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Autopsies drop in ND for first time since ’07

BISMARCK -- After a steep rise that forced North Dakota to provide more help to the state medical examiner, the number of autopsies performed in North Dakota fell last year for the first time since 2007, a trend expected to continue because of th...

BISMARCK –- After a steep rise that forced North Dakota to provide more help to the state medical examiner,  the number of autopsies performed in North Dakota fell last year for the first time since 2007, a trend expected to continue because of the slowdown in oil activity.

Department of Health officials also say they’re making progress on ways to improve the state’s system of death investigations and autopsies.

State law requires that all non-natural deaths be reviewed by the county coroner. Deaths that must be reported to a coroner include those involving obvious or suspected homicidal, suicidal or accidental injury, firearms injury, motor vehicle injury, starvation, drowning, suspected sexual assault, illegal drug use or “any other suspicious factor.”

When a county coroner determines that further forensic examination of a deceased person is needed, the body is sent to the state forensic examiner’s office at the Department of Health in Bismarck or to the University of North Dakota’s Department of Pathology in Grand Forks for autopsy.

The Bismarck lab performed 240 autopsies last year, while the UND lab performed 247, for a total of 487 autopsies, or five fewer than in 2014.

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That breaks a streak that saw autopsy numbers soar by 70 percent from 290 in 2007 to 492 in 2014. The forensic examiner office’s budget has more than doubled over the past decade, from $1 million in expenditures in 2005-07 to a $2 million appropriation for 2015-17. The state pays for the autopsy, while the county bears the cost of transporting the body.

State Medical Examiner Dr. William Massello said the caseload increase was driven largely by the influx of people into western North Dakota and the work-site fatalities, drug-related deaths and traffic fatalities that accompanied the oil boom.

North Dakota has grown by 110,000 people since 2004, to a record high estimate of 756,927 as of July 1, according to the U.S. Census Bureau.

Average annual traffic fatalities rose from 114.2 deaths per year from 2006-10 to 146.4 deaths in the five years since, according to state Highway Patrol figures. The state’s homicide count also is up, averaging 16 a year from 2010-14, compared with 10 per year over the previous 15 years, according to the attorney general’s office.

Slumping crude oil prices have significantly reduced drilling activity – with the number of active drilling rigs at 51 on Thursday, down from 188 at the same time in 2014 – and the workforce that supports it. The Occupational Safety and Health Administration investigated three oil- and gas-related workplace fatalities in North Dakota last year, compared with seven in 2014 and 10 in 2013.

“I do think, just my own gut feeling, we’re going to see some drop-off (in autopsies) because we’re not going to be seeing the number of work-related fatalities from the oil field,” Massello said.

Workload manageable again

A work group created at the request of the Legislature’s interim Health Service Committee in April 2014 has been studying ways to improve death investigations and autopsies.

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One issue identified was to maintain a manageable workload at the forensic examiner’s office in Bismarck.

The state began contracting with UND in 2013 to relieve the overwhelming workload in the Bismarck office, which had seen its caseload climb by more than 50 percent, from 240 autopsies in 2004 to 367 in 2012.

“The general consensus is any pathologist who does more than 400 autopsies a year is probably doing too many – catastrophically too many,” Massello said.

Massello said the contract with UND resulted in a manageable workload for the forensic examiner’s office. The office now performs autopsies for 32 counties in western North Dakota, while UND covers 21 eastern counties.

Last year, lawmakers approved $480,000 to continue the contract through 2015-17, plus $160,000 to UND to pay for autopsies.

Rep. Jay Seibel, R-Beulah, a retired funeral home director who previously served as a deputy coroner, said funeral directors support keeping the contract with UND in place because it reduces travel time and costs for many eastern counties and speeds up autopsy turnaround times, which means shorter delays for families waiting to bury their loved ones.

Maintaining the contract with UND is the highest priority, said Kirby Kruger, chief of the health department’s medical services section.

Improving training

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Another priority, he said, is increasing and improving training for coroners and other death investigators.

“I think that getting them at a basic understanding is really our goal,” he said.

To be eligible to be a coroner in North Dakota, state law requires that the person be a licensed physician, registered nurse, physician assistant or “any other individual determined by the state forensic examiner to be qualified to serve as coroner.”

If a coroner isn’t available or doesn’t live in the county, the duties fall to the sheriff.

By occupation, 22 counties are served by coroners who are medical doctors, 18 by sheriffs or police officers, nine by funeral home directors, two by EMTs, one by a nurse and, in McKenzie County, by a rancher who is also a funeral director.

“But their job duty is the same across the board: to determine if a death occurred naturally or not,” Kruger said.

Progress has been made. A death investigation course at UND is now available online, and Massello continues to offer eight hours of training annually for coroners, law enforcement, paramedics and other first responders. But House lawmakers defeated a bill last session that would have provided about $30,000 to offset travel costs that can be a barrier to training.

Kruger said he expects the work group will have additional recommendations for the 2017 Legislature.

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