NJ’s Medical Examiner System Needs More Resources, Oversight

Is the ME a patchwork of protocols and disconnects straining to cope with the rising number of drug-related deaths in New Jersey?

Dr. Andrew Falzon, the current state medical examiner, and Dr. Carolyn Revercomb, appearing before the Senate health committee.
New Jersey’s medical examiner system has struggled for decades without effective oversight, coordination, staff, or funding, leaving mourning families without answers — or waiting longer to get them — and contributing to a growing backlog of bodies under the current opioid epidemic.

That was the picture painted Monday by experts familiar with the state’s capacity to investigate suspicious deaths during a Senate health committee hearing in Trenton, scheduled by the chairman, Sen. Joseph Vitale (D-Middlesex), in response to an investigation published by NJ.com. The report suggested New Jersey’s system was a national disgrace, in part because it investigated far fewer deaths and took longer in doing so than is the norm in many other states.

“You have families who wait and wait for their loved ones to be autopsied. It’s brutal,” noted Sen. Richard Codey (D-Essex), who runs his family’s funeral business. “You see the bodies stack up in the hallways.”

Dr. Andrew Falzon, the current state Medical Examiner, said the NJ.com story was essentially factually correct, although privacy laws prevented state officials from responding in detail to some of the allegations. But he said the reporting doesn’t fully account for the challenges facing those who do this work, including low salaries, limited staff, and outdated, even unheated, facilities.

Calling the system “dysfunctional or incompetent…is an injustice to the people who work hard to provide the best services they can to the public,” Falzon said. In 2017, the system reviewed some 21,000 deaths and conducted nearly 5,000 autopsies, he said, noting these numbers continue to rise with the increase in drug-related deaths. (More than 2,100 residents died of addictions in 2017.)

Upgrades in order

Falzon, who has worked for the system since 2001, noted that some of the professionals on staff earn as little as $35,000 a year and the facilities are in bad need of upgrades. The boiler in the Newark office broke earlier this month, he said, and he recalled in years past that he often had to warm his hands under hot water to keep them flexible enough to do his job.

“This is a crucial public service,” Falzon said, “and definitely not as glamorous as it is portrayed on TV.”

Under New Jersey’s system, suspicious fatalities are investigated by one of 10 regional offices. The state medical examiner directly controls two offices, a northern office —where Falzon is based — and southern facility; county governments or independent contractors run the others.

All operations fall under the jurisdiction of the state’s attorney general’s office, but they aren’t required to meet a unified set of standards, and the medical examiner has limited control over facilities not run by the state. Funding is provided by multiple budget lines and totals about $26 million annually, according to NJ.com.

“It’s a fragmented system,” added George Kelder, CEO of the New Jersey State Funeral Directors Association, which has complained about the system for at least 15 years, “generally characterized by an absence of clear lines of authority.”

Fragmentary and underfunded

The Garden State was among the first in the nation to replace the use of coroners with trained medical professionals to examine suspicious deaths, starting in Essex County in 1925, according to Victor Weedn, a national expert who served as New Jersey’s Medical Examiner from 2007 to 2009 before he resigned in frustration. But the system that has developed since is fragmented and underfunded, he said, resulting in low staff morale and performance.

“I believe the state has mismanaged and poorly resourced that office,” explained Weedn, a forensic pathologist who teaches at George Washington University and helped create the nation’s accreditation process for medical examiners. “Throughout my professional career, New Jersey has had a poor reputation within the medical examiner community in the nation,” he added.

Weedn said the lack of a “true state system” — with a centralized command and unified protocols — is a primary concern, something that has been raised repeatedly since the last coroner was replaced in 1967. While the state added some employees to the system recently, staffing levels remain where they were in the 1970s, he said.

Another concern is the potential conflict of interest caused by having the medical examiner system report to the attorney general, the state’s top law enforcement office, Weedn and Falzon noted. Given their role investigating homicides and other deaths, it is important that medical examiners remain independent of police and prosecutors, they said.

Legislation sponsored by Vitale — and based on previous efforts to reform the state’s system, which he said failed to gain traction under former Gov. Chris Christie — would address several of these concerns. Assemblywoman Valerie Vainieri Huttle (D-Bergen) is expected to champion a companion bill in that house.

The latest Vitale bill (S-976), introduced last week, calls for shifting oversight of the system to the state Department of Health, requiring the state to appoint a network of trained medical professionals to carry out these investigations, and properly staff the work. It also spells out when an autopsy is necessary and calls for the offices involved to meet national accreditation standards.

John Donnadio, executive director of the New Jersey Association of Counties, said he was supportive of improving protocols around death investigations. But he urged caution in the reform process, noting that whatever lawmakers prescribe, the cost could end up falling to already cash-strapped county governments to implement.

Even with greater resources and more staff, the system must do more to embrace quality assurance, explained Dr. Carolyn Revercomb, who leads the medical examiner work in the state’s southern office, and previously oversaw several statewide systems. While that process has begun in her office, Rivercomb said more needs to be done to encourage a “quality improvement culture” statewide.