NWFL medical examiner asks for budget increase as deaths soar, supply costs skyrocket
The new chief medical examiner for District 1 is asking the four Panhandle counties she covers to bump up her current budget by $815,350, saying her caseload increased in 2020 by 30% — and that doesn't even include COVID-19 deaths.
Dr. Deanna Oleske, who has been medical examiner since November 2020, said that if she were to include COVID-19 deaths, the caseload of her office — which serves Escambia, Santa Rosa, Okaloosa and Walton counties — increased by more than 60% from 2019 to 2020.
The pandemic also caused the cost of autopsy supplies to skyrocket, with manufacturers statewide increasing the prices of body bags, autopsy saws, scalpel blades, specialized surgical gloves and more.
The rise in supply costs and surge in cases are stretching Oleske's already thin resources even thinner as her lean staff of 19 people work to serve an area that includes about 787,000 residents — more than the cities of Denver or Washington, D.C.
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With the office's current budget already set at $2.86 million, Oleske is asking for an additional $815,350 just to make it to the end of the current fiscal year, which ends Sept. 30.
"I'm covering a population of almost a million, with 19 people," she told the News Journal in an interview at her office on Wednesday. "Honestly, we are just so tired. I'm tired."
Oleske is asking for the four counties she covers to pay their share of the budget increase proportional to the amount of cases they contribute.
Escambia County deaths, for instance, comprised 49% of the office's caseload from November 2020 to March 2021, the lion's share of total cases. Escambia County is being asked to increase the medical examiner's budget by $399,521.50.
Walton County, by contrast, contributed the fewest number of cases at just 9%, and it is being asked to kick in $73,381.50.
Santa Rosa County, which had 14% of the caseload, already approved its budget increase at last week's County Commission meeting, giving Oleske an extra $114,149. Okaloosa County had 28% and is being asked for $228,298.
The commissioners of Okaloosa and Walton counties will vote on the amendment at their July meetings. Escambia County spokeswoman Laura Coale told the News Journal on Wednesday that budget amendment is on the county's agenda for July 8, but is "under review at this time."
Even if all four counties approve the budget amendment requests, getting through the rest of the year is going to be a challenge. Chrissy Nieten, a forensic investigator and senior medicolegal death investigator for District 1, said the office's staff of 19 people do the jobs of what should be 45 people.
"We have six forensic investigators — three for Santa Rosa and Escambia counties, and three for Walton and Okaloosa counties. We have an on-call rotation, but because there are so few of us, we’re basically on call all the time," Nieten said. "We do a kickass job, everyone is very passionate and a hard worker and doing whatever we possibly can to get the job done. But it’s hard, really hard."
Drug overdoses, deaths from delayed care, COVID drove surge in deaths
Even without the coronavirus pandemic, the District 1 office saw a surge in deaths in 2020.
From 2019 to 2020, three of the district's four counties saw the total number of deaths increase significantly, while only one saw a decrease, according to the medical examiner's office. The changes were as follows:
- Escambia: 390 in 2019 to 531 in 2020, an increase of 36%
- Santa Rosa: 117 in 2019 to 177 in 2020, an increase of 51%
- Okaloosa: 206 in 2019 to to 273 in 2020, an increase of 33%
- Walton: 85 in 2019 to 75 in 2020, a decrease of 12%
In total, that's a 32% increase in deaths over the span of one year, not including COVID-19 deaths.
Oleske said the two main areas where she saw an increase were in drug overdoses, particularly fentanyl and methamphetamine, as well as deaths by natural causes that were preventable but a person's treatment was disrupted due to the pandemic in one way or another.
"The No. 1 thing that continues to ravage us, and you’ve heard me talk about it before, is drug overdoses," Oleske said.
She noted that the Florida Medical Examiners Commission's 2020 report found that for the first time since 2013, fentanyl surpassed alcohol as the most common substance found post-mortem, a trend Oleske called "striking and disturbing."
Oleske said she thinks the shutdown and stay-at-home orders led to an increase in overdose deaths because people couldn't go to face-to-face support groups or see loved ones for help.
She also said fear of contracting COVID-19 led people to delay seeking critical care.
"People did not want to go to the hospital," Oleske said. "I had a 36-year-old gentleman, for example, who had been complaining to his parents for three days of crushing chest pain radiating down his arm, and he was found dead in his bed. That was a sure sign of a heart attack, but he didn’t want to go to the hospital because he was afraid of COVID."
Oleske said she also had deaths in which a person lost their job and no longer could afford medication for chronic illnesses.
"I had another young person, in their 40s, who had a history of asthma," she said. "But they could not refill their asthma inhaler because they lost their job and had no health insurance."
On top of its normal caseload, the medical examiner's office also was tasked with investigating COVID-19 deaths, which it normally wouldn't have had to do under Florida statute.
Death by natural causes, such as those due to viruses like the coronavirus or the flu, don't have to be signed off on by the medical examiner unless there's an immediate threat to public health — which there was when the governor declared a state of emergency in April 2020 due to COVID-19.
Between April 2020 and August 2020, the District 1 medical examiner investigated hundreds of suspected COVID deaths. Each case required between eight and 10 hours of investigation — gathering medical history, interviewing family and friends, and conducting autopsies when necessary. Of those hundreds of cases, 347 were deemed to be directly caused by COVID.
In August 2020, the state Medical Examiners Commission directed its members to no longer sign off on COVID-related deaths, since examiners across the state were getting behind on their normal caseloads.
"Miami was behind. We were behind," Oleske said. "We stopped signing off on these COVID fatalities because no medical examiner could keep up."
Cost of post-mortem medical equipment soars
Post-mortem medical supplies that the medical examiner's office uses daily weren't spared from the price surges seen in other industries such as lumber and consumer goods like toilet paper or used cars.
The cost of body bags more than doubled between 2019 and 2020, from $16 to $36 on average. A case of cut-resistant nitrile gloves, which are required during autopsies and are thicker than normal latex gloves, went from $133 per case to $255 per case. And stainless steel prices are driving up the cost of scalpels, blades and other metal medical equipment. An autopsy saw cost $1,400 pre-pandemic, while the same piece of equipment costs $2,500 today.
The cost of body bags is of particular concern to Oleske, since she expects the death toll to continue to rise next year, and body bags can't be reused or cheapened.
"There are three different kinds of body bags," she said. "The cheap, flimsy kind, where zippers break and you have to use two anyway to preserve the integrity of the body; the regular stuff that doesn’t break, which used to cost about $16 to $20 apiece and now cost $36 to $45 apiece; and heavy duty body bags for people who are already decomposing, which used to cost $40 to $50 but now cost between $80 and $110."
The medical examiner has seen similar price inflation for almost every other supply she uses on a daily basis: syringes, personal protective equipment, blood tubes and more. The only thing that hasn’t increased in price is formalin, a chemical used to help preserve bodies.
Oleske says the increase in prices for basic, day-to-day supplies is a huge part of her budget amendment request.
“More people are dying, so more body bags are needed. And COVID helped increase the demand,” she said. “Unfortunately, it also increased our demand, and prices have not gone down. We’ve asked our suppliers if they anticipate coming down this next calendar year, so we can budget, and they’ve told us they’re not going down.”
Still, the unexpected bump in costs puts the medical examiner's office in the hole if it doesn't get the requested budget increase from each of the four counties.
For the next fiscal year, the office is asking for a budget of $4.8 million, more than double its fiscal year 2019-2020 budget of $2.12 million.
While the needs behind the office’s current budget requests are grim, Nieten, the forensic investigator, said it’s the bare minimum that the office needs to provide important information to grieving family members who are often experiencing one of the worst times of their lives.
“If you look at the black and white, our job is to determine cause and manner of death. That can be for criminal reasons, pandemic reasons or whichever reason applies by statute,” Nieten said. “But at the end of the day, the important thing to all of us here is being able to give appropriate answers to family members so that they can gain closure, by telling them exactly what happened to their loved one.”
Oleske said she would like to be able to dedicate more time to finding the root issues of some of the causes of death that she sees, like traumatic brain injuries in veteran suicides or positional asphyxiation in babies who use a certain type of sleep equipment.
But first, her office has to catch up to all the current issues at hand, which sometimes seems like an impossible task.
"The goal of the medical examiner is to prevent death. Most of our deaths are preventable,” Oleske said. “We want to be able to have the energy and staff to educate and collaborate with the community and save some lives, but right now, we don’t’ have the time, staff or money.”
Annie Blanks can be reached at email@example.com or 850-435-8632.