Facing massive backlog of uncounted COVID deaths, FL medical examiners streamline review

Medical examiner’s offices in South Florida have a backlog of more than 1,200 suspected COVID-19 deaths awaiting certification, according to the Florida Medical Examiners Commission.

Medical examiner offices had struggled to keep up with a recent spike in COVID-19 deaths, with more than 2,300 deaths reported statewide in just the past two weeks, according to the Florida Department of Health.

The health department relies on its own information in determining the number of COVID-19 deaths in the state and didn’t respond immediately to a question about whether the backlog of medical examiner cases impacts the state’s numbers.

On Friday, the commission voted to streamline the review of such deaths.

In Miami-Dade County, which has been the epicenter of the state’s COVID-19 pandemic, the medical examiner’s office currently has a backlog of more than 650 potential COVID-19 deaths waiting to be certified, according to the commission. In Palm Beach County, the medical examiner’s office has a current backlog of more than 500 cases, while in Broward County the backlog is roughly 100 cases.

“There’s a squeeze point and I think most of the offices are beyond that squeeze point,” said Stephen J. Nelson, the chairman of the commission and chief medical examiner in Polk, Highlands and Hardee counties.

The commission agreed to allow a doctor who has treated a patient to certify whether the patient died from COVID-19, which represents the vast majority of COVID-19 deaths, Nelson said. No medical examiner certification would be required to log the case.

Last month, Emma O. Lew, Miami-Dade’s chief medical examiner, described the challenges her team faced in an email to Dr. Nelson and obtained by the Documenting COVID-19 project at the Brown Institute for Media Innovation. It was shared with the Miami Herald.

Lew said in the July 14 email that her team of investigators and medical examiners were exhausted after routinely working late to keep up with the mounting caseload. She wrote that the county had cut the department’s budget and was rationing resources. Because of the specialized nature of the work, it wasn’t easy to plug in additional staff to help lighten the load.

“Despite being understaffed, the Miami-Dade County Medical Examiner has kept up amazingly well with the numbers. However, the situation is no longer sustainable,” Lew wrote. “I am writing partly to inform, partly to vent, but mostly to request guidance and a realistic solution.”

Lew said Friday that the commission’s decision “was the relief we were hoping for.” While she acknowledged that her office still has a major backlog to work through, “an end is in sight.”

The Tampa Bay TImes reported in April that the Health Department’s COVID-19 death data was missing COVID-19 deaths included in data from medical examiners across the state compiled by the Florida Department of Law Enforcement. The state blocked release of the medical examiner data for several weeks, before relenting in early May.

Medical examiners in Florida have been called upon to certify deaths stemming from disasters since Hurricane Andrew, in 1992, and had been certifying deaths during the COVID-19 pandemic. But the arrangement was designed with short-term disasters, such as hurricanes or plane crashes, in mind.

“This was never envisioned to be a long-term thing,” Nelson said.

While medical examiners weren’t performing their own physical examinations on most COVID-19 deaths, the work of going through medical records to certify whether COVID-19 was responsible for a patient’s death was still laborious and made it difficult for examiners to keep up with their normal responsibilities, which include investigating suspected homicides to determine official causes of death.

One of Nelson’s nine staff members worked exclusively on COVID-19 cases and was relieved by the news, he said.

“They were ready to give me a hug and a kiss when I told them.”

This breaking story will be updated.