For more than 30 years, the Yellowstone County Sheriff’s coroner’s office in conjunction with the Montana Department of Justice have been conducting autopsies at St. Vincent Healthcare in Billings.

St. Vincent’s morgue is a small room located in an older section of the hospital. The refrigerator to store bodies can comfortably hold two gurneys, but, if needed, a third gurney can be squeezed in.

Because of space limitations, bodies awaiting a post-mortem exam are stored at funeral homes and then transported to St. Vincent.

While the system has worked for years, DOJ officials say the hospital morgue is no longer adequate to serve the population and that it’s time to update and improve medical examiner services for the eastern half of the state.

DOJ is seeking to establish a state morgue in Billings and recently reached out to Yellowstone County for funding help.

“All one system is what we’re going for,” said Phil Kinsey, administrator of DOJ’s Forensic Science Division, also known as the crime lab.

During a late January meeting with county officials, Kinsey outlined a plan for a state morgue that would cost an estimated $600,000 to $900,000 and would be staffed with two medical examiners along with support staff.

“For us not to help out is kind of crazy,” said Yellowstone County Attorney Scott Twito, who has been talking with state and other county officials on the issue.

Sheriff Mike Linder also backed the idea. “I don’t see a down side to it. I think it’s an investment in our future,” he said.

The county commissioners informally agreed to contribute $150,000 toward a state morgue in Billings. The county’s contribution would pay for itself in about three years by saving money on transportation and storage fees associated with autopsies.

The county could save about $50,000 a year with a state morgue, Twito and Linder estimated.

Kinsey, based in Missoula, said a state morgue in Billings would be a follow-up to the department’s opening of a new crime lab at the Billings Clinic last year.

Eric Sell, a DOJ spokesman, said a Billings morgue is one of the department’s funding priorities in the current legislative session. “We’re hopeful” a morgue will be funded, he said.

The need

The need for a state morgue in Billings, Kinsey said in a recent interview, stems from recommendations and position papers for improving forensic sciences by professional organizations, like the National Association of Medical Examiners and a 2009 report by the National Academy of Sciences.

Based on those recommendations, a state the size of Montana should have at least two autopsy facilities, each staffed with two medical examiners and support staff, Kinsey said.

Missoula has a state morgue in the crime lab. The morgue serves western Montana, has space for six to nine bodies and is staffed with two medical examiners and an autopsy assistant, he said.

In Billings, the state contracts with St. Vincent to use its morgue on a per-case basis. The arrangement, Sell said, has been in place since 2015, when the DOJ hired a forensic pathologist, Dr. Robert Kurtzman, formerly of Grand Junction, Colo., to be its deputy medical examiner in Billings to serve Eastern Montana.

For years, county coroners in Eastern Montana used private pathologists. And since 1998, that work was performed almost exclusively by Dr. Thomas Bennett of Billings, whom the state recognized as an associate medical examiner.

After a series of disputes between the DOJ and Bennett, who argued he worked directly for county coroners, the state ended Bennett’s appointment as an associate examiner and said the medical examiner’s office would be restructured so all coroner-ordered autopsies would be performed by state employees.

In its restructuring, the DOJ hired Kurtzman, who worked in Colorado for more than 20 years and served multiple counties. Kurtzman first visited Montana in July 2015 to help out in Missoula and ultimately took the job in Billings in late 2015. Kurtzman also has an autopsy assistant.

The Montana position, Kurtzman said, looked “like a great opportunity.”

Kurtzman and his assistant, Heather Beeler, have a small office in the DOJ’s building at 615 S. 27th Street.

While a site for a state morgue in Billings has not yet been identified, Kinsey said he has talked to Billings Clinic about space and would be meeting with real estate agents to look at private buildings that could be renovated. The state also is talking to St. Vincent.

Thinking bigger

The $600,000 to $900,000 cost estimate is a rough number, depending on the morgue’s size and setup, which is something Kurtzman is helping to determine, Kinsey said.

Kurtzman, Kinsey said, is “a sharp guy” who is “very conscious of tax dollars and impact on government. He’s not asking for the Taj Mahal over there.”

While storage capacity for a Billings morgue has not yet been decided, state officials said the number can vary depending on the size of a refrigerator and how that storage is arranged. Some vendors offer rack systems that can allow for more bodies to be stored in a small footprint, they said.

A rack system could accommodate 25 to 30 bodies, but that that would “far exceed” what would be a customary case load, Kurtzman said.

Another matter to consider is that Billings has no storage facility capable of handling fatalities in a mass disaster, Kurtzman said.

The goal is to tailor a morgue to meet the community’s current and future needs, Kurtzman said. A morgue should provide adequate storage with some extra capacity, he said.

“You don’t want to overbuild. You don’t want to waste taxpayers’ dollars,” Kurtzman added.

Death investigations are performed to determine the cause and manner of death. Autopsies generally are conducted when a death is unattended, sudden and unexplained or violent.

People may associate autopsies with homicides or criminal investigations, but not all post-mortem exams involve criminal cases.

Kurtzman said autopsies provide information about injuries and diseases that can benefit public health. “We want to look at those so we can improve the lives of the living,” he said.

If someone previously healthy dies unexpectedly, Kurtzman said, it is “usually good to find out why." Determining a cause may be “a relief to the family or community,” he added.

Autopsies also can determine if there is an unrecognized disease that may be significant for a community, Kurtzman said.

Last year, the state conducted about 599 autopsies, with about 250 exams done in Billings and about 350 exams performed in Missoula, Kinsey said.

While the number fluctuates, Kinsey said the annual figure is in the 500 range, with 550 postmortem exams conducted in 2012.

For “optimal surveillance” of disease in a community, autopsies should be conducted on about 10 percent of the annual deaths, Kurtzman said.

In general, 1 percent of a given population will die each year, Kurtzman said. About two-thirds of those deaths are not unexpected and have known causes, like cancer or heart disease, he said.

About one-third of deaths may not have a readily apparent cause and will be reported to the county coroner’s office, Kurtzman said.

In Montana, the coroner usually is an elected or appointed position administered through the county sheriff’s office. The actual autopsy is performed by the medical examiner with the coroner present.

In Yellowstone County, the sheriff’s office has a coroner’s division with a coroner and an assistant coroner.

With a population of about 165,000 in Yellowstone County, about 1,650 people are expected to die each year, Kurtzman said. Of those, about 500 to 600 deaths are reported to the coroner’s office.

Sheriff’s Deputy Cliff Mahoney, an assistant coroner, said the county had 515 death investigations in 2016 and about the same number in 2015. Last year, the county performed about 120 autopsies, he said.

Yellowstone County’s 2016 autopsy rate was about 7 percent of the deaths, which is close to the 10 percent optimal rate for a community, Kurtzman said.

As the state’s deputy medical examiner in Billings, Kurtzman serves all of Eastern Montana and some counties to the west, including Sweet Grass, Stillwater, Park and sometimes Gallatin County.

Counties are responsible for transporting bodies to Billings for autopsies and for storage.

The state bills counties $1,500 per autopsy and pays for morgue, lab and X-ray fees.

Seeking efficiency

Before the restructuring, Yellowstone County paid the state an autopsy fee and paid St. Vincent fees for its morgue and medical services, Linder said.

Twito and Linder both said autopsy costs add up and could be reduced with a state morgue.

The sheriff’s coroner’s budget has about $280,000 operating expenses.

One of the expenses is for transporting bodies, Linder said. Bodies may need to be transported from a crime scene, residence or nursing home to a mortuary for storage until an autopsy can be scheduled. Then the body has to be transported to St. Vincent’s for the exam and returned to the mortuary.

Transportation costs can run about $300 per trip, Linder said.

He cited a recent case where transportation and storage costs for one body totaled $770. The cost included $310 to remove the body from its initial location and transport it to the morgue, another $310 to transport the body from the morgue to a mortuary and three days of storage.

“It really adds up. We want to run efficiently,” Linder said.

If Billings had a state morgue with adequate storage, Yellowstone County could reduce its transportation and storage costs, the sheriff said.

Twito also said a state morgue would allow coroners to serve Yellowstone County residents better by having a quicker turnaround for autopsies.

County officials also said that if the county contributed to state morgue, it would be interested in a partnership for use of a new facility. Linder suggested putting the coroner’s office in the same building as the state morgue.

A state morgue, Twito said, also would fulfill a government responsibility.

“We’re actually going to improve service and spend less money to do it. It’s a no-brainer,” he said.

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Federal Court, Yellowtone County Reporter

Federal court and county reporter for The Billings Gazette.