The Honolulu Medical Examiner’s Office hopes the arrival of its first new deputy in five years will help it winnow down the time it takes to finalize reports, which has mounted due to increasing caseloads and staff shortages.
Sasha Breland, who assumed her new role on Oct. 1, said one of her main goals is to help families with loved ones who died find closure, as well as to learn from the deaths.
“We are servicing people and families in one of the most trying times of their life,” she said. “And so if we can be there to not only tell the story of their loved one and help them close that chapter, but then influence their lives after that, we can make a difference.”
Chief Medical Examiner Masahiko Kobayashi said Breland’s appointment will help the office cut in half its turnaround time for final reports and ease each employee’s caseload by more than 100.
Breland, a New Jersey native, also will attend the mayor’s Cabinet meetings and help the department obtain accreditation from the National Association of Medical Examiners. She most recently served as deputy chief medical examiner and medical director for the Office of the Chief Medical Examiner in Washington, D.C.
The department also employs two forensic pathologists and is looking to hire one more.
Forensic pathologists and medical examiners both perform autopsies and investigate deaths, but the chief and deputy medical examiner are appointed by the mayor and have additional leadership and administrative duties.
Kobayashi said he expects each forensic pathologist’s caseload to drop from about 414 to 471 cases per year to around 300 to 325 cases, about a third of which will involve autopsies. Some cases only require a review of medical records or the external examination of a body.
The National Association of Medical Examiners recommends forensic pathologists perform no more than 250 autopsies per year.
The lighter individual caseload will also help the department finalize reports faster.
Autopsies are always performed within a day of receiving a body at the morgue, Kobayashi said, but final reports can take six months or more to be completed depending on the complexity of the case and how much testing is required. But Kobayashi said by next year, 90% of cases will be completed within three months.
Improving Efficiency
The Iwilei Road facility just underwent a $5.9 million renovation, which included increasing its storage capacity from 60 bodies to 140.
Kobayashi said the facility is not at capacity, but it’s important to have extra space in case of a mass casualty incident. The department also has three refrigerated trailers that can hold 150 bodies.
The medical examiner’s office has not only been dealing with a lack of staff, but its cases more than doubled between 2008 and 2023.
Kobayashi attributed the increase in part to the Covid-19 pandemic, which caused many people to forgo regular checkups from their primary care physicians. This meant that many who died did not have doctors to sign their death certificates, causing their deaths to be deemed “unattended” and get referred to the medical examiner’s office.
Another reason for the increase is spiking drug overdoses. Last year was the deadliest year on record for overdoses in Hawaii.
The deputy medical examiner position in Honolulu had been vacant since 2019 in part due to a nationwide shortage of forensic pathologists.
Recruiting Challenges
In 2020, there were only about 500 practicing board-certified forensic pathologists in the country, even though more than 1,000 were needed to meet demand, according to an article in the American Journal of Forensic Medicine and Pathology.
The Honolulu Salary Commission recently approved 10.5% raises for the chief and deputy medical examiner to help with recruitment. The chief earns $400,008 and the deputy earns $390,120.
The salary range for the open forensic pathologist position is $295,000 to $338,472, according to the city. The Salary Commission does not control the pay for that job because it is not an appointed position.
Even though the jobs are among the highest paid in city government, it’s still difficult to recruit because many private sector medical jobs pay much more, Kobayashi said, adding that a recent applicant to the forensic pathologist position rejected an offer last month saying the salary was too low.
Forensic pathology also isn’t presented to medical students as a potential career as often as other types of medicine are, such as pediatrics, family medicine and surgery, Breland said.
For her, though, forensic pathology was a calling.
Influencing Policy And Improving Lives
Breland said when she first entered medical school at the University of Medicine and Dentistry of New Jersey, which has since merged with Rutgers University, she wanted to become a neurosurgeon. But she found learning about the brain’s physiology to be mundane. She transitioned into trauma surgery but later realized a surgeon’s demanding schedule of early mornings and late nights wasn’t for her.
She ended up doing a residency program at the Northern Regional Medical Examiner’s Office in Newark, New Jersey.
On her first day, she said she observed an autopsy on a person who had been hit by a train.
“As soon as they opened the (body) bag, I ran over and I was like, ‘What’s this? Why is the head here?’ and all the other medical students kind of backed off,” she said. “And so that day the attending (physician) was like, ‘You need to be a forensic pathologist.’”
Breland, originally from Irvington, New Jersey, graduated medical school in 2009. She lives in Ewa Beach with her husband and their 7-year-old daughter.
Kobayashi said Breland’s knowledge and experience, which includes directing a death investigations division with 70 employees in Washington D.C., will help his office achieve its goals.
Breland said throughout her career one of her passions has been to use death investigations to influence policy and improve people’s lives.
For example, while working in Washington D.C. at the beginning of the opioid epidemic, her office was able to alert correctional facilities to an increase in inmates dying from opioid overdoses. The facilities in turn examined their policies to address how inmates were getting drugs and where addiction programs could be implemented within the correctional system.
“The dead tell the story of the living,” she said. “If you know why and how people are dying, you can make changes so that people live longer.”
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This story was originally published by Honolulu Civil Beat and distributed through a partnership with The Associated Press.
