Cowlitz County coroner’s office performing more autopsies, in part due to overdoses

The Cowlitz County Coroner’s Office is on track to perform double the amount of autopsies on county residents this year as in 2022 because of rising drug overdoses and decedents with a lack of medical history, according to the coroner.

Other counties statewide are experiencing a similar trend amid a shortage of forensic pathologists available to perform the work, Coroner Dana Tucker told the Cowlitz County commissioners last week.

Seven Washington counties have appointed medical examiners, forensic pathologists who perform autopsies and lead their offices, according to the Municipal Research and Services Center of Washington. Most counties — including Cowlitz — have elected coroners and contract with traveling forensic pathologists to perform autopsies.

Cowlitz County is unique and fortunate to contract with forensic pathologist Clifford Nelson to provide autopsy services full time, Tucker said.

On Tuesday, the commissioners approved an agreement with traveling forensic pathologist Emmanuel Lacsina to provide autopsy services on an as-needed basis through the end of 2023. The county will call on Lacsina when Nelson is unavailable because of illness or vacation, Tucker said.

A backup pathologist will help the county comply with the state law requiring coroners’ offices to perform an autopsy or other postmortem within five days, Tucker said.

“A lot of other counties are struggling and are taking way longer to get a pathologist to do an autopsy, even on homicides,” she said. “So we’re very lucky to have somebody that’s willing to step up and to cover the county.”

The county will pay Lacsina $2,100 for a full forensic autopsy, $4,200 for a homicide autopsy, $1,500 for a partial autopsy and $1,200 for an external examination, according to the agreement. Nelson is paid $90,000 annually to perform 48 autopsies, but he could perform more for a fee for service, she said.

Washington reimburses counties up to 40 percent of the cost of contracting with a pathologist to perform an autopsy or 100 percent for autopsies of children under 3 years old. So far this year, Cowlitz County has paid $78,715 for autopsies, with the state set to reimburse about $31,485, Tucker said.

Overall, Cowlitz County has recorded 543 deaths so far this year, with about 90 percent, or 487, from natural causes, Tucker said. About one-third, 161, fell under the coroner’s office jurisdiction, and 45 of those — or 28 percent — included an autopsy, she said.

Coroners have jurisdiction over certain sudden deaths, suspicious deaths, those indicating an unnatural or unlawful cause, and deaths with other circumstances outlined in state law. Autopsies are not performed for all coroner cases and are authorized to determine the cause and manner of death when other means are inconclusive, Tucker said.

So far this year, the Cowlitz County Coroner’s Office has performed 45 autopsies for county residents, on track for about 90 by the end of 2023, Tucker said. The office performed 44 autopsies for Cowlitz County residents in 2022.

The office has performed 56 autopsies total this year, including seven for Pacific County, three for Lewis County and one for Wahkiakum County. Last year, the office performed 63 total autopsies, including for other counties; it performed 38 in 2021 and 32 in 2020, Tucker told the commissioners on Monday.

Drug overdoses are driving up the number of autopsies performed statewide, including in Cowlitz County, Tucker said. The county recorded 38 drug overdose deaths in 2022 and 19 so far this year, she said. That’s up from 33 in 2021, 29 in 2020 and 19 in 2019, according to coroner’s office data.

The office is also seeing more decedents with no medical history, which makes it more difficult to determine what their cause of death is without an autopsy, Tucker said.

For example, an autopsy showed that one woman, whose death was considered a possible drug overdose, died of a pulmonary embolism, Tucker said. The toxicology report revealed the woman had methamphetamine in her system but not enough to kill her, the coroner said.

“We’re having a lot of younger people coming in with no medical history and suspicion of drug use,” Tucker said. “We can’t bypass doing an autopsy on somebody (for whom) we do not know what they died from.”

The county commissioners supported the idea of having a backup pathologist but questioned what the increased number of autopsies would mean for the budget.

Tucker said she is working with finance department staff on the coroner’s office budget she inherited in January. At the end of this year, Tucker will have a better idea of how many autopsies to budget for next year, she said.