Letter to Jeff Sessions, Attorney General and Tom Price, Secretary of Health and Human Services - Provide Relief for Medical Examiners Facing Overdose Deaths from Opioid Epidemic

Letter

Dear Attorney General Sessions:

As the Department of Justice's Task Force on Crime Reduction and Public Safety develops a strategy to advance national forensic science standards and operations, I encourage you to give particular consideration to the forensic pathologist shortage facing communities nationwide. In doing so, I request that you take steps that could immediately close the gap and incentivize more interest in this critical field. Specifically, I urge you to enact a number of recommendations previously published by the National Commission on Forensic Science.

As you know, the widespread uptick of illicit opioid and prescription drug abuse has presented grave new challenges to local communities. The rise in fatal drug-related overdoses has overwhelmed medical examiner (ME) offices across the country, many of whom are on the front lines of battling the growing caseload of autopsies fueled by the opioid epidemic. Some estimates report that the nation has less than half the number of forensic pathologists it needs. Furthermore, only 30 to 40 doctors complete forensic pathology training annually. Of those, few go into full-time forensic pathology practice.

As workloads increase, ME offices across the country face limitations that raise their costs while threatening their accreditations. According to the national accrediting association, MEs are recommended to performing no more than 250 autopsies a year in order to minimize risk of error. As a result, ME offices that are close to surpassing the limit are forced to contract outside pathologists in order to keep caseloads within the guidelines and maintain accreditation. This shortage has been particularly damaging to Monroe County in Upstate New York, where the Monroe County Office of the Medical Examiner which provides forensic death investigations and autopsy services to thirteen counties in central and western New York is working diligently to attract and recruit full time forensic pathologists to fill three of their four FP positions. While Monroe County is working diligently to use all the resources at its disposal recruit full time forensic pathologists, including adding one new hire beginning this month, the FP shortage is a national issue and requires a national response.

With the rate of opioid overdose deaths expected to grow, the need for adequate MEs is more important now than ever. The National Commission on Forensic Science recently considered this issue and offered a number of fruitful recommendations that could help to combat this growing shortage. First, the Commission recommended the creation of a new grant to support a fellowship program between universities and local MEs, a step that could encourage interest in the field and a new pipeline of FPs to help shoulder the increasing workload of understaffed ME offices. Secondly, the Commission recommended that university medical schools add forensic pathology in the medical school curriculum within the first 2 years as this is a prime time to attract future FPs, followed by elective rotations in forensic pathology in later years. Put together, these recommendations could have a worthwhile impact to reverse the nationwide shortage, and I strongly urge you to implement them as part of your mission to update national forensic science initiatives. In doing so, I also ask you to help support a new innovative Forensic Pathology Fellowship program that Monroe County has now begun to develop with the University of Rochester School of Medicine and Dentistry. This new Fellowship program would be only the second of its kind in New York and is representative of exactly the type of new Fellowship program envisioned and recommended by the National Commission on Forensic Science for national support from the Department of Justice. Costs associated with the training and support of the FP Fellows during their time working in an ME office could be supported by new DOJ grant programs while ME offices would receive the benefit of a new pipeline of trained forensic pathologists.

It is essential that our local counties have the tools necessary to perform toxicology testing, determine causes of death, and issue timely reports. These reports are often integral to determining unknown causes of deaths, facilitating police investigations, and providing the information necessary to properly diagnose this raging epidemic. If the federal government fails to provide the targeted investments needed to address the growing shortage of forensic pathologists, communities will be left without the vital resources that are necessary to confront this growing crisis.

Thank you for taking the time to consider this request. I look forward to hearing from you.

Sincerely,

Charles E. Schumer

United States Senator

Secretary Price:

I write today with great concern for the increase in deaths drug-related overdose across the country. As we work to combat the epidemic of opioid abuse, it is critical that the entirety of the medical community providing preventive and recovery services receive support. That is why I ask you to strongly consider adding forensic pathologists as eligible providers in the National Health Service Corps Loan Repayment Program.

As you know, the death rate related to drug overdose has risen exponentially in the past few years. According to the National Center for Health Statistics, since 2015, over 50,000 people across the country have died from drug-related overdoses annually. With this unfortunate increase in access to opioids, resources for providers have become more strained and forensic pathologist offices are no exception. A thorough forensic examination of a drug-related death can take months to allow the necessary procedures and testing to be completed. According to the National Association of Medical Examiners, individual providers average 250 autopsies per year and any more than this threatens the quality and thoroughness an examiner may be able to provide. In its 2015 report the U.S. Department of Justice's National Commission on Forensic Science (NCFS) concluded that while there are only an estimated 500 Forensic Pathologist in the nation now working full time, the workload requires that there actually be between 1,100 and 1,200 full time forensic pathologist to meet present day needs. Therefore, to meet this need and address the national backlog for FP services, the nation needs to more than double its current FP workforce. Moreover, the increase in drug-related deaths is exacerbating the need for forensic pathologists.

By allowing these providers to be eligible for the NHSC Loan Repayment Program, states and localities will be able to ease the growing number of cases forensic pathologists undertake. A recent study commissioned by AAMC and cited in the NCFS' 2015 report found that 86% of medical school graduates report having debt, and in 2012, the median debt of graduating physicians was $170,000. By allowing medical students to receive loan repayment in return for becoming forensic pathologists and work in underserved states and localities, the Department of Health and Human Services can help incentivize more FPs to enter the workforce and thereby help reduce the national shortage of full time practicing forensic pathologists.

Forensic pathologists provide a crucial service that allows doctors and researchers to better understand the pathology of harmful drugs in the human body, while facilitating police investigations, and providing the information necessary to properly diagnose this raging opioid epidemic.

Thank you for your attention to this request.

Sincerely,

Charles E. Schumer

United States Senator

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