Autopsy backlog plagues Mississippi, with worst delays in US

An Associated Press analysis has found that Mississippi has long operated in violation of national standards for death investigations, accruing a severe backlog of autopsies and reports

After Truitt Pace admitted to law enforcement that he beat and shot his wife, her family expected a swift conviction. The 34-year-old mother of three’s tiny frame was so bruised and traumatized that the funeral home suggested a closed casket. But as months went by, state prosecutors told Marsha Harbour’s family they were waiting on a key piece of evidence: the medical examiner’s autopsy report.

National standards recommend most autopsy reports be completed within 60 days. Prosecutors in Harbour’s case waited for a year.

Across Mississippi, many families wait even longer. An Associated Press analysis based on state data and documents, as well as dozens of interviews with officials and residents, found that Mississippi’s system has long operated in violation of national standards for death investigations, accruing a severe backlog of autopsies and reports.

Autopsies that should take days take weeks. Autopsy reports that should take months take a year or longer, as in Harbour’s case. Too few pathologists are doing too many autopsies. Some cases are transferred hundreds of miles to neighboring states for reports without their family’s knowledge.

The office was waiting for about 1,300 reports from as far back as 2011, records sent to AP in early April show. Around 800 of those involve homicides — meaning criminal cases are incomplete.

District attorneys have resigned themselves to long waits: “We’re at a point now where we’re happy if it’s only a year,” said Luke Williamson, who's been a prosecutor for 14 years in northern Mississippi.

The National Association of Medical Examiners, the office that accredits U.S. death investigations offices, dictates that 90% of autopsy reports should be returned within 60 to 90 days.

Mississippi’s office has never been accredited. The majority of U.S. medical examiner agencies, which are chronically underfunded and face a shortage of forensic pathologists, are unaccredited. States such as Georgia have raised the alarm about autopsy report delays of up to six months. But nowhere is the issue more severe than in Mississippi.

Mississippi’s delays are an “emergency-level” concern, said Dr. James Gill, the association’s 2021 president and a leader in the College of American Pathologists. “That’s a disaster situation where you need to do something drastic.”

Public Safety Commissioner Sean Tindell is a former Mississippi Court of Appeals judge who stepped into his role — overseeing the state medical examiner’s office, the highway patrol and other agencies — in May 2020. He called the backlog “unacceptable” and said he's made eliminating it the top priority of his administration. He said working as a judge, he saw how trials were delayed while prosecutors awaited reports.

“I knew it was bad,” he told the AP. “I didn’t know it was this bad.

“Families deserve better. I'm sorry that they've had to experience delays in laying to rest loved ones, to getting closure in these cases, but we’re going to fix the problem.”

Tindell said he’s instituted a policy that all reports must be back within 90 days. Using contractor pathologists in other states, the office began working to whittle down the backlog. Tindell said around 500 cases have been completed since summer.

But Tindell — who has hired two new pathologists, started university recruiting efforts and streamlined staff duties — said it’s been a challenge trying to fix old problems while facing new ones: the pandemic and an unprecedented increase in violent crime.

Mississippi saw 597 homicides in 2021 and 578 in 2020 — record numbers for the state of 3 million. That’s compared with 434 in 2019 and 382 in 2018.

Arkansas, with a similar population, had 347 homicides in 2021 and 386 in 2020.

From 2020 to April 2022, Arkansas has employed five to seven pathologists performing autopsies. Mississippi has employed two to three, as people left jobs.

Tindell said both the forensics laboratory and medical examiner's office haven't been a state priority for funding or staffing in over a decade. The forensic laboratory's budget has essentially remained unchanged since 2008.

But during Mississippi's 2022 legislative session, lawmakers approved $4 million that must be used to address backlogged cases.

Like most states, Mississippi does not perform an autopsy — a post-mortem surgical procedure by a forensic pathologist to determine cause of death — for all people. Autopsies are reserved for homicides, suicides, deaths of children and those in correctional facilities, and other unexpected cases. Forensic pathologists are responsible for performing autopsies at Mississippi’s two medical examiner offices — one in the Jackson metro area, one on the coast.

After the autopsy, pathologists complete a report explaining their findings and results, including an official cause of death. Reports can help determine whether a death was an accident, a suicide or a homicide. They shed light on child deaths, or show whether a person accused of murder acted in self-defense.

In 2017, 93-year-old World War II veteran Durley Bratton died after two employees of a Mississippi veterans home dropped him and put him back in bed without telling anyone. Police began an investigation after a tip from the hospital where Bratton was taken.

Arrests didn't come until 15 months later, after the autopsy report was returned, concluding the veteran died of blunt-force trauma.

In the Harbour case, the autopsy report was the critical piece of evidence after Pace claimed self-defense for shooting his wife.

At the December 2021 trial where Pace was sentenced to life in prison, a medical examiner said Harbour suffered from blunt force trauma wounds consistent with being beaten before she was shot.

Harbour, who helped deliver babies as a surgical technician at a local hospital, had endured months of abuse. She once went to a domestic violence shelter. But she worried for her children's safety and never went to the police.

Because Pace had no criminal record, he was released on bond days after his arrest.

Harbour’s stepmother, Denise Spears, said she and her family felt dejected as they went to the mailbox month after month to find notices that the trial was being pushed back. Once the report came in, the trial was delayed further because of the pandemic. Pace didn't stand trial until more than three years after killing his wife.

One of the worst parts was explaining to her grandchildren why the man who killed their mother was able to live free for years, Spears said. More than once, they came to her, afraid they’d run into him.

“They couldn’t understand it,” Spears said. “It was hard for me to explain to them, because I couldn’t understand it either.”

Ben Creekmore, a district attorney in northern Mississippi, said conversations with families about delays are always difficult. He worries about the impact the postponements have on trust in the criminal justice system.

“Those things dramatically impact our relationship with people who have suffered loss,” he said. “It undermines your credibility on everything else.”

Beyond effects on criminal cases, the lack of an autopsy report and official death certificate can prevent families from collecting benefits.

Mississippi Lt. Gov. Delbert Hosemann said he’s been contacted by families who can’t get insurance payouts without a certificate.

“One that contacted us was a mom and two children whose husband died unexpectedly,” he said during a fall budget hearing. “They couldn’t get their life insurance benefits, and that’s the only money they had.”

More than money, families can also find closure. Rebecca Brown lost her brother unexpectedly in 2018. It wasn’t until last June — three years after his death — that his report was completed.

Her brother, in his early 40s, had a history of drug addiction but was in recovery. He lived with his mother, who worried he’d started using again and had died of an overdose. When they finally learned the cause of death was a heart attack, Brown said she felt no relief — just anger that it had taken so long. When she showed her mother a photo of the death certificate, she cried.

"In my mind, what they did is they called for my mother to grieve harder for three years than she could have,” Brown said.

Tindell said the problems won't be fixed until the state is able to hire more pathologists. The National Medical Examiners Association standards recommend that pathologists perform no more than 250 autopsies a year. If pathologists perform more than 325 a year, the office risks losing accreditation.

In 2021, two Mississippi pathologists performed 461 and 421 autopsies. Arkansas’s six pathologists completed an average of approximately 282 each.

During most of the 1990s and 2000s, Mississippi had no state medical examiner, instead contracting with a private physician, Dr. Steven Hayne, who performed 80% of autopsies in the state. He completed as many as 1,700 autopsies a year.

Hayne’s work was repeatedly attacked in court as sloppy and scientifically unsound. Verdicts in multiple murder cases in which Hayne testified were overturned by the Mississippi Supreme Court.

In 2011, the state hired Pathologist Dr. Mark LeVaughn as its first chief medical examiner since 1995. During his tenure, LeVaughn spoke publicly repeatedly about a lack of resources, calling his office a critically understaffed public health risk.

Tindell said a substantial number of autopsy reports that are pending are LeVaughn's. Because of the department’s staff turnover rate, LeVaughn was the only forensic pathologist handling all the autopsies in the state at times and fell behind on paperwork.

“He was put in the impossible situation of trying to do all the autopsies for the entire state, and just unfortunately, he was not able to get it all done,” Tindell said.

LeVaughn resigned as chief medical examiner in January 2021. He has since been rehired as a pathologist finishing outstanding reports and testifying on them in trials.

Tindell said the office expects an additional pathologist to start late next month, and that he's recruiting to hire another as soon as possible.

In the meantime, to meet demand, the Mississippi Medical Examiner’s Office has been forced to send bodies to neighboring states such as Arkansas. In 2021, 284 autopsies were completed by contractor pathologists.

The National Medical Examiner’s Association recommends autopsies be completed within 72 hours. The turnaround time in Mississippi has exceeded three weeks in some cases. The problem is especially severe in north Mississippi, where there is no medical examiner’s office.

One family in Tupelo waited 24 days. After he was shot and killed in May of last year, Lorenzin Brown’s body was first brought almost 200 miles (322 kilometers) away for an autopsy at the Mississippi State Crime Lab in Pearl, the closest state facility that could do it.

Brown lay for two weeks in the morgue before pathologists determined they couldn't get to his case fast enough. They decided he should be transferred to Little Rock — more than 260 miles (418 kilometers) away — for an autopsy by a contractor.

His family wasn’t notified that he was being transferred or told when he’d be returned. Without updates, they struggled to make funeral arrangements. His father wondered if he’d be able to see him before he was buried.

“To get a call saying that he’s been murdered, it was already a tragic enough situation,” said Brown’s uncle, Tim Butler, a pastor who organized the funeral. “The grieving process is always bad. Under these circumstances, it’s made everything that much worse.”

His mother, Geisha, said she couldn’t work while she waited for his body to be returned and to hold his service. It wasn’t until a month and a day after he died that they were able to bury her son.

Clayton Cobler — coroner in Lauderdale County, where Harbour was killed — said families try calling the medical examiner’s office for answers about the status of autopsies and reports, and they often don’t hear back. Each of Mississippi's 82 counties has an elected coroner who's responsible for collecting and transporting bodies to the medical examiner's office. They end up acting as liaisons with families and answering desperate calls month after month, Cobler said.

“I’ve got a grandmother that her grandson died in 2017, and she wants to know why," he said. "It just breaks my heart every time she calls, because I can’t tell her.”

Cobler, who has worked in death investigations for decades, said he recently made the difficult decision not to run for reelection.

“More and more coroners or long-term coroners are saying, ’I’m done. I’m not going to run again, because it’s just too frustrating, and it’s too heartbreaking,'” he said.

Rocky Kennedy, the Lafayette County coroner, said many people who work with families feel the same fatigue.

“It’s a waiting game, and I think everybody’s patience ran out a long time ago," he said. "Words without results mean nothing."

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Leah Willingham is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.