LONGVIEW — The Cowlitz County coroner’s office hit over twice its contracted annual cap in autopsies in 2023, so commissioners recently increased the number of autopsies performed by the office’s forensic pathologist by a dozen more.
So far in 2024, the coroner’s office has performed 36 autopsies — just 12 shy of reaching the contract’s max in the first quarter of the year.
Due to the rise, Cowlitz County Commissioners increased forensic pathologist Cliff Nelson’s cap from 48 to 60 in February.
Last year, the office performed more than 2.5 times the autopsies done two years prior. The coroner’s office performed a total of 97 autopsies in 2023, 63 in 2022 and 38 in 2021.
Cowlitz County Coroner Dana Tucker told commissioners in June the county was having to perform far more autopsies in 2023 than 2022 because of an increase in drug overdoses and decedents without medical history.
However, drug overdoses last year lowered compared to the year before. The final number of drug-related deaths in 2023 was 49, down from 65 in 2022, but the number of fentanyl-related deaths specifically increased from 18 to 42. The office saw a higher number of accidental deaths in general in 2023, Tucker said.
If the office suspects drug use but the decedent does not have known medical issues, they will do an autopsy to determine if the death was caused by drug use or by a previously undiagnosed medical issue, Tucker said.
“If you only rely on a positive drug test, those quantitative amounts may not come back high enough to have killed them,” Tucker said. “Then you are at a loss on what happened. Our job is to find cause and manner for the families and the decedent.”
In the majority of cases, an autopsy is not necessary; the office had jurisdiction over 1,077 deaths in 2023, meaning that fewer than one tenth required an autopsy.
Along with performing their own autopsies, the office also assists other counties with their autopsies in 40 cases due to a nationwide shortage of pathologists. Cowlitz County is the only Washington county with a dedicated professional to perform autopsies, Tucker said.
“The lack of pathologists in Washington state has made it difficult for other counties, especially on the mid to east side of the state, leaving them to rely on the few of our offices that are set up and able to accommodate them,” Tucker said.
While most counties contract with pathologists on a case by case basis, Cowlitz County pays Nelson a flat fee to perform a certain number of autopsies per year. Once that cap is exceeded, Nelson can choose whether to continue assisting and charge a fee per autopsy if he does.
This arrangement helps save the county money because it locks in a low per-autopsy cost and does not leave them vulnerable to price fluctuations, Tucker said. At $120,000 per year, the county will pay $2,000 per autopsy until they hit the cap of 60 autopsies. Other Washington pathologists can charge between $2,100 and $4,800 per autopsy depending on the type.
Under Washington law, the state reimburses 40 percent of the cost of each autopsy, or 100 percent for autopsies of children under 3. A bill passed in 2021 requires coroner’s and medical examiner’s offices to be accredited under national or international standards by July 1, 2025, to receive the full reimbursement. The Cowlitz County recently renewed their accreditation with the International Association of Coroners and Medical Examiners.
