Sonoma County morgue grapples with backlog, long delays

In the past two years, hundreds of unfinished autopsy reports have piled up in boxes at the Sonoma County morgue, delaying court proceedings in criminal cases and leaving grieving family members in limbo as they await final death certificates.

The massive backlog at the Sonoma County Sheriff’s Office has kept the siblings of Petaluma mortgage broker Dean Ratto waiting for a death certificate for nearly 10 months. The 36-year-old died in December, and his family still cannot close his bank accounts or handle other matters of his estate.

“I’m looking for an explanation,” said one of Ratto’s older brothers, Lance Ratto of Marin County. “Is this just a file sitting on the desk, a dispute between (the doctor) and the county and you’re not doing any further work? If there is a valid explanation we’ll continue waiting, but this just seems not normal.”

Lynn Harenberg-Miller, 58, of Petaluma started calling the morgue every two weeks after her husband’s unexpected death in January, but didn’t find out until July that the preliminary cause of death had been ruled out. Nearly seven months after he died, she’s just now getting accounts into her name.

“This is ludicrous. People’s lives depend on getting these things tied up and finalized,” said Harenberg-Miller, who was married for 22 years. “Just dealing with the paperwork, it’s taken all of my internal strength to handle that. It has taken so long.”

At the backlog’s peak in late spring and early summer, nearly 400 cases were beyond national standards that recommend the bulk of death cases should take no more than 90 days between autopsy and the completion of the report required to get a final death certificate, Sheriff Steve Freitas said.

The backlog has delayed some criminal proceedings and the Sonoma County District Attorney’s review of deaths involving law enforcement and the jail, but the vast majority of cases involve people who died outside of hospitals and require a forensic pathologist to determine cause.

A final death certificate can be critical for closing bank accounts, accessing retirement plans and handling other estate matters after a death. While some institutions will accept a preliminary death certificate, others require a cause of death be known. For some survivors, finding out how a loved one died is a crucial step in the grieving process.

Freitas admits that making families wait many months or, in some cases, a year to get a death certificate is not how he wants the Coroner’s Office to operate.

Though he became aware of the problem in 2012, it took nearly two years and a grand jury inquiry before his office hammered out a plan to start clearing cases with Forensic Medical Group Inc., or FMG, the Fairfield company that it has hired to provide forensic pathologist services.

“You learn the most from mistakes,” Freitas said.

Resolving the backlog has been among the top priorities for the Sheriff’s Office this year, spurring many “uncomfortable phone calls and emails from me” to FMG, Freitas said.

Facing the threat of a possible lawsuit or fines imposed by the county, FMG has agreed to clear the backlog before the end of January 2015. FMG president Dr. Kelly Arthur-Kenny, who has served as Sonoma County’s chief forensic pathologist since 2006, said she expects to be done well before that time.

Complex factors cited

FMG provides the primary forensic pathology services for six counties, including Sonoma, and assists in an additional 12 counties. It has three full-time doctors, including Arthur-Kenny, and one part-time doctor.

The root of the backlog is a complex set of factors including a national shortage of forensic pathologists, a series of time-consuming death investigations and allegations of mismanagement on both the part of FMG and the Sheriff’s Office.

The Sheriff’s Office and FMG don’t agree on all of the factors.

Cases began piling up toward the end of 2011, according to Arthur-Kenny and coroner staff. This year, the backlog reached about 400 cases, Arthur-Kenny and coroner staff said. The oldest death still pending is from April 2012; however, most have been completed through summer 2013, according to the doctor. By mid-September, the doctor said, she had reduced that list to fewer than 250 cases.

Arthur-Kenny said that she accepts some responsibility for the backlog because when cases started piling up, she didn’t speak up.

“I wasn’t being reasonable with myself or with them,” she said, referring to coroner staff. “They’d say, ‘We need this,’ and I’d always say ‘yes.’ I’ve stopped doing that because it only led to disappointment.”

Cases already were taking longer when several factors collided in 2012 and put the backlog into overdrive, according to Arthur-Kenny.

FMG lost one of its full-time doctors, Dr. Mark Super, who took a staff job with Merced County, although he still fills in with FMG from time to time. Sonoma County’s five-year contract with FMG, signed in 2012, called for 1.5 forensic pathologists to handle the county coroner’s workload. Arthur-Kenny said she had trouble recruiting someone to fill Super’s shoes and attempted in the interim to do the work herself because the company’s other two doctors already had full caseloads.

Arthur-Kenny also said the coroner lost two staff positions in 2012 because of budget cuts, putting more work on the doctor’s plate, such as requesting medical records, getting X-rays and other office work - a claim disputed by the Sheriff’s Office.

Sgt. Greg Stashyn, who runs the Coroner’s Office, said his office lost a community service officer and a clerical position but gained a forensic assistant and shuffled work responsibilities among staff to make do. His supervisor, Lt. Carlos Basurto, said he doesn’t know if the doctor took it upon herself to take on extra work during that time, “but to say she had to because of cutbacks, that wasn’t the case.”

Arthur-Kenny said the backlog was compounded by a high volume of “unprecedented … complex and high-profile cases.”

It started with a series of pedestrians struck by motorists in 2011 and 2012, she said. Then in 2013, the Coroner’s Office handled nine homicides and four officer- involved deaths, including the Andy Lopez shooting, and a triple homicide in Forestville.

“We have lists of cases to complete, but the problem with the list is, it is always changing,” Arthur-Kenny said.

Pathologists in demand

Both Arthur-Kenny and Freitas said they’ve had trouble recruiting forensic pathologists to help deal with the caseload.

Nationwide, there are 500 full-time forensic pathologists but “projections suggest that 1,000 are needed to provide adequate coverage,” according to a 2012 report funded by the National Institute of Justice.

The Sheriff’s Office has spent the past year trying to find a forensic pathologist to supplement Arthur-Kenny’s work. A contract was signed with United Forensic Services, based in Novato and run by Dr. Joseph Cohen, in July 2014, but the company still is trying to hire a forensic pathologist to start the work.

The Sonoma County Coroner’s Office handles about 1,600 deaths each year, an average that has remained fairly steady for the past five years, Stashyn said. The majority of cases are deaths reported to the Coroner’s Office that don’t require the services of a forensic pathologist. For example, a doctor will sign a death certificate but because the person who died hadn’t been to visit a doctor within the past 20 days, a coroner detective reviews the case.

Just under 400 deaths go before a forensic pathologist each year. The vast majority - about 90 percent, or about 360 cases - are fairly straightforward deaths from disease or other natural causes, Arthur- Kenny said. They are cases involving people who died outside of hospitals and don’t have a recent medical history that would enable a primary care doctor to sign off on a cause of death. A typical example is a man in his 60s who died in his sleep but hasn’t seen a doctor in the past five years, Arthur-Kenny said.

Of those 360 deaths from natural causes, about 75 percent, or 270 cases, require a full autopsy that includes cutting open the body for an internal examination. For the remaining 25 percent, or about 90 cases, an external inspection is all that’s needed.

The remaining 40 cases of the 400 take up the bulk of the doctor’s workload. They include homicides, vehicular deaths and in-custody and officer-?involved deaths.

Different cause of death

Lost in the mix of that backlog was the death of Harenberg-Miller’s husband, retired Sonoma State University professor Louallen Miller.

It was 4 a.m. Jan. 10 when Harenberg- Miller awoke and wondered why her husband wasn’t next to her. She found Miller outside their Petaluma home in the hot tub, where he would often soak before coming to bed to ease the effects of insomnia. He was unresponsive, and paramedics pronounced him dead.

Days later, Harenberg-Miller said she was told the forensic pathologist had found some evidence of heart disease and a heart attack was likely. They would wait for toxicology tests to finalize their findings. Time passed, and she started making regular calls to the coroner.

“They’d say, ‘Call again in two weeks.’ I would, I started logging it down,” ?Harenberg-Miller said. “After two or three months, there were a couple times on the phone I was close to hysterical.”

Without a final death certificate, she couldn’t put their house in her name, couldn’t transfer or access her husband’s bank or retirement accounts. The phone bill, vehicle titles, utility service, car insurance, all were in her husband’s name. At one point, stacks of paperwork covered her living room floor.

“In the beginning you’re on adrenaline, ‘I can get through this,’?” she said. “But once the time has gone, for me, it was overwhelming. I would look at the stack of papers and say, ‘I can’t even make a phone call.’ I couldn’t do it.”

Then in July, she received a call from coroner staff telling her a final death certificate was ready. The woman on the phone asked if she wanted to know how her husband died.

Harenberg-Miller said yes and was taken aback by what she heard.

The forensic pathologist found that he didn’t die of a natural disease but rather had drowned after a sleeping pill made him drowsy in the tub.

“When the final cause of death differed so much from the implied cause of death, you’re right back where you were a week after he died,” Harenberg-Miller said. “Emotionally, you’re at the same point, only you’re six and a half months in. I had to pull it together.”

Family still waiting

Lance Ratto said the wait has been very stressful on his family, too. After several months, a coroner’s investigator provided his family a letter stating there had been no “foul play” involved in his brother’s death and that he died of natural causes. The letter was an attempt to help the family close out Dean Ratto’s estate.

“It was sufficient for the DMV and dealing with his car. That paperwork is not sufficient for banks to proceed with processing of the estate,” Lance Ratto said.

About two months ago, he was told by the Coroner’s Office his brother’s report was put on a priority list to be finished. They’re still waiting.

Freitas said he’s received about 10 formal complaints from people waiting for final death determinations.

A complaint made to the Sonoma County grand jury regarding the county’s contractual arrangements with FMG launched an investigation for the fiscal year that ended in June. It was the first investigation into the Coroner’s Office to be done since 1999 by the panel of citizens charged with reviewing local government operations.

The sheer number of backlogged final autopsy reports was a red flag for the grand jury, which called it a sign the Sheriff’s Office lacked effective management of the Coroner’s Office and oversight of FMG.

According to the grand jury:

For 2010 and 2011, one autopsy each year was incomplete.

For 2012, 286 reports were completed and 110 were incomplete.

Through November 2013, 104 reports were finished and 244 were not.

The investigation found sheriff’s administrators could have improved the backlog by imposing a 2 percent fine each day per late report - a repercussion already in the current contract with FMG.

Jurors noted stacks of boxes lining the floor and walls in a downstairs area of the morgue indicated a lack of appropriate storage, and outdated software used by the office had added to the delays.

In his formal response to the jury, Freitas disagreed with much of the panel’s findings. Freitas said the boxes represent the uncompleted case files and once the backlog is gone, they will be moved to proper storage. He noted efforts were underway to use a better software program but said the current system hadn’t added to the delay.

Freitas partially disagreed with the criticism regarding a lack of oversight, saying Coroner’s Office staff as far back as January 2013 had brought the problem to the attention of Arthur-Kenney and began trying to figure out solutions, including extensive efforts to hire another doctor.

Admonitions of Arthur-Kenny continued, including an April 2014 meeting where she was cut off from further autopsies, unless urgently needed, in an attempt to focus her completely on the unfinished reports.

In May, county attorneys got involved and have been negotiating with an FMG attorney. Sonoma County is now withholding payment to FMG by 30 days. If FMG doesn’t clear the backlog by the end of January 2015 as agreed, it will start imposing fines for late reports. Going forward, any new contract will establish a split payment plan for autopsies and then for final reports.

Options of fining, suing or dumping the company have been considered, but are unrealistic, Freitas said, because the company could go bankrupt or it would leave Sonoma County’s dead without a trained autopsy doctor.

Arthur-Kenny said the company met with the Sheriff’s Office in January 2013 to discuss solutions to the problem. “And there is only one solution to fix it: The addition of a forensic pathologist,” she said.

Court proceedings stalled

District Attorney Jill Ravitch said the backlog has delayed some court proceedings. She noted one case for which the statute of limitations has passed while they waited for the coroner’s report, meaning prosecutors can no longer seek a misdemeanor charge, leaving them with only two possibilities: File felony charges or nothing.

“Any time there is a delay in the opportunity to review a thorough investigation, it’s justice delayed, not only for the victims but also for the individual who may have been a suspect,” Ravitch said.

As of mid-September, the District Attorney’s Office was waiting for autopsy reports for several cases, some dating back to early 2013 and including three reports for fatalities involving law enforcement, such as deaths in the jail.

Sonoma County Public Defender Kathleen Pozzi said the delay has pushed trial dates into the future. She said defense attorneys have been given no explanation for the numerous delays in getting the reports - which often are key pieces to a homicide case and trial.

“It is quite ridiculous how long it is taking for autopsy reports to be completed and come in,” Pozzi said. “Some are well over a year after the defendant has been arraigned on murder charges and the cause of death is not an issue.”

In its response to the grand jury report, the Sonoma County Board of Supervisors said it felt Freitas and the Sheriff’s Office were on top of the issue.

Supervisor David Rabbitt said he’s received a few calls about the backlog, including one from a funeral director concerned about the number of families waiting a long time for death certificates.

“It’s frustrating. I can only imagine, you’ve lost a loved one and you’re waiting for insurance purposes, or whatever reason, before going forward … something that takes months and months and months to get sorted out,” Rabbitt said.

“The county is walking a fine line. We don’t have a lot of alternatives,” he said.

Staff Writer Elizabeth M. Cosin contributed to this report. You can reach Staff Writers Julie Johnson at 521-5220 or julie.johnson@pressdemocrat.com and Randi Rossmann at 521-5412 or randi.?rossmann@pressdemocrat.com.