SF Medical Examiner Reviews First Year, Previews New Site

San Francisco's chief medical examiner is approaching his first anniversary on the job, during which his agency cut a huge backlog, as the office prepares to open a new, larger facility at 1 Newhall Street in 2017.

Dr. Michael Hunter, 49, took over the medical examiner's office March 30. Since then, the agency has made tremendous strides.

"There was no secret that a huge number of cases weren't getting turned around in a timely fashion," Hunter, who is straight, said in a recent interview at the medical examiner's office, which is tucked away in the back of the Hall of Justice at 850 Bryant Street. The pile of cases often meant long delays for families who had to wait for information about what happened to their loved ones.

Hunter said that now, "there's a sense of a normally functioning office," and "the phones aren't ringing like they were when I first got here," with people looking for death certificates and other information.

According to the National Association of Medical Examiners, 90 percent of reports should be completed within 90 days.
Chief Medical Examiner Dr. Michael Hunter. Photo: Kelly Sullivan

Deputy director Christopher Wirowek said 1,233 cases came into the office in 2015. Of the cases that came in in the first quarter, just before Hunter joined the agency, about 71 percent took 90 days or longer to complete. Only 6 percent were closed in six days or less. Cases that remained open commonly needed more analysis done, such as tissue that needed closer examination.

By the last three months of the year, there had been vast improvement. In the fourth quarter, just 20 percent of the cases took 90 days or more to close. During the same period, 40 percent of the cases closed in six days or less.

In all, the office closed 1,909 cases from April, just as Hunter was taking over, through the beginning of December. That included both the backlog, which stemmed in part from departing staff leaving behind open cases, and the daily cases that continued to come in, Wirowek said. (The backlog was first reported by the San Francisco Chronicle .)

Getting through the pile was "a tremendous amount of work," Hunter said.

"We had dedicated staff members putting in the time and effort" to address the problem, including doctors and administrative staff, he said.

One thing that's helped is "We finally became fully staffed," Hunter, whose total salary is $346,840, said. The agency, which has a budget of $9.5 million, has 43 staff, which includes full and part-time positions.

Prior to his current job, Hunter worked for 15 years in the Florida state medical examiner system. He replaced Dr. Amy Hart, who stepped down from the post but still works for the San Francisco agency.

According to the medical examiner's office, "Only medical examiners can investigate and sign the death certificate if a death is related to a homicide, suicide, an accident, a patient with no attending physician, an industrial related death, an unidentified person, or where there is some medical reason to consider that the death might be due to a contagious disease."

The office has started stating the manner and cause of death sooner in many cases, allowing death certificates to be issued quicker. There are cases where the cause and manner seem clear, such as where someone is hit by a car. Amendments may be added as toxicology results come in.

"We're going out with the cause of death the day of if we can," Hunter said. Having the death certificate helps families deal with insurance, the probate process, and other issues.

Besides examining deaths, the office also does the city's DUI analysis, "sexual assault workups," and other work, Wirowek said.

New Facility

During a recent tour of the medical examiner's facilities, Wirowek said, "very, very little has changed" since the 1962 opening of the building, which also houses a jail, criminal courtrooms, and the district attorney's office.

The main autopsy space is almost completely occupied by five white, decades-old autopsy tables. Hunter said it's "a difficult place to do autopsies." If there are four doctors working on bodies simultaneously, along with other staff, "we fall all over ourselves."

The new facility's main autopsy suite will include six autopsy stations, along with separate suites for decomposition, forensic anthropology, and other types of autopsies, according to project manager Magdalena Ryor, who's with the city's public works department.

The agency's current space is 26,000 square feet. The new facility, for which the budget is $65 million, will be twice that, giving staff more space to do the work, and more room for bodies.

Hunter said with the current site it "would be very difficult for us" to handle "a mass fatality situation." The new space is designed to hold 477 bodies, which is many times what the current space can handle.

The Newhall site will also include improvements for grieving families. The current space's viewing room, where grieving family and friends can identify bodies, isn't much bigger than a walk-in closet.

Hunter noted the "somewhat claustrophobic" room is "not a pleasant environment."

Even before the move to the new site, the medical examiner's office already has some new equipment. In December, the agency got a new X-ray machine, with help from the mayor's office. Hunter said the previous machine, which dated from 1974, was "very, very antiquated, but it did the job." The new machine can do a full body scan in 13 seconds.

"It really helps us out," Hunter said.

He also said, "We create a lot of data," and the office has been working to "make sure our data gets utilized."

The agency has been working with other city departments as part of a homeless death review committee. That effort "gives you a really good idea of what's happening in the community that ultimately leads" to the deaths of many of the people whose bodies come to the agency, Hunter said.

The office is responsible "for indigent remains," Hunter said, and Wirowek said that includes people with no families, or people whose remains have been "abandoned." In those cases, he said, "We become their family. We have to take care of their remains."