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The Coroner’s Office Time to Build for the Future
THE CORONER’S OFFICE
Time to Build for the Future
BY CHRISTINA VANDEPOL, M.D.
Ahealthy young woman becomes ill while working from home in 2020 and dies within hours of being brought to the Emergency Room. She does not have COVID. A husband and father in his early fifties is found dead at home at the end of a trail of blood. A high school athlete collapses during a workout and cannot be resuscitated. A pregnant woman goes into labor and dies in the ambulance en route to the hospital. A frail elderly woman dies within days after a fall at a nursing home. Each case is referred to the Chester County Coroner’s Office (CCCO), which is tasked with determining the cause of death, how it happened, and whether or not there was criminal intent or neglect in these and thousands of other deaths every year. Headed by an elected official, the Coroner’s Office is an independent county government agency, but its budget and resources are determined by the County Commissioners. As Coroner, I found the resources available to the CCCO, especially the infrastructure, grossly inadequate and outdated for the needs of a county of over 525,000 people. Despite years of lobbying, little changed during my four years in office.
In a previous article in this magazine (VandePol, 2019) which reviewed the 334 years’ history of the CCCO, I decried the fact that the office had “failed an accreditation audit in June 2019 because of the dismal state of its morgue and autopsy space.” In response, Dr. Donald Harrop, Chester County Coroner from 1966 to 1990, wrote a Letter to the Editor of this magazine in Fall 2019, urging that “we need to provide active physician leadership on...establishing a proper facility to continue to professionalize the Coroner’s Office.” He recounted how, decades ago, Chester County physicians advocated for a county health department in the face of vehement opposition from the County Commissioners and some other elected officials. The physicians, including Drs. Bob Poole, Bill Limberger, and of course Dr. Harrop himself, succeeded in getting the decision on a county-wide ballot, which voters then approved. The Chester County Health Department was formed, and County Commissioners now tout its accomplishments and benefits to the community. Perhaps history will repeat itself if Chester County finally constructs the infrastructure necessary to bring our Coroner’s Office into the 21st century.
Has the COVID-19 pandemic, which has taken over 1,000 lives in Chester County, brought any changes to the Coroner’s Office since the June 2019 audit? Let’s go back (reluctantly) to March of 2020, when the first COVID-19 death was reported to the CCCO. In April 2020, as the death count climbed at an alarming rate, hospitals, nursing homes, funeral homes, and the Coroner’s Office scrambled for morgue space. Chester County had no county morgue so the CCCO had been dependent on limited donated morgue space in our hospitals. Hospital deaths took priority over Coroner cases for morgue storage though, and cross-contamination between hospital staff/patients and CCCO staff/decedents was a constant worry. The lesson learned was that hospitals are not a good location for coroner operations. Recent hospital closures further highlight the risk of depending on forprofit facilities to provide infrastructure for public services.
With little to no access to hospital morgues during COVID-19, the CCCO had to arrange for body storage at private funeral homes. To address this emergency need, in May 2020 the county used funding from the Coronavirus Aid, Relief, Economic Security (CARES) Act to quickly construct refrigerated storage space in an existing county maintenance structure. This temporary fix, which consists of 12 refrigerator and 3 freezer spaces, remains in use at this time, but it is not a long-term solution because it lacks privacy, adequate security, or space for projected increases in
caseload. CCCO’s major functional areas are now scattered across three locations, with offices in one building, the temporary morgue in another, and an autopsy lab (Figure 1) at Chester County Hospital. This logistical inefficiency saps time, money, and energy.
In 2020, as the temporary morgue was put into use (Figure 2), the county contracted with Crime Lab Design (CLD), an internationally-known planner of modern forensic labs (Figure 3), to perform a Needs Assessment for a centralized coroner forensic facility. The Needs Assessment (Crime Lab Design, 2020) concluded that the CCCO facilities were “decentralized, outdated, and insufficient for current and projected operations.” A centralized facility of 20,000 square feet, which would include administrative offices, refrigerated morgue capacity for up to 120 decedents (including surge capacity for mass fatalities), and at least three autopsy stations was recommended. An example of a modern forensic facility can be seen in Figures 3 and 4. The estimated construction cost at that time was approximately $15 million for a facility that would serve the county for at least 30 years. This capital investment will save taxpayers money in the long run by eliminating current inefficiencies, bringing costly outsourced services like autopsies in-house, reducing the risk of injury to county employees, and achieving energy savings through green building design. The August 2020 report recommended new construction on county-owned land at the Public Safety Training Campus in South Coatesville. In early 2021, CLD provided the county with additional assessments of the feasibility of retrofitting two commercial properties available at that time.
In December 2021, Chester County included $2 million in the proposed 2022 capital investment budget for a new coroner forensic facility. A county spokesperson was quoted (Rellahan, 2021) as saying that “the county ... will continue in 2022 to explore the options of purchasing a dedicated facility, or partnering with an organization that can accommodate and support the required resources.” The article noted that a coroner forensic facility had been “lobbied for by a succession of elected coroners, including outgoing coroner, Dr. Christine (sic) VandePol,” and that the proposed plans differed from the construction of a new 20,000 square foot facility on county property, as recommended in the Needs Assessment.
Where do things stand now? A call to the County Commissioners’ Office on May 6, 2022 yielded the following statement: “The County has approved a budget of $14.9 million over three years for the new Coroner’s Office facility, and locations for the new premises are currently being evaluated. The County Coroner is apprised of current location options and County facilities staff will continue to work with her office as the project moves forward.” According to the Chester County website, approximately $2 million is in the 2022 budget. Future year budget plans are shown, but budgets are not formally approved in advance. continued on next page >
The Coroner’s Office: Time to Build for the Future
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Modern autopsy suite (photo courtesy of Crime Lab Design)
Meanwhile, the receipt of $102 million in an American Rescue Plan Act (ARPA) grant offers a new funding opportunity. Allocation of the funding is to be determined by applications submitted to a County-appointed committee. The Chester County Medical Society (CCMS), recognizing the importance of coroner services to the community, has stepped up to advocate for a coroner forensic facility. Taking to heart Dr. Harrop’s call for “active physician leadership” on this issue, CCMS (2022) sent a strong letter of support to current Chester County Coroner Sophia Garcia-Jackson in support of an application to the ARPA Committee for funding the forensic facility construction.
Coroner Garcia-Jackson responded by stating that “Chester County badly needs this critical infrastructure. Few county agencies have been more directly affected by the COVID-19 pandemic than the Coroner’s Office. A successful application for American Rescue Plan Act funding could help ensure the goal of a modern coroner forensic facility. I’m very grateful to the Chester County Medical Society for their support of this application.”
The CCMS letter emphasized the many benefits of a modern centralized coroner facility to the medical community and the patients they care for, including “closer collaboration with treating physicians and hospital pathologists” when investigating why someone died, and educational and training opportunities for physicians in various stages of their education.
The Medical Society also expressed its concern that “our patients and their families be treated with dignity and respect after death.” Sudden or violent death inflicts great emotional trauma, making “a dignified waiting room and a respectful, safe viewing room for families to view their loved ones” an important element of a coroner forensic facility. The CCCO currently has no family interaction space, and viewings are not permitted due to safety, security, and sensitivity concerns.
The Coroner’s Office performs another important community function. It is the last resource for those who die unidentified or without next of kin, including veterans in our community. Without a proper facility, bodies must be cremated quickly, even while identification tests are pending or searches are still underway to find family or friends willing to make funeral arrangements. Is Chester County ready to recognize the essential public services performed by its Coroner’s Office by providing the critical infrastructure required to meet current and future public health, public safety, and criminal justice needs? Let’s not wait for the next pandemic or disaster. Let’s not rely on temporary fixes or kick the can down the road. This is the time to build for the future.
Footnotes 1. Crime Lab Design. (2020). Chester County Facility Needs Assessment, August 4. Available at https://www.chesco.org/209/ Coroner. 2. Chester County Medical Society. (2022) Letter of Support to Chester County Chester County American Rescue Plan Act Funding Committee, May 3. Pending publication, https://www.chestercms.org/ index.html. 3. Rellahan, M. P. (2021, December 12). Chester County Budget includes no new taxes but funding for a morgue. The Daily Local News. Retrieved from https://www.dailylocal.com/2021/12/12/ chester-county-budget-includes-no-new-taxes-but-funds-for-a-morgue/. Accessed May 7, 2022. 4. VandePol, C. (2019). The Coroner’s Office. Then and Now - 334 Years of History. Chester County Medicine. Summer 2019. Available at https://www.nxtbook.com/hoffmann/CCMSMedicine/ ChesterCountyMedicineSummer2019/index.php#/p/22. Accessed May 8, 2022.
