Amid increases in both homicides and fatal drug overdoses, the Maine medical examiner’s staff is slowly ramping up the number of autopsies it conducts after years of lagging behind national averages.

Annual autopsy rates in the state consistently hovered at well under 20 percent of deaths investigated for the past five years, an analysis of the Maine Office of Chief Medical Examiner annual reports shows. State medical examiner offices nationwide, on average, perform autopsies in 38 percent of deaths investigated, according to a 2018 Department of Justice report, the most recent available data.

“I would say that’s unusual compared to the nation,” said Denver Chief Medical Examiner Dr. James Caruso, the secretary of the American Academy of Forensic Sciences.

“All of us have many more cases than we’ve had, mostly due to drug overdoses,” Caruso said. “The real driver of the workload is not COVID. And it’s not really even (the) increasing homicide rate. It’s drugs. Specifically, it’s fentanyl.”

In 2021, the Maine OCME’s office performed 277 autopsies out of the 2,391 cases it took jurisdiction over – an 11 percent rate, according to the OCME’s 2021 annual report. In 2022, the office performed 403 autopsies of 2,526 deaths – 15 percent, said Lindsey Chasteen, the Maine OCME office administrator.

The medical examiner’s office in New Hampshire, which is similar to Maine in staff size and state population, in 2021 performed 607 autopsies of 1,794 deaths it investigated, or 33 percent. In 2022, the New Hampshire medical examiner performed 605 autopsies in 2,037 deaths it investigated – 29 percent, state records show.

Maine’s chief medical examiner, Dr. Mark Flomenbaum, did not dispute Maine’s autopsy rates.

“I agree fully that the number of autopsies is small compared nationally. That is OK,” Flomembaum said. “The numbers are what they are.”

He said Maine’s numbers may be lower because his office is selective about which deaths to autopsy.

“If a person commits suicide with a gunshot wound to the head, most jurisdictions will automatically do an autopsy. In Maine, if the circumstances are not at all questionable, we don’t always autopsy those cases,” Flomenbaum said.

Flomenbaum also said Maine’s aging population can be a factor in lower numbers.

“We have our elderly folks who fall and break a hip. We don’t need a full autopsy to know they died of that fracture,” Flomenbaum said.

Limited resources for staffing and funding also force the agency to make choices.

“There are jurisdictions that can autopsy every motor vehicle accident,” Flomenbaum said. Maine can’t, he said.

In Maine, the OCME is mandated by law to investigate all violent or drug-related deaths and unexpected natural deaths. But last year, the OCME said in its annual report: “While most cases should be autopsied, constraints at the office only allow for full autopsies to be performed when they are necessary for criminal prosecution, for unexpected deaths in individuals under 55 years old or for deaths suspected of being due to a threat to the public health.”

The National Association of Medical Examiners, which that accredits state offices, recommends the Maine OCME perform at least 625 autopsies annually based on the number of potential death investigations in the state, according to the OCME’s 2021 annual report.

But Chasteen said despite the lower-than-average rates, “Maine is not lagging behind. We are being more discerning” about which cases to autopsy.

Still, the number of autopsies in Maine has left some families with unanswered questions.

Elizabeth Lafortune, 35, was found dead last Sept. 27 at Oakwood Inn Town Motel in Sanford. The police reported her death to be drug-related, but her family believes it is suspicious because Lafortune did not use drugs, according to her sister, Michelle Medevielle. The OCME did not perform an autopsy, Medevielle said.

“We think it’s pretty messed up,” said Medevielle.

Medevielle said her family was told by the OCME that “there wasn’t any foul play that they noticed” – and because of that, there was no need for an autopsy. In her view, the OCME wanted to “take the easy way out, so they don’t have to do the work.”

Flomenbaum said he couldn’t comment on a specific case due to the privacy of the deceased and the family.

Similar to Medevielle, Sally Blais of Sturbridge, Massachusetts, said the Maine OCME did not conduct an autopsy for her son, David Blais, after his death from a gunshot wound in late 2018, even though she believes he was entitled to one under the state law.

Blais said police ruled her son’s death a suicide. He was found dead in a gravel pit during a gun target practice in Maine, and had been accompanied on the trip by two others, Sally Blais said. His mother thinks the case should have been investigated further and an autopsy performed to confirm it was not a homicide.

Instead, the medical examiner conducted an external examination of the body and toxicology testing, according to Sally Blais, who has been left with years of unanswered questions.

“…  I should have insisted (for an autopsy to be conducted),” she said.

The OCME case report for investigations into Blais’ death also mentions David Blais’ history with mental illnesses, including major depressive disorder, anxiety and ADHD.

But Sally Blais said her son’s mental health had stabilized by June 2018.

“Some people will commit suicide without giving any hint that they were intending to do that,” Sally Blais said. “But I never thought, and anybody who knew David never thought, he was that hopeless that he would kill himself.”

Maine State Police records show there were 29 homicides in 2022, the most in recent years. In 2021 there were 18 and in 2020 there were 20.

Also rising in recent years are confirmed and suspected drug overdose deaths, state data shows. A February report from the Maine Attorney General’s Office shows there were 10,110 overdoses reported in Maine in 2022, with 716 suspected or confirmed deaths. In 2021, there were 631 suspected or confirmed overdose deaths of 9,678 overdoses reported.

Flomenbaum’s tenure has been punctuated by controversy. He was originally appointed to his seven-year term in 2014 by then-Gov. Paul LePage. In 2021, he said he would not seek reappointment after being privately reprimanded by Gov. Janet Mills after his office gave an inappropriate gift to a departing worker, and for questioning a second worker’s approved sick and medical leave, according to news reports.

Flomenbaum is remaining as medical examiner until his replacement is hired.

Flomenbaum was fired as chief medical examiner in Massachusetts in 2007 after a consultant’s report revealed rampant mismanagement and the misplacement of the body of a Cape Cod man.

Flomenbaum said the OCME’s inadequate budget, staffing and facilities have contributed to his office’s lack of ability to perform autopsies.

In 2021, the agency’s budget was approximately 55 percent of the recommended national standard, according to the OCME’s annual reports. The average budget for state medical examiner offices was $5.8 million in 2018, according to a Department of Justice report. In contrast, Maine’s budget was $2.2 million for 2018 and $2.5 million for 2021, according to OCME annual reports.

The OCME facility, built about 30 years ago in Augusta, has two autopsy tables and shelving units to store 15 bodies, according to Chasteen. The facility also lacks proper ventilation and is unable to keep up with current health codes, said Flomenbaum.

“We are the final point for people who do not get identified, so we have to hold them in our facility, do the DNA testing, find out who they are … It’s a huge burden,” Flomenbaum said. “This building was not designed for that.”

It also lacks the capacity for multiple autopsies to be conducted simultaneously and is not set up to perform autopsies on infectious cases, Flomenbaum said.

In 2020, legislation for a new OCME facility was approved and construction is expected to begin this year. The building will be equipped with six autopsy tables and can store closer to 30 bodies, Chasteen said.

An ongoing shortage of forensic pathologists is creating a problem nationally. In Maine, there are only two full-time forensic pathologists and Flomenbaum has asked the Legislature to increase the agency’s budget to hire more.

“There’s not enough people to hire and competition for hiring is bringing salaries out of scope for jurisdictions like Maine that can’t really afford to keep up,” Flomenbaum said.

He also said the pandemic hampered the agency’s ability to move quickly because people were working remotely, deaths were not reported or bodies were not transported as quickly as usual. Some deaths were not reported until a body was cremated, preventing the OCME from conducting examinations or autopsies, Flomenbaum said.

“What slows us down is stuff beyond our control. If we have to wait for toxicology samples to come back from the labs, we can’t do anything but wait,” he said.

The number of autopsies in Maine has increased slightly this year partly because a slowdown in COVID deaths has given the office more capacity to focus on other cases, Flomenbaum said.

“As the drug epidemic continues, we, as a state, decided we are going to autopsy all individuals under the age of 30, even if it is a suspected drug overdose,” he said.

Other internal changes are increasing the autopsy numbers, he said, including the OCME taking jurisdiction in the deaths of individuals who are homeless, incarcerated or under guardianship.

Chasteen said the OCME asked for four additional staff for this budget cycle but the request was cut from the budget before it reached the full Legislature. A request for $330,405 in funding is pending, Chasteen said.

“We are always doing the best we can,” he said. “The numbers are going up. There’s more reason to investigate traumatic deaths because there are more traumatic deaths. There’s more reason to autopsy drug deaths because there are more drug deaths.”

This story was originally published by The Maine Monitor, a nonprofit and nonpartisan news organization. To get regular coverage from the Monitor, sign up for a free Monitor newsletter right here.

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