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New Jersey to Overhaul Beleaguered Medical Examiner System

A decade in the making, legislative reform may finally be coming to the state’s inefficient, fragmented ME’s office

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New Jersey is soon likely to launch a reform of its long-criticized process for investigating suspicious deaths — modernizing and standardizing protocols, increasing independence from law enforcement, and providing more funding for staff, equipment, and facilities.

The state Senate is poised today to adopt minor changes Gov. Phil Murphy made to bipartisan legislation outlining the overhaul; the Assembly will also have to approve these tweaks for the measure to become law. The bill — which debuted nearly a decade ago — passed both houses with unanimous support earlier this year.

“I commend the sponsors of this legislation for responding to the critical need for comprehensive reforms to the State’s medical examiner system,” Murphy wrote when he conditionally vetoed the bill last week, sending it back to the Legislature for minor technical changes. “These reforms will ensure that medicolegal death investigations are conducted effectively and consistently throughout the State.”

Clear support from governor

Murphy has made his support for an overhaul clear, calling for “wholesale reform” of the system in December, before he took office, in response to an NJ.com investigation. The Democratic governor also added $500,000 to his proposed budget to boost funding for the medical examiner program, conceding at the time it was “only a start.”

New Jersey’s current medical examiner system has been criticized by outside experts, family members, and current and former leaders who testified in January, describing a program that lacked oversight and coordination and struggled without adequate staff and facilities. The result, they said, was a backlog of bodies awaiting autopsy, and frustration and pain for the families awaiting answers.

In 2017, the system — a patchwork of 10 county and regional offices operating under different protocols, often without real state oversight — reviewed some 21,000 deaths and conducted nearly 5,000 autopsies. The caseload is continuing to rise, thanks to the opioid epidemic’s growing death toll, which shows no sign of slackening. State figures show more than 2,200 residents died of drug-related causes in 2016, the last year for which there is good data, and more than 1,200 have overdosed so far this year.

Better data gathering

Improving data collection has been a priority for Murphy and his department leaders, including Attorney General Gurbir S. Grewal, whose office is charged with tracking the impact of the opioid epidemic. Ensuring medical examinations are conducted in a standardized manner helps the state accurately assess the impact of this disease.

Health Commissioner Dr. Shereef Elnahal is also depending on better data to help reduce the racial gap in maternal and infant health; black mothers and babies die at more than three times the rate of whites. But accurately tracking those deaths is complicated, especially for maternal mortality, which includes fatalities up to a year after the birth of a child — incidents that are frequently misclassified in investigations.

To improve the process, the legislation — sponsored by Sen. Joseph Vitale (D-Middlesex), chair of the health committee, Sen. Christopher “Kip” Bateman (R-Somerset), and Assemblywoman Valerie Vainieri Huttle (D-Bergen), among others — spells out exactly when an autopsy would be required. These situations include suicides, drug overdoses, fatalities related to work and deaths in jail or within 24 hours of being admitted to a hospital. The death of a minor would also require an autopsy.

Under current law, lead investigators at each office can decide when an autopsy — or full dissection, with lab tests and other analysis — is needed. A standard death investigation, in contrast, involves tracking down the cause through interviews, records reviews, and external assessment of the body.

Under construction

The measure would essentially eliminate the current system and rebuild it under the guidance of a chief medical examiner with statewide authority over protocols, training, staffing, and resources at all county and regional offices. Counties could create their own medical examiner’s office or join with others to do so, but all offices would adopt nationally recognized standards and report to the chief examiner, who would be appointed by the governor to a five-year term. It also calls for the creation of a lab that would be required to process all samples related to death investigations statewide.

"These reforms are long overdue and are desperately needed for a system that is fragmented, mismanaged, under-resourced, and overworked," Vitale said when the measure passed the Senate in April. "For too long, the medical examiner's office hands have been tied making it an ineffective manager of a fragmented system with no central oversight, inadequate staffing, meager funding, bad standards, and poor quality control."

One of the most important changes, supporters said, is that the law would shift the medical examiner system from the office of the attorney general, the state’s top law enforcement official, to the Department of Health, which is better equipped to oversee it. That also reduces the chance for a conflict of interest; under the current system, a regional examiner may feel influenced by the police or prosecutors to produce certain results.

The legislation requires the chief examiner to compile annual reports on the system’s performance, which would be made public, and calls for the state to create a lab to test all samples from investigations at regional offices. In his CV, Murphy added language to ensure county prosecutors and the state attorney general’s office could also have access to these toxicology reports.

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