It is the last legal requirement before a body can be sent to a funeral home---a death certificate, and in the case of skyrocketing fatal opioid overdoses, it can tax the state's team of forensic pathologists.
At the Office of the Chief Medical Examiner in Baltimore, pathologists already average an autopsy per day not counting the weekends, and there is concern the office could lose its accreditation if the load keeps growing.
Deputy Secretary of Public Health Dr. Howard Haft says overdoses are driving the overload and that's where the solution to the problem lies.
"Our number one initiative, our number one hope is that we can take the pressure off of the Office of the Chief Medical Examiner by reducing fatal overdoses, and we're doing absolutely everything we can to achieve those goals," said Haft.
The effort includes distributing more Naloxone, more substance abuse treatment and less exposure to prescribed opioids to begin with.
While some suggest more overdose deaths may require more autopsies and people to perform them, Haft says Maryland must break the recent trend.
"Sadly, I think that deaths from opioid overdoses now have risen to the fourth leading cause of death in our state,” said Haft. “That's horrible. So the answers are not found in increasing the number of people who are doing autopsies. That's a temporary measure. What we want to do ultimately is reduce the deaths from opioids."
While some fear medical examiners risk losing their accreditation, and prosecutors have expressed concern that overworked pathologists may produce less reliable autopsies that could be challenged in criminal proceedings, haft remains confident in their work.
"I think autopsies are done in a rigorous way and I'm quite proud of the fact that our Office of the Chief Medical Examiner led by Dr. Fowler is among the best in the country,” said Haft. “It's nationally renowned, and they don't scrimp or do a shoddy job on anything. Everything they do is absolutely first class."
While some may question the need for an autopsy in obvious overdose cases, experts say the toxicology tests are essential to spot tainted drugs that could cause a widespread loss of life. In other words, they can't afford not to.