State medical examiner’s office in danger of losing accreditation, records show
The state’s chief medical examiner’s office is in danger of losing the accreditation it received just months ago, a potential black eye that its leader — fearful it could be made public — told officials should not be scrutinized by the media.
In late January, the National Association of Medical Examiners told chief medical examiner Dr. Mindy J. Hull that her office will “most likely” lose its fully accredited status after it reported it was unable to complete 90 percent of its autopsy reports within 90 days — a key standard — during an annual review late last year.
Hull argued that the slipping performance, which dropped the office’s turnaround time to 84 percent since it was last reviewed, is largely tied to “unforeseen” personal issues involving two medical examiners and the performance of a part-time worker, according to a letter she sent the association, known as NAME, on Feb. 14. The Globe obtained the letter and other records through a public records request.
In a separate e-mail to the organization’s president, Hull charged that her staff — which then had 19 full- or part-time examiners — would in fact be meeting the 90 percent threshold “if you exclude the 2 problem employees.”
Association officials told Hull that they would delay a decision on the office’s status, including whether to downgrade it to a provisional accreditation, so Hull could submit more information.
The NAME committee tasked with reviewing accreditations has yet to discuss the case, according to its chairwoman, Dr. Barbara Wolf. A spokesman for Hull said the office has not received any update on its status and defended its progress.
The medical examiner’s office “has implemented a number of operational and investigative improvements over the last year and remains focused on its mission to deliver timely information to citizens of the Commonwealth,” said Brian Merrick, a spokesman for the Office of the Chief Medical Examiner.
The accreditation program is not a requirement for public medical examiner offices; instead, it’s an endorsement that an office is meeting the “minimum standards for an adequate medicolegal system,” according to the association’s website.
But last month, Hull became so concerned about the threat to her office’s accreditation and reputation that she actively sought help from officials at the accrediting agency when she thought a local TV station would report on the developments.
Dr. Jonathan Arden, the organization’s president, e-mailed Hull on Feb. 6 to tell her that he was doing an on-camera interview with Boston 25 News, the local Fox affiliate, which ran a segment days later about families who have waited months, if not years, for the medical examiner’s office to produce death certificates for their children.
That same morning, Hull sent an e-mail to two NAME officials, seeking help.
“Dr. Arden is about to vet the [our office’s] accreditation status on Fox25,” she wrote. “I am really quite surprised by this. Any help or advice??”
In her separate exchange with Arden, Hull said she was working on providing additional data for the association, asking him to “please keep this in mind before you have [Boston 25] report our NAME full accreditation is going to be pulled after only having it a few months.” She also felt her office should not lose its accreditation, Hull wrote.
The office “is in good shape, and cleaning up many old messes,” Hull wrote. “This should be vetted by NAME not the media.”
Arden wrote that he did not intend to discuss details about the office’s accreditation, telling Hull that’s something “they really should get from you.”
The station, citing data from the office, reported that the department was meeting NAME’s 90-day standard “in all categories except for children under the age 1.” The report did not mention the office’s accreditation status.
Dr. Edward Mazuchowski — who sits on NAME’s Inspection and Accreditation committee and, with Wolf, was one of the officials from whom Hull sought help — told her in a Feb. 6 e-mail that he still considered her office fully accredited until he could update the full committee, which would decide its status.
“I agree that the media should not decide,” he said.
Mazuchowski did not respond to requests for comment.
Arden told the Globe that he notified Hull about the interview as a professional courtesy and that he did not feel pressured by her to keep information from the TV station. He said, in general, the association does not discuss individual cases or offices.
“She wanted to make sure I knew her side of the story,” Arden said. “Dr. Hull is a strong leader and a strong personality. She’s not shy. But at no time did she pressure me or threaten me or try to tell me what I could or couldn’t say.
“I don’t go to the chief medical examiner and say, ‘What do you want me to say?’ ” he said.
Merrick, the chief medical examiner’s spokesman, did not address questions about Hull’s exchange with Arden but touted efforts to improve the office, including earning full accreditation last year for the first time. The agency is also planning to hire three additional medical examiners by July 1 and elevate a part-time worker to full-time status to help turn cases around more quickly, officials said. The office reported at the end of last year having 10 full-time pathologists and nine pathologists working part time, on contract, or as fellows to perform autopsies.
Gaining the accreditation has been a years-long goal of the chief medical examiner’s office, which has historically struggled to complete timely autopsy reports. The office completed them within the 90-day window just 58 percent of the time in the two years before Hull took over.
When the office finally earned “full accreditation through December 16, 2022,” according to a press release, Governor Charlie Baker called it a “milestone.” That review was based, in part, on data detailing its turnaround time over three months at the end of 2017 and the beginning 2018.
“My goal now,” Hull said at the time, “is to showcase the world-class forensic pathology institution that we are.”
The office, however, has helped improve its performance by routinely forgoing autopsies in favor of less-rigorous testing to investigate deaths, including some of the hundreds of suspected fatal overdoses across the state.
And when the office came up for an annual review in December, the news was mixed at best. Hull reported that the turnaround time had begun to lag, citing the “legitimate personal issues” that two employees juggled and the “sporadic” performance of the part-time contractor. She also said there was “no improvement” on completing reports within a tighter, 60-day window.
Documents the office submitted as part of the review also noted that given the information it submitted, the office would qualify for “provisional” status, not full accreditation.
Mazuchowski wrote in a Jan. 21 e-mail to Hull that the office would “most likely” lose its status as a result, though it could be restored once the problems were “rectified.”
The possibility appeared to catch Hull off guard.
“I did not at all realize our full accreditation would be in jeopardy so early in this process, particularly with the remarkable demonstrable process we have made,” Hull said.
In praising Hull for the “hard work” she had done, Mazuchowski said he was fine with delaying any decision and requested additional documents, including the office’s 2017 annual report.
Hull provided it, and in the letter to NAME last month, also asked for another chance.
“We would implore NAME to allow us another annual review period to truly show the continued positive direction that the OCME is headed,” Hull said. “The negative reputational and societal impacts that a reduction in accreditation status would have on our office are large, and, in our opinion, undeserved.”