Bridging Staffing Shortages for Pathology in Puerto Rico

Commitment by American Society for Clinical Pathology

In 2019, the American Society for Clinical Pathology (ASCP) committed to support the Medical Examiner’s office at Puerto Rico’s Bureau of Forensic Sciences (BSF) in reducing their caseload of medical autopsies and external examinations used to determine cause of death and administer death certificates. After Hurricane Maria, the BSF faced staffing shortages and an overwhelming need for services that has led to difficulties in accessing timely forensic pathology services, causing a backlog of bodies waiting for autopsy and long turnaround times for families waiting for the bodies of their loved ones to be released. Through this commitment, ASCP will deploy teams of pathologists to Puerto Rico over the next 18 months to reduce caseloads back to normal levels by performing examinations and medical autopsies for pending cases while the BSF works to hire additional full-time forensic pathologists. Through these missions, ASCP will collect data to monitor impact and provide feedback to the BSF, and will provide a critical stopgap for the BSF's staffing needs.



Bridging Staffing Shortages for Pathology in Puerto Rico



Est. Duration

1 Year

Estimated Total Value



Latin America & Caribbean


Puerto Rico

Commitment by

American Society for Clinical Pathology

Partner(s) of the Commitment Maker(s)

Instituto de Ciencias Forenses de Puerto Rico

To fill the urgent need for staffing support at the Negociado de Ciencias Forenses (NCF), The American Society for Clinical Pathology (ASCP) plans to support short (three-to-five day) missions quarterly to assist with caseload reduction by performing autopsies and external examinations until permanent staff are retained by the Medical Examiner's office.

Based on an assessment in April 2019, it is estimated that the medical examiner’s office will need one to one and a half years at a minimum to recruit new and sufficient staff to meet their needs. ASCP plans to support up to four decompression missions (reducing caseloads back to expected levels) per calendar year for 18 months beginning in the summer of 2019. Each mission will include four staff (two pathologists and two technical staff) traveling to San Juan for three to five days along with an administrative support staff (depending on language proficiencies of medical staff). ASCP staff will perform external examinations and medical autopsies as directed by the lead medical examiner and the island's four other forensic pathologists and in accordance with the laws of Puerto Rico. Each mission will collect data consistent with prior data collection to monitor impact and provide feedback to the director. Throughout this commitment, ASCP will also provide consultations and advice to NCF for the recruitment and retention process of permanent forensic pathology positions.

Through this commitment, ASCP will assist the NCF in returning pending caseloads to normal levels, restoring an operable system that can be maintained and meet needs.

Q3 2019: First mission, 50 cases completed.

Q4 2019: Second mission, 50 cases completed.

Q1 2020: Third mission, 50 cases completed.

Q2 2020: Fourth mission, 50 cases completed.

Q3 2020: Fifth mission, 50 cases completed.

Q4 2020: Sixth mission, 50 cases completed.

Throughout the implementation of this commitment, ASCP will provide consulting to NCF as they hire additional permanent forensic pathologists to fulfill their staffing needs. This process is expected to conclude by the end of 2020.


There are currently approximately 80 deaths per day on the island of Puerto Rico, of which approximately 17 per day are transferred to the Medical Examiner's office in San Juan, Puerto Rico, the only such facility on the island. By law, these cases require an external examination and/or autopsy for completion of the death certificate, necessary for families to obtain support or plan funeral proceedings for the deceased.

After Hurricane Maria, the Medical Examiner's office was challenged by an overwhelming need for examination, refrigeration, and legal services in a setting of an already insufficient staff. This has led to well-publicized difficulties in accessing timely forensic pathology services on the island, causing a backlog of bodies waiting for autopsy and long turnaround times for families waiting for the bodies of their loved ones to be released.

The Federal Emergency Management Agency (FEMA) initially assisted in these challenges with two missions, and a third mission from non-governmental organizations funded by the US government – including The American Society for Clinical Pathology (ASCP) – completed a visit in April 2019. This mission specifically looked at processes to aid the director of the laboratory with finding permanent solutions to these challenges. During this mission, challenge and gap identification exercises resulted in a list of actionable items for which follow up is needed to create permanent solutions for the island.

One such challenge is staffing shortage of qualified pathologists needed to complete current caseloads and provide timely services to the families of the deceased. Puerto Rico's Negociado de Ciencias Forenses (Bureau of Forensic Sciences) currently has only five pathologists, 67% of minimum requirements and 42% of optimal staffing for their volume. The challenge of staff shortage has a series of long-term potential solutions for which ASCP, with others, is serving as a resource for action.

Partnership Opportunities

For this program in Puerto Rico, ASCP is seeking any fiscal support that may be available to ensure the sustainability of this project across the projected dates and potentially beyond depending on the success of the recruitment process. ASCP is also seeing support from the medical examiner community in sharing best practices, advice and consultation, and possibly in-person expert visits to assist with other challenges that may be encountered which are beyond the time frame of a decompression mission. Through this program in Puerto Rico, organizations focused on criminal medical investigation who want to assist with the work would have access to ASCP’s established contacts with Puerto Rico and, with adequate qualifications, may be eligible for funding to be part of the specific team approach described.

Progress Reports

February 2021

ASCP’s interventions with the medical examiner system in Puerto Rico have been based primarily on travel to PR with teams of pathologists and technicians to assist with casework while the PR leadership recruits and retains additional local team members. Due to travel restrictions for COVID19, (bi-directional), no teams have been able to travel. ASCP attempted to schedule a trip in May of 2020 but were ultimately unable to travel. ASCP is carefully monitoring the situation and is in contact with their volunteers and the PR leadership to determine when they can return to this commitment.