January 1, 2023
In this powerful autopsy of autopsies, Goldfarb, a former journalist and emergency medical technician who spent a decade as the public information officer for the Maryland Office of the Chief Medical Examiner, reveals how the opioid crisis, budget shortfalls, and insufficient staff have contributed to a demoralizing crisis. Goldfarb clearly reveres the old version of the Maryland OCME, the first centralized, statewide medical examiner system in the U.S., which conducts 12,000 investigations a year and works with 200 or so police departments to help family members and law enforcement quickly learn causes of death. Forensic pathologists spend at least 13 years in training and can rack up enormous student loans. But today, of 18,000 doctors graduating from U.S. medical schools each year, only about 300 choose a residency in pathology, and only 13% of them will become board-certified forensic pathologists. This lack of pathologists leads to backlogs and errors. Goldfarb tucks in many memorable lines in this important expos�, including his haunting final sentence: "The next death needing a competent, qualified forensic investigation could be any one of us."
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Starred review from December 15, 2022
A gripping account of Maryland's Office of the Chief Medical Examiner. Having spent 10 years as public information officer and executive assistant to the chief medical examiner at the OCME based in Baltimore, former paramedic Goldfarb, author of 18 Tiny Deaths, writes an expert combination of journalism, science, and personal experience. Modern medical examiners specialize in pathology and often hyperspecialize in forensic pathology. Not beholden to the criminal justice system, their sole responsibility is to the deceased. "The relationship between the medical examiner and the deceased is as sacred as any doctor-patient relationship, with the same ethical and legal obligations," writes the author. Activists regularly accuse police of persuading examiners to fudge their reports ("do us a favor and overlook that broken neck"), but that would be a career-ending move. Forensic autopsies to determine the cause and manner of an unexpected death take place at 74 centers in the U.S., and only 55 are fully accredited. Everywhere else, examinations of varying quality are overseen by a coroner or an appointed or elected official who may not be a doctor. After a compelling history of Baltimore's elite system, Goldfarb describes its operations, the many disturbing and often gruesome incidents that produce subjects for a forensic autopsy, and the problems of dealing with hostile activists and often uncomprehending media. In the epilogue, the author reveals that the nation's forensic medical services are on life support. A combination of the massive increase in opioid deaths and stagnant budgets is overwhelming these chronically understaffed agencies. In Baltimore, bodies awaiting autopsy have been piling up in refrigerated trailers, delaying funerals, religious ceremonies, and court cases. With the media and citizenry expressing outrage, morale has plummeted, and many experienced yet overworked staff members have resigned. In 2022, the state appealed to FEMA, which sent pathologists and technicians to temporarily relieve the backlog. Like its sister agencies around the U.S., a shrunken Baltimore OCME continues to do its best. A brilliant insider's view of a critical yet vulnerable government agency.
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