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Grand Forks County morgue sees growing work load from around region

Dr. Mark Koponen, deputy coroner, in the main autopsy room of the Grand Forks County morgue. The facility contracts with 19 counties in North Dakota and Minnesota and in 2012 performed 184 autopsies, up from just 73 in 2004. JOHN STENNES/GRAND FORKS HERALD1 / 6
Dr. Mary Ann Sens, Grand Forks County coroner and chairwoman of the UND medical school's pathology department, points out the features in one of the two coolers at the UND Forensic Pathology Center in Grand Forks. The coolers can accommodate up to 30 bodies in the event of a major disaster and one has a temperature control for thawing frozen bodies. JOHN STENNES/GRAND FORKS HERALD2 / 6
A secure evidence room at the morgue with access limited to only four staff members houses anything found on crime victims and has its own freezers, refrigerators and special forensic clothes dryers.JOHN STENNES/GRAND FORKS HERALD3 / 6
Service area of UND Forensic Pathology Center4 / 6
Autopsies conducted per year at N.D. forensic examiner's office5 / 6
Autopsies conducted per year at UND Forensic Pathology Center6 / 6

The waiting room is inconspicuous for a place where people tell the last story of their life.

Those telling the stories don’t enter through the waiting room, which features pale walls and simple furniture.

Instead, they are ushered discreetly through the back of the building by ambulance crews, funeral home employees and others.

There to let them in are staff members of the Grand Forks County morgue — more officially known as the UND Forensic Pathology Center.

They are charged with listening to the dead and sharing their stories with those who seek closure or justice.

At the end of the day, the staff’s purpose is simple.

“We work for the families,” said Dr. Mary Ann Sens, county coroner and chairwoman of the UND medical school’s pathology department.

Sens and her staff deal in the suspicious, unexpected and unknowns of death in the region.

One day the autopsy subject may be a homicide victim. On another day, staff may be conducting an autopsy at a family’s request.

Many times, family members fear a genetic condition hiding in their own bodies could be behind their loved one’s passing, according to Sens.

Those are just two examples of the growing number of autopsies performed by morgue staff.

Unmet need

Sens oversees a busy place that is about to get even busier.

Right now, the center contracts with 13 counties in eastern North Dakota and six counties in northwestern Minnesota.

On July 1, eight more North Dakota counties will fall into the morgue’s primary jurisdiction. The inclusion of more counties is part of a continuing growth trend witnessed by Sens and her staff.

Forensic pathology’s presence in the last decade in Grand Forks has grown from Sens and others conducting autopsies in hospitals to the construction of a $1.6 million morgue in the city’s south end.

In Sens’ first full year as county coroner in 2004, she and her associates performed 73 autopsies.

“There was a huge need,” Sens said. “We needed to come up with a better plan to address it.”

When construction started on the morgue building seven years later, their caseload had topped 115. In 2012, the latest data available, the number of autopsies performed reached 184.

Logic would dictate that more cases result in higher costs, but revenues and expenses for the center follow no set pattern. Factors such as sending samples off for certain types of testing conducted by outside laboratories can drive costs up dramatically.

Since 2005, the morgue has seen a total of $1.94 million in revenues and $1.8 million in expenses.

Counties are charged based on population rather than on a case by case basis, Sens said.

Regional service

The UND Forensic Pathology Center was built with the region in mind, according to Sens.

Under normal circumstances, a morgue needs a population of about one million people to support it. Regionally, Sens estimates Grand Forks County’s morgue serves about 500,000 people.

The rural nature of the service area makes this morgue’s service more about distance than population.

Each county in North Dakota and Minnesota technically has a county coroner but in rural counties with no hospitals or colleges, that duty can fall to a sheriff or another person deemed qualified by the state medical examiner.

Without the Grand Forks County facility, bodies would be sent to the state forensic examiner’s office in Bismarck or Hennepin County Medical Examiner’s Office in Minneapolis.

“That can become stressful,” Sens said. “Your loved one could be shipped five or six hours away. Tasks like figuring out when to make funeral arrangements can become complicated.”

The UND facility came in the nick of time, according to North Dakota State Forensic Examiner William Massello.

In 2007, the year Massello came on board, his office conducted 240 autopsies — a number that grew to 367 cases by 2012.

Rising population spurred by the oil boom is one factor driving up the number of cases his office sees, according to Massello.

Without the UND center’s presence, he estimated his caseload would be closer to 410 to 420 per year.

Facility features

Now, most of northeastern North Dakota’s autopsy requests arrive at Sens’ door. The facility where they will be evaluated is clean and well lit, not by the false glow of fluorescent lighting but by windows placed high on the wall.

The natural light is best for examination and photography, according to Sens.

While some deaths are investigated as part of a crime or accident scene, others are requested by hospitals and families, according to deputy coroner Sarah Meyers.

Most of the cases seen by morgue staff are natural deaths caused by conditions such as heart attacks, cancer or infectious disease.

Natural deaths represented 46 percent of cases logged from 2003 to 2012, followed by accidents at 31 percent and suicides at 18 percent.

Before a body is wheeled into one of three autopsy areas, it resides in one of two coolers. The coolers are capable of accommodating 20 to 30 bodies in the event of a major disaster.

One is a custom space with temperature regulation capable of thawing stiff bodies recovered in winter.

Anything found on crime victims is placed into a special evidence room complete with freezers, refrigerators and special forensic clothes dryers. Only four staff members have keys to the room, which is cinderblock from floor to ceiling.

“You can’t crawl over it, and you can’t burrow into it,” Sens said.

Many features of the building were included with achieving the highest national standards for forensic processes and buildings in mind.

The staff is in the midst of applying for accreditation through the National Association of Medical Examiners. If the application is accepted, the UND center would become the first NAME accredited facility in the state.

No typical day

The job of the morgue staff doesn’t end when an autopsy is finished.

Conducting autopsies is just one component of each case.

Staff members at the Grand Forks morgue are charged with a number of different tasks, according to Meyers.

“There isn’t really a typical day for us,” Meyers said. “Every day is a little different.”

On any given day, they may speak to families of deceased, explain autopsy findings to law enforcement and lawyers or head out to scenes of accidents and crimes. At least one pathologist or death investigator is on call at all times.

Sens, Meyers and deputy coroner Mark Koponen also teach at UND’s medical school.

Staff members are also working on projects that could improve death investigation in the region and nationally as well. 

Creating free, online training modules aimed at rural death investigators and first responders is one such endeavor.

“Most (investigators) can’t go to a week-long seminar,” Sens said. “There are places that just can’t lose their sheriff for a week.”

The training project is supported by a grant from the National Institute of Justice.