What We Can Learn From the Medical Examiner
They're often the ones who see public-health problems at their earliest stages. There are ways to make better use of their data.
Like many, I used to think of the medical examiner's role as defined by crime scenes, body tags and stainless-steel tables, a world with little application beyond backward-looking investigations.
But after four years managing community partnerships at a health department in Florida, my perspective changed. I came to see the medical examiner as a rich source of public-health data, one that tells stories and predicts epidemics, and one that is often and unfortunately overlooked.
Soon after I began working at Pinellas County's health department in 2013, I met with the chief investigator of our medical examiner's office. He was responsible for keeping track of data, and I asked him offhand what we should be watching out for. He didn't hesitate. "Fentanyl. It's a synthetic opioid, and we're seeing a sharp spike in deaths. This one is dangerous."
By now, this chemical and its deadly impact are well known. But our conversation happened years before the word "fentanyl" became commonplace in the news cycle, before the president could reference it in speeches with no context.
Medical-examiner data, grim though it may be, is where public-health trends often show up first. The ME knows where most fatal bicycle accidents happen in a city. Medical examiners are the first to know of an uptick in suicides or overdoses from a new drug. We are doing ourselves a disservice by not paying more attention to this data, information that could even have helped us get a head start on identifying and addressing the opioid epidemic.
We can fix this oversight. As a first step, health departments should connect with their local medical examiners' offices to regularly exchange and review data. Taking things further, I propose forming small, regional medical-examiner data review councils that could include physicians, public health officials, law enforcement representatives, elected officials, city planners, and social workers or behavioral health workers.
This council would monitor real-time data involving drug deaths, suicides, traffic accidents and unexpected deaths caused by infectious disease or asthma. Most importantly, the council would decide how to take action when it sees a concerning trend, either by notifying an existing group that's already working on the issue, forming a new program or policy proposal, or simply looking more deeply into the data to better understand what's going on.
The type of council I'm proposing is different from fatality review boards that meet infrequently or perhaps only focus on one type of issue. It's different from groups that are called together once an emergency is already underway. The goal of this council is to proactively monitor ME data, with the medical examiner or investigator present and with the specific purpose of shaping public health responses accordingly.
To be sure, ME data is public record, typically aggregated and published annually. Yes, many health departments are aware of this information. But waiting to look at data until it's compiled by a state's vital statistics office often means losing a year or more and potentially missing alarming trends as they first begin to develop.
There is no substitute for the direct input of a chief investigator like the one I worked with in Florida. There is no substitute for observing trends in real time -- not years down the line, when a trend has already become an epidemic. And there is no substitute for recognizing that medical examiners can and should participate in the public-health system. ME data tells stories that can help us prevent future problems, promote safety and create interventions that help our communities become healthier places to live.