Why Toxicology is So Slow
Unlike TV, real life medical examiners take weeks, even months, to establish a cause of death.
Slate recycles an old Explainer piece on “What Makes Toxicology So Slow?”
The piece was published a couple years back on the occasion of the death of Kanye West’s mother and is being renewed in the wake of Whitney Houston’s untimely death. Those who grew up on TV shows where forensics experts establish a cause of death in 15 minutes are shocked to learn that it takes several weeks–if not months–to get back a simple toxicology report in real life.
The answer is that, in real life, there are multiple cases going on simultaneously and very limited staff and lab resources to handle them.
Because there’s a backlog. Analysts typically work on multiple cases at the same time, and they’re always behind schedule due to staff shortages. For example: The 20-person team at the Washington state toxicology lab, which will handle the Tamayo-Fajaro screening, handles approximately 10,000 cases per year. To make matters worse, toxicologists often serve two masters; when they’re not in the lab, they’re at court offering expert testimony. In Washington state, lab scientists may spend as much as two days a week on the witness stand while their blood samples languish in a refrigerator.
Thorough tox reports require lots of effort. First off, labs try to collect at least 25 mL of heart blood, 10 mL of peripheral blood, and 50-gram tissue samples from the subject’s brain, liver, and kidney. An analyst then carries out an alcohol screening and a generalized immunoassay test, which can detect broad-based drug groups like opiates or tranquillizers. In the event of a positive drug test, the analyst must complete a confirmation procedure, designed to ferret out the exact nature of the offending substance. Next, a supervisor reviews the analyst’s report and either approves the conclusions or requests more tests. This whole process, barring glitches or lengthy tests for hard-to-detect drugs like neuromuscular blockers, could take just a couple of days ifanalysts were able to devote themselves exclusively to a well-preserved specimen. (They rarely get this opportunity.)
Not every case proceeds up the lengthy toxicology queue in the same amount of time. Labs handle screening requests for living as well as deceased subjects, and the living get first priority. Some evidence gets rushed to the top of the list because of an upcoming court date or because it might shed light on an ongoing investigation.
I’m currently caught in this backlog following the death of my wife over the Thanksgiving weekend. It’s been ten weeks now and I’m still waiting.
Aside from the obvious closure issues, there’s a huge practical effect to this backlog: Without a completed toxicology report, there is no final death certificate. Without a final death certificate, insurance companies won’t pay off on life insurance policies. Indeed, they won’t even start processing the claim without one.
In my own case, I’m fortunate enough to be making a decent living and to have accumulated a decent amount of savings. But for a stay-at-home parent who has lost their breadwinner–or even a struggling family who lived paycheck to paycheck and depending on both partners bringing in money every two weeks–this inordinate wait can be financially devastating. People are surely losing their homes, having cars repossessed, and ruining their credit ratings trying to get by in the meantime.
Given that this is a problem created by government, it’s one that has to be solved by government. The most obvious–but prohibitively expensive–solution is to radically ramp up the government’s capacity to do toxicology analysis. A related–but probably even more expensive–solution would be to outsource the job to private industry. The cheapest solution would be to mandate that insurance pay off based on the preliminary death certificate absent strong reason to suspect suicide or foul play.
Laboratory glassware image via Shutterstock