Oregon is facing a medical examiner shortage, and those in the field are advocating for legislation they believe can help address the crisis.
House Bill 4003 A was approved in the House last week, and is under consideration in the Senate. The bill would direct the Oregon State Police Department to study the causes of, and ways to address the state’s medical examiner shortage, and provide results of the study to legislative committees by May 1st, 2025.
Dr. Kimberly Repp, supervisor of the medical examiner’s office and chief epidemiologist for Washington County, discussed the challenges those in her profession face during a Senate Committee on Health Care meeting on Wednesday. She said medical examiners are critical for Oregon’s public health system.
“Medical examiners play a critical role in public health through death investigations,” Repp said. “We would not know about the severity of the fentanyl crisis without medical examiners. Or the disproportionate acts of violence experienced by some of our community members. If you aren’t measuring something, you can’t improve it. And the medical examiner’s office provides the foundational measurement of population health.”
Medical examiners also play a key role in community safety, Repp said.
“Medical examiners are equally as important as law enforcement, district attorneys, and defense attorneys as they play a critical role in providing expert witness on the manner and cause of death,” she said. “This helps the justice system determine who should or should not be charged with a crime. Justice does not and cannot happen without medical examiners. However, Oregon’s medical examiner system continues to struggle. One of the reasons is because of the severe shortage of medical examiners.”
HB 4003 A sponsor Rep. Kim Wallan (R-Medford) is an attorney whose husband used to be an assistant district attorney in Jackson County. She discussed challenges the county faced with medical examiner protocols.
“We were told we were missing about nine to 12 homicides a year because we didn’t have the right kind of protocols in place,” Wallan said. “So they established a homicide team and trained deputies to preserve the crime scene, to be able to make official determinations, and then the medical examiner would come in and do the autopsy and sign off on it.”
The medical examiner there is 78 and covers seven counties, Wallan said. Jackson County has approximately 240,000 people.
“The other counties are significantly smaller, but he has a big area to cover and that’s our system. We have medical examiners who are aging out, (and) we have situations where we don’t have enough medical examiners to keep up with the demand in certain counties. Different counties have different protocols. The state police didn’t have deadlines and particular (examples of) what the medical examiners and counties needed. So this bill gives them a checklist. Things they should analyze (and) consult.”
— Wallan
Repp provided some context explaining the medical examiner shortage, which is not limited to Oregon.
“The level of training and education expected from a medical examiner in the US is four to seven years past medical school,” she said. “This shortage crisis is not unique to Oregon or the US. However, we’ve had a little trouble in Oregon getting ourselves in a position to get out of this crisis. I want the committee to understand the severity of the situation and the help that’s needed.”
Even if Oregon was able to add more medical examiners, there would be much more work to be done in order for the state to function at the level expected by its communities, Repp said.
“State facilities are too small and have been overgrown for years,” she said. “There isn’t enough body storage. And staffing is significantly less than it should be to even handle the current caseload. Due to this lack of staffing, our state medical examiner’s office has had to restrict the criteria for decedents who receive a full autopsy. This puts my death investigators in the unenviable position of explaining to yet another family why their loved one cannot have an autopsy.”
The state police implemented the Medical Examiner Improvement in Oregon workgroup last year to address the crisis, Repp noted.
“And while those recommendations are forthcoming, we want to ensure that those recommendations are supplemented, operationalized, and strengthened by this new workgroup with additional parties, including legislators who are not able to be at the table for that workgroup. Fundamentally, we want to ensure we are ready for a robust advocacy plan for the 2025 long session with legislative champions ready to help guide our package.”
— Repp
Repp provided several recommendations for addressing the state’s medical examiner shortage and improving related protocols.
“While we have waited and hoped for policy, funding, and innovative changes to arrive in Oregon, other states like Washington are already acting,” she said. “State law requires law enforcement in Oregon to be nationally accredited. But the state medical examiner’s office has never been expected to become nationally accredited. We should push for accreditation within a decade, and we should see counties provided with a sustainable funding model to best serve all Oregonians. This bill is an opportunity to change our future.”
Timothy Grisham, deputy director for the Washington Association of County Officials (WACO), provided an update on how Washington was able to improve its medical examiner operations.
“Nearly a decade ago, the Washington Association of Coroners and Medical Examiners (WACME) and WACO identified a disparity of medical death investigation services among our state’s 39 counties,” Grisham said. “To best serve all of Washington’s citizens, no matter their geographic location or size of community, WACO and WACME created a policy platform that addressed three key elements in ensuring a uniform level of training for all practicing medical death investigators.”
The policy required that all autopsies would be conducted at facilities that meet national standards, and that all counties had access to a board-certified forensic pathologist, Grisham said.
“Over the past several years, WACME, WACO, and the legislature worked toward achieving this goal by addressing the funding mechanism for autopsy reimbursement rates and training dollars, (and) by providing a uniform case management system all counties can utilize and access. And by requiring all medical death investigators to be nationally certified, that all autopsies be conducted at nationally-accredited facilities, and that all autopsies be conducted by board-certified forensic pathologists.”
— Grisham
In 1983, Washington created the death investigations account, which is administered by the Forensic Investigations Council, Grisham said.
“This was to fund an investigation system and make related state and local institutions more efficient,” he said. “Yet these moves didn’t address the shortage of board-certified forensic pathologists working within Washington. Like most states, Washington is facing a shortfall of pathologists.”
WACO then worked with Sen. Manka Dhingra (D-Redmond) on Senate Bill 5523 to provide short-term aid and long-term sustainable solutions to bolster the state’s forensic pathologist supply, Grisham said.
“SB 5523 created a tuition reimbursement model for pathologists serving underserved counties in Washington,” he said. “It provided reimbursements to counties for the transportation of bodies to accredited facilities when they had none in their county, allocated marketing dollars for WACME to advertise in the medical community about working in Washington, and created a study on how to address long-term, sustainable solutions for the forensic pathologist shortage.
It is my belief that with the collected minds and efforts of the education, medical, and healthcare communities—as well as the criminal justice community—we may be able to come up with solutions that are professional and transparent for communities.”
Happy to hear that Dr. Repp’s recommendation is being analyzed by the decision makers and some time in the near future, Oregon will be able to offer autopsies to those whose manner and cause of death may require one.