A year after heavy scrutiny was put on backlogged death rulings by the Medical Examiner's Office and six months after the chief medical examiner was demoted, the backlog remains and many continue to bemoan the issues even as progress has been made.
The office, which deals with about 1,200 death cases a year, has a backlog of 958 cases that remain to be completed — many dating back to 2012. More than 200 of those cases came into the office since March.
But the continued backlog means a final death certificate and cause of death in many cases have not been issued, which leaves the courts and, more importantly, families in the lurch.
While most autopsies are completed soon after death, the final report with the cause and manner of death can often take months or years. The industry standard is to have 90 percent of cases completed within 90 days.
Still, last year at this time, the office had more than 1,200 incomplete cases.
“When you're in a hole, the first thing you do is stop digging,” Bill Barnes of the City Administrator's Office said of the limited reduction of the backlog.
Barnes, whose office oversees the medical examiner, blames part of the backlog on the loss of staff, poor facilities and outside forces like lab work they have no power over.
But critics, including former staff, have said the issues at the office are rooted in bad management and a lack of financial and political independence.
As for the continuing impact of these issues, law enforcement sources — whose cases usually receive priority — say many important cases are still being impacted by the backlog.
“We have experienced what I think is an unreasonable delay in receiving these reports,” Public Defender Jeff Adachi said. “It really makes it difficult, if not impossible, to work on a case without the report.”
And despite progress, Adachi's office still has cases that have been postponed or impacted by the length of time it takes the Medical Examiner's Office to complete a report. For instance, a case involving someone who died in July is still awaiting a report.
The average wait in Adachi's office for such reports is eight to nine months.
“It's no secret,” Adachi said of these ongoing issues, adding that many in The City's legal system that rely on these reports have “bemoaned the delay in getting autopsy reports. We have been met with a deadening silence.”
Judy Melinek, a former forensic pathologist who resigned in 2013, wrote on an industry blog in March that the replacement of the chief medical examiner that same month only solved one of the office's issues.
“It's going to take a lot more than replacing the chief medical examiner to repair the problems at our city morgue,” she wrote, adding that The City will need to hire additional administrative staff, investigators and technicians to have a real impact on the backlog.
And in the long run, Melinek wrote, San Francisco must commit to fully funding and staffing such a vital office.
The City Administrator's Office admits that issues remain, but also said there is progress.
After losing two of its forensic pathologists recently, the office hired one and put the former chief medical examiner, Amy Hart, into a pathologist position. That leaves the office one permanent pathologist short of its full complement of four.
But a new chief medical examiner has yet to be hired, and that delay, according to Barnes, is due to the lengthy background checks and difficulty of searching for a replacement in an industry with few qualified prospects.
Barnes said that along with new hires, The City is talking with San Mateo and Alameda counties to help reduce the backlog. Temporary staff also might be hired.
When the new $65 million Medical Examiner's Office in the Bayview is complete, projected for 2017, and the department is once again fully staffed, The City hopes to meet industry standards of having all cases completed within 90 days.
As for now, the office remains on probation, so to speak.
“We are currently accredited on a provisional basis,” Barnes said.
The reason for provisional status, he said, is the old, outdated and unsafe facility located in the Hall of Justice, among other issues.
In The City's last budget, the medical examiner received $1.1 million for additional equipment, including X-ray machines and toxicology equipment.
In September 2013, City Administrator Naomi Kelly said her office was working to fix the backlog at the morgue, yet it remains.