High turnover is straining a small staff at the Bexar County Medical Examiner’s Office, and the additional responsibility of giving court testimony about autopsies done by other doctors before their time is piling onto the workload.
On Tuesday, Bexar County Commissioners approved a change in its incentive program to give stipends to encourage medical examiners to volunteer to testify when needed, hoping it will balance workload within the department.
Bexar County currently has only four full-time medical examiners and four medical examiner positions are open, according to the county. Chief Medical Examiner Dr. Kimberley Molina and the deputy chief — whose duties usually take them out of the morgue more often — are currently filling in as full-time medical examiners due to the short staffing.
The incentive update adds a $1,000 stipend for a medical examiner to give a substitute testimony in court on behalf of physicians who are no longer employed by the county.
“Our office is essentially one forensic pathologist away from collapse,” Molina told commissioners. “Three of our medical examiners are very close to retirement, myself included. And if any of us choose to retire, again, we’ll be in an untenable situation with office.”
Meanwhile, the office’s case load has increased by 30% in the past year, which Molina attributed to an increase to population growth, the COVID-19 pandemic, an opioid epidemic, civil unrest and two mass casualty events nearby in 2022.
After the COVID-19 pandemic, more medical examiners chose to leave the field and others are retiring, Molina said.
The newly approved court testimony stipend will be added to an existing stipend related to workload: after a Bexar County medical examiner has completed 300 autopsies in a calendar year, they get a $1,000 stipend for each additional autopsy they perform beyond that.
The changes in the program are funded by the existing budget for fiscal year 2023. The new incentive will be paid out to each medical examiner monthly and will cost the county up to $10,000 a month, according to an estimate provided to commissioners.
Medical examiners are pulled from the morgue between two to three days per week for “intersections in the legal system,” Molina said. This includes attending pre-trial and attorney interviews with the prosecution and defense, as well as reviewing cases before court, which typically takes an entire day.
According to the most recent Bexar County Medical Examiner’s Office annual report, 3,657 autopsies were completed by the staff of six medical examiners in 2021.
The Bexar County Medical Examiner’s Office is currently on probation due to its workload with the National Association of Medical Examiners, Molina said.
Having a staff of at least 10 medical examiners would alleviate workload issues and bring the office back to compliance with accreditation standards, she said.
Commissioners commended Molina and her staff for their handling of two mass fatality events last year, referring to the 53 migrants that were found in a sweltering 18-wheeler on the South Side and the Uvalde shooting that killed 19 students and two teachers.
Molina has absorbed much of the court testimony workload herself, she said, since the office is at the same level of staffing it was in 2015. And other Texas medical examiner offices, like in Austin, Houston or Dallas, offering similar pay makes Bexar County hard to stand out, she added.
An open medical examiner position listed publicly on Bexar County’s job board is currently listing the job’s salary as up to $304,500 annually.
Tarrant County is hiring a deputy medical examiner and the position is listed with a salary up to $375,000 per year, and Harris County is seeking an assistant medical examiner for up to $320,000 a year, adding to the competition for talent.
“If any one of these offices chooses to increase salaries or increase benefits and recruits one forensic pathologist away from our office, our office will collapse,” Molina said.
Molina said the Bexar County Medical Examiner’s Office has been working with its Human Resources Department to come up with additional pay incentives, like medical school loan payoffs or a bonus after a certain amount of years, which would help set the office apart.
Bexar County Judge Peter Sakai said the move was first step to a bigger conversation about the workload at the Bexar County Medical Examiner’s Office, committed to hearing the office’s needs moving forward and promised Molina lecture time with UT Health Science Center medical students to help with their recruitment issues.
Commissioners have increased the Medical Examiner’s Office budget from $6.5 million in 2020 to $9.2 million this year, and increased the number of positions in the office from 56 to 66, including administrative positions.
The court testimony and additional autopsy stipends are expected to be temporary, according to a county document— incentives will remain in place until the medical examiner’s office is fully staffed.
