Behind The Curtain At Maine’s Medical Examiner’s Office — Named One Of The Nation’s Best

May 30, 2018

Maine’s medical examiner’s office has been named one of the best in the country. The pronouncement from the National Association of Medical Examiners came earlier this month in the form of full accreditation — a major accomplishment for an agency that was struggling with a backlog of cases just a few years ago.

The Office of the Chief Medical Examiner is in a small brick building in Augusta, tucked back from the street. This is where the staff conducts about 300 autopsies a year.

“We’re now standing in the main autopsy suite of the Office of Chief Medical Examiner. We can see how clean it is, how dignified it is,” says Dr. Mark Flomenbaum, the chief medical examiner, a post he has held for the past three and a half years.

It’s a space built for function. Bright lights shine down on two metal exam tables, each outfitted with surgical instruments, scales, sinks and cameras.

“We wear masks and gloves, not because we’re afraid of infecting the patient, it’s because we don’t know what we’re dealing with,” he says.

Flomenbaum holds up a pair of metal woven gloves.

“They’re basically chain mail. Every case I do I have gloves under these and over these. As you can see, they’re impossible to be cut with a scalpel or knife,” he says.

Chain mail gloves used by Dr. Mark Flomenbaum during autopsies.
Credit Patty Wight / Maine Public

Autopsies can take anywhere from a couple of hours to a couple days. It’s careful work, in part to preserve each body for open casket viewing, but also to find answers.

“I am the voice of the dead person,” Flomenbaum says.

When he and his team examine an unexpected death, they try to uncover a story of sorts. They want to find out not only why a person died, but also what the body tells them about the person’s life and how that information might help others.

“That’s why this office exists. We’re really trying to extend quantity and quality of life based on circumstances of why people died,” Flomenbaum says.

Upstairs in his office, Flomenbaum opens a file cabinet.

“I have in front of me the numbers from 2015, 2016 and, now, from 2017. And the manners of death — certainly accidents double the naturals,” he says.

Some of those accidents include a spate of co-sleeping deaths a few years ago, when five infants died. Flomenbaum and Attorney General Janet Mills issued an advisory to parents, and co-sleeping deaths went down.

Drug overdoses also account for many of the deaths his office investigates. Though the number reached an all time high last year at 418, Flomenbaum says his office has provided vital information about who is dying and from what substances.

“I can guarantee that if we were not doing surveillance, the numbers would easily be close to at least double,” he says.

That surveillance isn’t just from autopsies. The medical examiner’s office reviews a total of about 3,000 deaths a year. About half of those are accepted for investigation, and several hundred require full autopsies.

A few years ago, all of that work translated into a backlog of cases that stretched for months. Flomenbaum says a combination of hiring more staff, increasing efficiency and some longer hours put in by his team helped reduce that backlog to zero and achieve accreditation earlier this year.

“We are, I think, among the finest people, because we do things no one else either wants to or can do, but absolutely need doing,” he says.

But Flomenbaum admits that sometimes the work can take a toll.

“Some of the most difficult cases, as I’m sure you’re aware, are child abuse cases. And after a few of them, people have asked, doesn’t it get easier? Don’t you get desensitized? And my response is absolutely the opposite. If anything, makes me more sensitive, and makes me want to fight even harder to make sure these issues are addressed properly,” he says.

Flomenbaum says some of the most rewarding moments of his work are when he can help grieving family members find some solace after a loved one’s death.

“For me to be able to say that there was nothing you could have done. And somehow the sense of imaginary guilt just dissipates and they’ll break down crying, and I feel like I’ve returned some citizens back to functional people,” he says.

Flomenbaum is planning to make further improvements to the Office of the Chief Medical Examiner, including a new facility, which he says played a role in winning accreditation. It’s the first time the office has achieved that status since accreditation was first possible, about two decades ago.

This story was originally published May 29, 2018 at 5:38 p.m. ET.