Forensic pathologists are problem solvers. They are tasked with determining the cause and manner of sudden, unexpected, and/or unattended deaths — drawing from their medical school education, residency training in pathology, and, oftentimes, fellowship training.
While forensic pathologists typically use their diagnostic know-how to answer medical questions, last year Clark County Coroner Melanie Rouse turned her penchant for analytics toward a field-wide issue: the forensic pathologist shortage in the U.S.
Rouse reached out to Dr. Kate Martin, associate dean for graduate medical education at the Kirk Kerkorian School of Medicine at UNLV, to ask about partnering to create a forensic pathology fellowship, the first of its kind in Nevada.
Rouse had watched as the medical school built its new Medical Education Building just north of the Clark County Office of the Coroner/Medical Examiner. She thought it natural to ask the new neighbor how they might support a pipeline bringing more specialists to Southern Nevada.
Thrilled by this possibility, Martin and the CCOCME began the intensive process of obtaining Accreditation Council for Graduate Medical Education approval for the fellowship program.
“It took almost a year just to get [the council] to review and approve the program because they don't meet often for forensic pathology or pathology in general,” Martin explains. That approval came in January 2023, and the program plans to take on its first cohort of fellows in July 2024.
“We’re [the school of medicine] the umbrella or the sponsoring institution," Martin explains. "So anytime someone wants to start a residency or fellowship, they need a sponsoring institution and need someone who's going to vouch for the program. The trainees (need to) have certain protections that the educational program is going to have oversight of. So that’s my job.”
Currently, there are no pathology residency programs – a prerequisite for the fellowship – in Nevada. So the fellowship plans to recruit out-of-state residents while the school of medicine develops an in-state pathology residency program.
A Critical and Growing Need for Forensic Pathologists
That the U.S. – and Nevada particularly – has a critical need for forensic pathologists is backed by staggering statistics. “As a whole, we have very few forensic pathologists across the country. There's roughly 500 to 700 forensic pathologists that are actively practicing for the entire country,” says Dr. Lisa Gavin, the senior forensic pathologist at the CCOCME and fellowship program director. “We are a small group that's responsible for the deaths that occur suddenly and unexpectedly throughout the entire country.”
Gavin adds that, as with other specialized medical professions, there are a considerable number of forensic pathologists retiring, with those numbers expected to climb within the next several years.
Aside from the CCOCME, Nevada has a single other medical examiner’s office (in Washoe County), and the state ranks 49th in coroners and medical examiners per capita with one coroner and medical examiner per 721,931 people. Las Vegas is unique in the field of forensic pathology, not only because of its titular role in CSI: Las Vegas, but also because the CCOCME, according to Rouse, sees at least 1,000 cases annually represented by out-of-state or international visitors.
Additionally, the CCOCME serves several rural counties, “so you can add several thousands” of death investigations beyond the unexpected or unattended deaths that occur in Clark County, Gavin explains. “You’re talking about a pretty big catchment area.”
Given the office’s impressive workload, you may expect the CCOCME to be bustling with medical professionals, but that is not the case.
“We've been getting a lot of support from the county. We have funding for six positions. We have enough work for about eight and a half or so full-time doctors, and we currently only have staffing for four doctors and we're about to get our fifth,” Gavin says. “That is a common factor across the entire country, because very few people are going into the field of forensic pathology, and that's why the forensic pathology fellowship becomes paramount to be able to have more.”
What can future fellows with the CCOCME and the school of medicine expect? Because of Las Vegas’s population – both local and visiting – and the diversity of pathologies seen in that population, fellows will gain an invaluable and unique work experience. Per Rouse, “We have enough casework to go around to get people a ton of experience in different types of cases and things that some people who are going to be practicing may never see in their careers.”
Gavin adds, “When someone comes in for fellowship, they're doing the work of the forensic pathologist. They're automatically getting in right away in learning how to assess cases and learning how to document injuries and then how to also, importantly, put that into words and into documents so you can generate reports to talk about your findings.”
Spotting Trends in Public Health
Thanks to the profusion of true crime media, those outside the field are most likely to associate forensic pathologists with solving murders, but these specialists also play an integral role in public health.
Rouse notes that forensic pathologists are often “the first ones to see something going on” when it comes to causes of death, meaning that they are uniquely attuned to a community’s public health needs. Moreover, forensic pathologists have played a role in recalling harmful products and amending vehicle safety measures, all in the name of keeping their community safe. “We're really the collectors of this information, and then sharing that information back with people that can make these changes is the foundation of what we should be doing as a practicing agency,” Rouse says.
Beyond the role’s importance in monitoring risks to public health, forensic pathologists serve as an advocate for the silenced. “The forensic pathologist becomes the last voice for that person, and the only voice for that person who's died, and we’re able to speak for them,” Gavin says.
Gavin hopes that the fellowship program will attract students who have felt similarly called to speak on behalf of those who die unexpectedly or unattended, a job that, while solemn, Gavin loves.
“The people who do this job tend to love this job because we really like to be particularly analytical,” Gavin says. “We like the detective work of it, we like solving the mysteries of what's happening, and then being able to provide that information to legal next of kin or family members.”
Rouse, who is also on record as loving her occupation, is “thrilled to have this amazing opportunity to build that collaborative piece with the educational institutions in our communities, sharing information, a mission, knowledge, and resources.”
