After decades of getting called to death scenes at all hours, former Dodge County Coroner Barry Dibble was happy to hand over his side job to medical examiners at Mayo Clinic.
“I tried to give it up many times and I didn’t have anyone that would take it,” said Dibble, a funeral home owner. “I don’t mind not having to knock on mom and dad’s door and telling someone why their son or daughter is not coming home.”
County coroners, the origins of which date back to medieval England, are slowly disappearing in Minnesota. Counties are eliminating the post in favor of highly trained forensic pathologists at regional medical examiner offices, like the one at Mayo, to determine how someone died. Over the past seven years, the number of counties using a regional hub instead of a county coroner has nearly doubled.
In Hennepin County, which merged its medical examiner functions with Dakota and Scott counties two years ago, officials will talk with the County Board this week about eventually consolidating with more counties and moving their facility away from downtown Minneapolis.
Coroners, medical examiners and sheriffs say the transition to such consolidated offices is for the best. Minnesota counties still have a patchwork of officials who respond to deaths, but five hubs have emerged, serving at least 43 counties.
“When you look around the country, there have been such egregious errors in forensics and so there is this real push to try and improve quality,” said Lindsey Thomas, assistant medical examiner at the Hennepin County office. She said people have come to expect more than “a family practice doctor who’s doing it as a community service and basically operating out of a file cabinet in their garage.”
But the shift means some of the medical examiner offices may need to expand.
Regional offices grow
Body bags, shaped in the unmistakable outlines of their occupants, lie on carts lining the walls of a “cooler” in the Hennepin County medical examiner’s office.
Every couple of weeks, the cooler nears capacity. When there are more than 32 bodies, it starts getting cramped. With the help of funeral homes or the hospital, Medical Examiner Andrew Baker said the space works fine. For now.
The cooler is one of the “pinch points” that has Baker thinking about expansion and the office’s future as a regional site for autopsies. This week, Baker and Hennepin County Administrator David Hough will update the County Board on population growth, present a consultant’s study of capacity at the medical examiner’s office and review future options, Hough said.
If the board wants to expand the operation, it will not be able to do so in the present location, Baker said.
“We don’t really have the option of expanding any further,” he said. “When I say we’re in the shadow of the new stadium, I mean that literally.”
Baker worries about police, attorneys and families navigating gameday traffic.
Dakota County officials recently said they talked with Baker and Hough about potentially partnering with Ramsey and other counties and moving to a larger site near the airport.
It is premature to talk about a specific site, Hough said, and Hennepin County has not had formal conversations with other counties about combining operations.
But, he added, a regional concept makes sense, and if the County Board supports relocation, officials will consider partner counties’ accessibility.
Last June, Wabasha County Medical Examiner Dr. Kent Jeffery told the County Board to get rid of his job. He said the office should consolidate with a regional examiner’s office at Mayo Clinic, which handles autopsies for at least six other counties.
“Not to belittle myself, but I honestly think they do a better job than I do,” Jeffery told the commissioners.
Wabasha County’s switch from Jeffery to Mayo came amid a push by national and state officials for accreditation and higher standards in the field. Minnesota medical examiners persuaded the Legislature to pass a law in 2006 requiring coroners elected or appointed in subsequent years to be physicians who are trained to investigate deaths. Medical examiners must also be certified forensic pathologists.
But there is a national shortage of forensic pathologists. It’s difficult to get doctors to opt for a field that requires 13 years of college and usually leads to government pay, Baker said.
With too few of the professionals to go around, regionalization is necessary, medical examiners said.
Minnesota counties have gravitated to five regional offices: in Anoka County, Hennepin County, Olmsted County, Ramsey County and Grand Forks, N.D. The North Dakota office receives bodies from six counties in northwest Minnesota, according to the most recent list compiled by the Minnesota Coroners and Medical Examiners Association in May 2014.
There are drawbacks to a regional system, including wait time. Wabasha County sheriff’s deputies sometimes wait hours for someone to remove a body, Jeffery said, compared with 10 or 15 minutes. Some outstate counties that work with medical examiners in the metro area rely on a local official to start investigations and call a funeral home to move the body.
It’s difficult to determine if consolidating medical examiner services saves money.
When Jeffery chose which bodies to autopsy, he said he was “rather conservative,” knowing an autopsy cost county taxpayers about $1,500. The regional office, which has different standards, would likely choose to do twice as many autopsies, he said.
There are many situations in which autopsies are supposed to be conducted. Sometimes they are done for evidence in criminal cases. More often, they are conducted when a death was unexpected or suspicious or if the person will be cremated.
Regional medical examiners have more resources than county coroners, said Thomas, of the Hennepin County office, and may be able to provide more answers to families after a death, including notice of circumstances and hereditary conditions.
“For the rest of your life you wonder, ‘Well yeah, I know my dad died in a car crash, but did he die of a heart attack first? What caused him to have that crash?’ ” Thomas said. “It’s still a tragic loss, but at least you have answers.”