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Chapter 1: What is the current crisis in autopsy services?
We are being warned that there is a crisis in autopsy services causing distress to families waiting years for closure on the death of their loved ones. And there are concerns that a temporary solution, bringing locums from the UK, won't solve the crisis. For more on this, I'm joined by Professor Dennis Cusack, Professor of Forensic and Legal Medicine in UCD. Dennis, good morning to you.
Good morning, David.
This started, we have discussed this on the programme before, but this started as a regional issue affecting Waterford, but it now appears to be spreading to other parts of the country.
It is indeed, and it's very worrying. Just to put it in context, we had about 32,000 deaths last year, and of those, about 23,000 were reported to the coroners, and about 6,000 post-mortems were directed by coroners, 2,500 of which went to inquests.
And of those 6,000 post-mortem examinations, 95% are carried out by hospital-based pathologists who have an interest and expertise in post-mortem examination, trying to ascertain the cause of death and reporting to the coroner. And this topic came up surprisingly in the
Joint Europtics Committee and Transport, which I spoke to them just the week before last about road traffic crashes, which are obviously an important smaller number of deaths. And there were quite concerns about delays for families in the process and the facilities. So as you've said, we have a shortage of pathologists.
In the southeast, it's affecting Wexford, Waterford, Carlow, Kilkenny, Tipperary. It is spreading now to Limerick and Clare. and also Kildare. And there are issues with mortuary facilities in Kildare, Cork and Kerry. And Cork and Kerry are having to take the workload of autopsies from some other counties. And there's also been some ongoing difficulties in Dublin.
And it has been a helpful solution, and we have to be grateful to our colleague pathologists in the UK and the Department of Justice for this temporary measure. But it's inefficient. It means the pathologists from the UK are flying over, spending two to three days. And by the way, the University Hospital in Waterford, ironically,
has been updated with a lot of money spent on it, and now we have no pathologists to do the post-mortem service because of the pressures on pathologists in diagnostic services. So we have an inefficient answer. A service only two to three days, and my colleague, Coroner John Goff in Waterford, has spoken about this. It is far more costly than it would be to have... Irish-based pathologists.
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Chapter 2: How does the shortage of pathologists affect autopsy services?
Now, in fairness, some of the inquests cannot be held, if I just go to that, until, say, a criminal process, if there's been an assault causing death or a road traffic crash causing death. But the postmortem service, as I said, we have about 6,000 postmortems. And about 3,500 turn out to be natural causes.
So we also have people waiting months, three to six months, and maybe more, before they can get a death certificate from the coroner. And of course, this means they can't deal with probate. It's already a distressing issue for families. So whether it's a natural or unnatural causes, there are needs for families to be able to deal with all of the sad practicalities of wills and probate and so on.
And this is why the reforms, there was a consultation in 2024 with a report from the Department of Justice and a heads of bill that is leading to reforming legislation was meant to be brought before the government at the latest last year. We're still awaiting it, although from contacts in the department, we know in the Coroner's Council
that the minister and the officials are working on this, but it's very dire need to look at structures, to have a central office with the chief coroner, looking at standards, addressing some of these issues about postmortems and toxicology.
And it just happens that coincidentally at a forensic meeting, speaking to you from an international forensic meeting abroad, and there are loads of ideas here, and one of them, if you want I can proceed on to talking about why we have to tackle this problem with a bit of vision, imagination and innovation.
We might get to that in a second. Is the core issue staff shortage? Is it because there aren't properly qualified people in this country or is it because people aren't interested in carrying out autopsies or postmortems?
It's a combination of both. We have a shortage of pathologists in the country, and it's particularly acute for children and newborns, pathology service, but also in adult services. And there's also huge pressure on our pathology colleagues to provide diagnostic services for cancer and other diseases.
And that's actually what has brought about the crisis, the combination of the shortage of pathologists and the pressures on them to provide the pathology service to hospital patients. So it is a major issue at the moment.
And it's going to get worse. Okay, it's going to get worse. Well, just very briefly, Dennis, what is the answer?
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