Professor Johan Dempers, forensic pathologist and head of the division of forensic medicine and pathology at the Tygerberg Forensic Pathology Laboratory, has spoken about the backlog at state mortuaries and the work that pathologists do.
“Both facilities in the metro (Tygerberg and Salt River) have an ever-increasing case load, and therefore a backlog. In the past we would see around 2 600 to 3 200 cases annually, and this figure slowly went up, and we expected that. But in the last year-and-a-half the curve just shot up and now we expect to do around 4 200 or so cases for the year. We are sitting now at over 3 200 and we are not even in November.”
Dempers said the increase could be attributed to a number of factors, such as the increase in population and surge in crime.
“Internationally the standard is that a pathologist in training should not do more than 250 autopsies a year under supervision, but many years ago we sat down and considered the South African medico-legal environment carefully, which is more challenging. A figure of 350 cases was considered doable.
Currently, our registrars are doing between 450 and 500 cases a year, so there are too many cases. Our doctors do anything between nine and 12 difficult, complicated cases a week, and at a push 15, but it is logical that as the numbers go up, quality suffers.”
Dempers said autopsies were about 70% of their work and the rest was administration, court attendance, medico-legal opinions, death scene attendance, academic activities and other issues.
“A pathologist could theoretically do 10 cases a day, but quality would suffer massively and the admin for those cases would become insurmountable. People are saying ‘Why can't you do more cases?' What they don't understand is that the autopsy is not the part that takes longest necessarily. It's the compiling of the notes, preparation of the paperwork for court, getting your head around the case, integrating toxicology and histology results, formulating a medico-legal opinion, and so on, that adds to the time it takes to complete a case that is ready to stand up to court scrutiny.”
Dempers said the profession had changed in many ways over the years and the cases had become more complex.
“When I started as a registrar, a gunshot wound meant that if the guy was shot more than three times, the guy who shot him was very angry. Now we don't even classify it as multiple gunshot if the victim was not shot more than 10 times. If it's a single gunshot, it is suicide until proved otherwise,” Dempers remarked.
“Most of the cases we see are multiple gunshot wounds, in which ammunition clips have been emptied. This adds significantly to the complexity of the cases.”
Dempers added the department employs medical officers to whom uncomplicated cases like car crashes, burn cases and single stab and gunshot injuries are allocated.
“Complicated hospital-related deaths, multiple gunshot, sudden infant death, and sudden death in adults, the more challenging cases, are allocated to the pathologists and trainees.
"Every week we have to scrutinise cases so as not to allocate very complicated cases to the medical officers. A single gunshot wound might take me 40 minutes. I have to look at all the organs and make sure about particular things like the probable position of the gun and all those details important to the police investigation and the court, plus paperwork.
"But a multiple gunshot could be a four-hour exercise because you have to be very careful to collect all the evidence and follow the tracks precisely. This can culminate in a 15-page report. That constitutes a massive admin burden,” he said.