A look inside the Utah medical examiners office

Dr. Deirdre Amaro wanted to be a physician, but as she successfully worked her way through medical school and actually became a doctor, she learned something vital about herself: She hates suffering. And often, that’s what sick patients are doing. It’s even worse, she said, when the patient is a child.

“Suffering gets to me,” she said.

So Amaro changed the direction of her medical career. Utah’s chief medical examiner, who took the post in June, still gets to help people, but her patients are “no longer suffering.” And the help she provides remains focused on the living — the family and other loved ones who want answers and a measure of peace after someone they care about dies. The office also prioritizes learning from deaths so that future ones can be forestalled.

Sometimes, that degree of comfort is delayed, at times by many years. There’s little that’s more satisfying than identifying someone whose remains were a mystery, sometimes for decades, and reuniting their bodies with those who have searched and wondered what happened.

Recently, as Amaro and some of her staff gave local reporters a tour of the Utah Office of the Medical Examiner in Taylorsville, she very nearly literally jumped for joy when answering how satisfying she found it when her staff successfully identified someone who’d been missing and had for a time been a Jane or John Doe.

“That’s very exciting,” she said, a huge smile on her face.

Amaro’s also now at the helm of an unusual — even perhaps unique in some ways — medical examiner’s office.

Just 11 states, including Utah, have a statewide medical examiner instead of a version of a local elected coroner to lead death investigations. Sometimes, that elected official has little or no investigative or medical experience. Utah’s office has a dozen highly trained forensic pathology experts and a number of trained and certified medical investigators, as well. The office is accredited by the National Association of Medical Examiners.

Utah’s was the first medical examiner’s office to rent out a pair of surgical suites onsite to organizations that collect donor tissue and long bones, which can benefit up to 100 people. The Utah Lion’s Club and Donor Connection rent the suites so donated eyes, skin and long bones can be recovered without having to transport the bodies of the donors elsewhere first, which sometimes means the tissue is no longer suitable for donation because of the time that has passed. The result is a higher number of successful tissue donations.

Utah is one of few death investigation offices that has an in-house epidemiology team. Suicide and drug overdoses are both significant areas of focus. Utah’s office is also the only one that interviews family members in cases of overdose. It often offers some grief support and outreach for families. Medical examiners regularly deal with family members and hope to help them understand what happened as they unravel the circumstances of the deaths within their purview.

Part of the office’s focus is on gathering data on such deaths to help prevent future similar deaths. It also looks at disease processes. When COVID-19 was new, for instance, the office studied the effect of the virus on bodies to help untangle how it killed.

“We took a deep dive,” said chief medical investigator Dr. Cory Russo.

That the system is statewide allows for uniform and high-quality data collection, among other benefits, the officials said.

The death investigation

The Utah medical examiner’s office has oversight of specific deaths: those that are sudden, unexpected or happen in suspicious circumstances. Those deaths could include accidents, homicides, suicides and deaths where it’s not clear what happened. Children’s deaths are in their purview. Staff members interact with families, law enforcement, hospitals and care providers, among others. Not all investigations lead to a full review, including autopsy.

Just over a third of deaths in Utah fall under the jurisdiction of the office. It investigated 7,899 deaths in 2023. Medical examiners don’t investigate or do autopsies on Sundays, though they receive bodies around the clock. That means Mondays can be very busy, with as many as 24 autopsies. Most days, they average about 10 which, without complications, take about an hour each.

Native American remains are returned to tribes, as they have their own jurisdiction.

As chief medical investigator, Russo leads a team that starts its work with a scene investigation to learn more about the life that ended and how that happened. Trained investigators photograph the scene and collect evidence that will help the medical examiners reach conclusions.

The goal is to answer two questions. Cause of death is the injury, illness or disease that killed the person. Manner of death is different and limited to five categories: natural, accident, homicide, suicide or undetermined.

Family members and even friends are asked for information that helps complete the picture of the person’s life, to help the medical examiner understand and explain how he or she died.

After the body is examined carefully, there’s an autopsy, where internal organs are examined and weighed. The purpose is to find disease or injury that may have caused or contributed to death. Sometimes, the examination includes toxicology, tissue samples and even genetic testing. Toxicology results can take weeks and it could be months before all the work is done on an individual death and a report completed. They also look through medical and law enforcement records to glean relevant information.

Pulling back the curtain

As he led Thursday’s tour, Brandon Callor, the morgue operations manager, talked about the toll on staffers and the need to find coping mechanisms to avoid what he called “secondary trauma.”

A press release from the office said the staff “deal with the weight of their jobs in many ways: spending time with their pets, volunteering, exercising, being outdoors, enjoying music and the arts, birdwatching, coaching youth sports and more.” It noted that their pets include “dogs, cats, turtles, snakes and a lobster.”

The tour, of course, included physical locations: The Sally Port is a large garage-like area with fast-moving doors where bodies are brought in, then moved to receiving to be weighed and measured and paperwork filled out. There are checks throughout the process to be sure the chain of custody is ironclad and the identification established, if it’s known, which is usually the case. Personal effects are gathered and logged then placed in lockers, so families get them back, though sometimes that’s delayed if it’s evidence in a case.

Morgue clerks work 12-hour shifts receiving and releasing bodies, Callor said.

Identification of who died is an important part of the job. Sometimes, that’s trickier than it might seem.

There are some 40 full or partial remains that await identification, some going back many years — at least one back half a century. As DNA and other advances are made, some that have lingered will likely be identified. The office has helped solve three cold cases so far this year. It works with fingerprints, dental records and DNA. A grant has bolstered cold case efforts by covering the cost of DNA testing.

There are 14 brightly colored, decorative two-dimensional skulls on the door to the office where the forensic pathologists (the medical examiners) work — a reminder that the staff retain a sense of humor and a healthy appreciation for life, though their labor includes the dead.

Eleven forensic pathologists are all board certified physicians, many with different specialties, including neurological pathologists and a pediatric pathologist. A forensic pathology fellow is completing his fellowship at the U. of U. Medical School. The investigators are also board certified.

“Our level of training and experience is pretty unparalleled,” Amaro said.

The autopsy room

Standing in the hallway between the special procedures room — where extra precautions must be taken to protect the medical examiner’s staff in case of unknown disease or toxins or other factors that could be risky — and the room where remains are kept until they’re identified, which sometimes takes decades, one detects the faint, oddly sweet odor of decomposing tissue. The special procedures autopsy room has special ventilation and sterilization procedures, Callor said, but the odor lingers lightly.

The office can store 60 bodies awaiting an autopsy at a time. But what happens with a mass casualty event? Is there an overflow plan?

There is, Russo said, and it’s about 200 pages thick. They think — hope — it will cover any eventuality, though that’s never sure until a plan is tested, which is something no one wants to have to do.

The office space includes a low-dose radiation X-ray machine, because sometimes they find foreign objects, such as bullets, that might not be readily visible that help explain how someone died.

In the stark white autopsy room, where stainless steel sinks and tables allow multiple examinations at one time, there are plants up high in the windows. It’s a spotless, but not dreary utilitarian space. The goal is to understand how someone came to be there, in need of examination, and to help those left behind find answers.

The room and the entire office are really “more about living than death,” Amaro, Callor and Russo agreed, with what’s learned in some cases a tool to prevent further deaths and in others a tool to help grieving families find answers.

The trio laughed when the public information officer Danielle Conlon asked if they still watch “CSI” episodes on TV. “Or does it drive you a little bananas?”

The fact that what most people know about their work is from TV shows and movies that may not really reflect what they see or do is one reason they opened doors that are normally closed to the media and the public. As Callor noted, “We don’t see homicides every day” like TV pathologists do. But they do see them.

They hedge a little when asked if they have all they need to do their job. “Is your budget adequate?,” a reporter asks. They allowed that statewide jurisdiction means travel costs are sometimes high, but emphasized collaborating with legislators. Their goals, they say, are similar, including reducing preventable deaths and understanding those that do occur.