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Long waits for autopsy results add to grief of survivors

Jay Czelusniak, president of the Western Massachusetts Funeral Directors Association and owner of Czelusniak Funeral Home in Northampton, says long wait times for autopsy results are becoming more common.

GAZETTE FILE PHOTO Jay Czelusniak, president of the Western Massachusetts Funeral Directors Association and owner of Czelusniak Funeral Home in Northampton, says long wait times for autopsy results are becoming more common. Purchase photo reprints »

NORTHAMPTON — When Diane Alexander’s husband, James Nieskoski, died suddenly and unexpectedly at the age of 55, she had no idea it would be four and a half months before she learned what exactly killed him.

Alexander, 57, said she and her family had suspicions the death was heart-related, but couldn’t be certain until the medical examiner’s autopsy results were back.

That delay prevented Alexander from getting any closure around her husband’s death and caused her to wonder and second-guess about what really happened, she said.

Similar, long wait times for autopsy results are becoming more common, according to Jay Czelusniak, president of the Western Massachusetts Funeral Directors Association and owner of Czelusniak Funeral Home in Northampton.

Czelusniak said wait times are increasing as a result of reductions in staffing and budget cutbacks at the state medical examiner’s offices.

But Terrel Harris, a spokesman for the medical examiner’s office, disagreed with the term “delay” when discussing how long it takes for cause-of-death results to be released. If there’s been an increase in the time it takes for some causes of death to be determined, he maintained, it’s due to more complex testing procedures, not cutbacks or inadequate staffing.

Unexpected death

Alexander left her Sunderland home Oct. 20, 2012, for a trip to visit family out of state, and was dropped off at the airport by her husband.

After not hearing from him over the rest of the weekend and not being able to reach him at work Monday, she called Sunderland police, who went to their home, where they found Nieskoski dead inside.

Because he died alone, Nieskoski’s demise is classified as an “unattended death.”

Alexander said whatever was required to perform needed tests to determine a cause of death at the state medical examiner’s office was collected from his body within two days after he was found.

It was March 8, 2013, when Alexander finally learned the medical examiner had determined her husband died from a heart-related ailment.

“It took quite a few calls,” she said.

Alexander said each time she spoke to anyone at the medical examiner’s office they were apologetic and assured her they were doing everything they could to get the results to her as soon as possible.

“It was very hard for me,” she said. “Part of the grieving process was missing.”

Despite there being no evidence of foul play or suicide, Alexander said the longer it took for the results to come back, the more she began to wonder if there was something more to her husband’s death than she initially thought.

“In the waiting, you start wondering, because you don’t know, you don’t have any idea,” she said.

“He was on the couch, everything in its place, there was no disruption, it seemed that he died in his sleep,” she said. “But then you wonder, because you don’t know. You start doubting it. All those sorts of things cross your mind.”

And while the verification of the cause of death is important, it carries with it another set of difficult emotions.

“It brings it all back again,” she said.

The delay was not only disconcerting and left Alexander without a true sense of closure, but it also caused practical problems.

She said her husband had an ex-wife who had a life insurance disbursement due to her, held up because of the delay in an official confirmation of cause of death.

Insurance payments and other legal matters depend on establishing causes of death, she said.

Alexander said her larger concern is how widespread the problem might be and how many families, some of whom may be in more dire financial straits than she, are held up in their grieving process.

“This is not a good situation,” she said.

Alexander went so far as to contact U.S. Sen. Elizabeth Warren about the problem via email.

“My husband passed away over three months ago. I still have not received the autopsy report and they can’t give me a date. It’s been over 15 weeks. I am not able to move forward to make financial decisions necessary until I have the reason of death on the death certificate,” she wrote.

“This is extremely frustrating. What I am hearing is that they are backed up. I have never heard of this type of process taking so long. I know there are others who are in a more difficult financial situation than I and are dealing with the same frustrations,” Alexander wrote.

No set time

Harris, of the state medical examiner’s office, said the irony is that improvements in science and the ability to precisely determine causes of death mean that tests require more time to complete than in years past.

“I hope a family would understand,” Harris said. “I know it’s hard for them, I would also hope they know we’re doing everything we can.”

There’s no such thing as an “average” autopsy, Harris said, and there’s no set amount of time or an average time period for results of an autopsy to be determined.

Neighboring states provide a range of expected wait times for results of autopsies.

In Connecticut, the medical examiner’s office says due to a backlog of cases and staffing cutbacks it is advising up to a four to five month wait for results.

On the Rhode Island medical examiner’s website, it says it can take from three to six months to get results.

Staff at the Vermont medical examiner’s office said it can take three to four weeks for a basic toxicology report to be finished, but the wait can be much longer if more complex testing is required.

Czelusniak said without a death certificate, paperwork can’t be completed, life insurance disbursements can’t take place and the wait can sometimes be up to six months.

It’s largely a matter of chance how long it takes for a particular death certification, Czelusniak said.

“It’s pure luck,” he said.

Whereabouts in the state you die and on which day determine which medical examiner’s office handles the testing.

Czelusniak said budget cuts and reductions in hours for examiners have left the offices “kind of overwhelmed.”

The medical examiner in Holyoke is not available on Wednesdays or weekends, for example, so regional unattended deaths on those days are handled in Worcester or Boston, according to Czelusniak.

Twenty years ago, there were three or four examiners who were available seven days a week as well as one part-time examiner, he said.

“They can’t keep up,” Czelusniak said. “The death rate hasn’t dropped.”

Czelusniak said cases get prioritized: homicides first, so other bodies and other cases get pushed back.

With fewer examiners to perform testing, it takes longer to get autopsies done.

Czelusniak said fewer examiners, less availability and fewer places to conduct testing have created a “snowball running downhill.”

Families will sometimes wait up to six months to get a cause of death, Czelusniak said.

Those families often can’t get over the grieving process with lingering questions about what exactly happened, he said.

In addition to delays in insurance payments, other financial problems arise from unsettled death cases, Czelusniak said.

For example, if a bank account is held in the deceased’s name only, the survivor can’t access the account until a cause of death is established and a certificate provided.

“It becomes really frustrating,” Czelusniak said.

Funeral homes may have to wait to get paid for their services, because often the funeral arrangements are paid for from a portion of a person’s life insurance policy.

Funeral homes don’t get paid without a certified copy of a death certificate, Czelusniak said.

“It shouldn’t happen,” he said. “It’s becoming a real problem for our industry and the poor families that have to deal with it.”

Delays in results can sometimes delay funerals as well, Czelusniak said.

Newspapers, including the Gazette, have deadlines by which obituaries must be submitted. If the funeral home can’t get a body back from a medical examiner’s office or know when it’s going to be released into their care in time to meet deadline, funerals can be pushed back until the issue is resolved.

“You don’t want to be in limbo,” he said.

When bodies are transported to Worcester or Boston offices for initial testing it can add to the funeral costs for families.

Czelusniak said no matter what the reasons and no matter how long the wait, uncertainty surrounding a loved one’s death is always frustrating for those affected.

“You can’t plan for it and when it happens, it happens at one of the worst times of your life,” he said.

Bob Dunn can be reached at bdunn@gazettenet.com.

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