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Cowlitz County medical examiner reports sharp rise in ME caseload, warns of higher-strength fentanyl and drug combinations
Summary
Dana, a representative from the county medical examineroffice, told commissioners the office handled 73 more jurisdictional (ME) cases in 2025 than in 2024 and reported unusually high toxicology readings and combined-drug events; staff described increased in-house testing capacity and reimbursement rules for autopsies.
Dana, a representative of the Cowlitz County medical examineroffice, told the county commissioners that while total case counts were roughly unchanged year-to-year, the number of jurisdictional medical-examiner (ME) cases rose sharplyby 73 in 2025 compared with 2024. "We had 73 more in 25 than we did in 24," Dana said, adding that the office had already logged roughly 80 calls so far in the new year.
Why it matters: County ME caseloads drive workload, autopsy expense and local forensic capacity. A sustained increase in jurisdictional cases can strain staff, delay reports and raise costs for toxicology and pathology services.
Dana described changing overdose and toxicology patterns. She said drug-only overdoses were down compared with 2024, but that fentanyl concentrations and combinations with other substances were producing more severe outcomes. "Fentanyl doses are a lot higher now," Dana said, and gave a recent example of a cocaine toxicology result that the office measured at 15,000 ng/mL. She also said the highest fentanyl level they had seen in recent tests was about 340 ng/mL.
The ME office has expanded in-house testing. Dana said the office moved from qualitative to quantitative blood testing and that equipment issues that slowed work had been resolved. The change allows staff to identify toxic ranges more quickly and sometimes avoid unnecessary autopsies by getting actionable toxicology results sooner.
Autopsy counts and reimbursement: Dana said the office performed about 75 autopsies last year, including three infant cases. She said Washington state reimbursement covers infant autopsy costs at 100%; other autopsy costs are reimbursed at about 40% under state rules, and timing of submissions means some reimbursements show in different fiscal years. The transcript included unclear numeric totals for overall expenditures; those specific totals were not stated clearly enough to report here.
Staffing and legislation: Dana described a statewide shortage of forensic pathologists and said a study and recruitment incentives are being pursued to attract more pathologists to Washington. She also described two recent legislative items discussed at the state level: a proposal to change some offices from elected to appointed (a bill the speaker could not recall the exact number for) that did not pass, and renewed efforts on a PTSD/benefits bill affecting coroners/medical examiners.
What the county said it will do next: Commissioners and Dana discussed the practical limits of reimbursement, staffing and regional mutual-aid patterns. No formal board action was taken during the update. The office asked commissioners to be aware of rising workloads and to consider workforce and funding implications as part of future budget and policy discussions.
