, circumstances, medical history, and external examination of the body provided sufficient information for death certification."
Source: 2010 annual report of the Office of Chief Medical Examiner
Original Print Headline: State ME's office has 800-case backlog
Ziva Branstetter 918-581-8306 Casey Smith 918-732-8106
Kathy O'Connell's husband, Larry O'Connell, was a decorated Vietnam War veteran who died April 26. Kathy O'Connell has been living on her shrinking savings while she waits for the medical examiner's office to complete a report that she needs so she can claim life insurance benefits. MIKE SIMONS / Tulsa World
Vietnam War veteran and Sand Springs resident Larry O'Connell is shown in a family photo. His widow, Kathy O'Connell, waited more than three months for a death certificate to be certified and had no income due to the delay. COURTESY