When La Plata County Coroner Jann Smith first began working with Dr. Carol Huser, a forensic pathologist and La Plata County’s coroner from 2003 to 2012, she would assist with about 60 cases per year.

About a decade later in 2021, she worked more than 200.

“I’ve seen a big increase,” Smith said. “In the last probably three years we have just gotten a lot.”

Death is not an uncommon occurrence, even in rural areas with smaller populations. But across Southwest Colorado, deaths are steadily growing.

As they do, they are straining county coroners and the single forensic pathologist who covers a five-county area in Southwest Colorado. Increasingly overloaded, the region’s officials are forced to work nearly 24/7 as they perform more autopsies and help more families. Yet, amid the crunch, county coroners remain passionate about their work.

George Deavers, Montezuma County coroner, has also seen his caseload rise in recent years. The climb was a steady creep with a few additional deaths each year. Deavers got a break from 2017 to 2019, hitting the same mark of 125 cases every year. But two years ago that changed.

“It’s been going up dramatically,” he said.

In 2020, Deavers added 13 cases. In 2021, he added 31.

Over the two years, he saw a 35% increase in annual cases from 2019.

In the smaller Archuleta County, burgeoning caseloads have also made more work for County Coroner Brandon Bishop.

“In my four years, it’s probably gone up about 20%,” he said.

“I share a cooler in Pagosa Springs with Hood Mortuary, and it’s to the point where I’m going to have to get my own,” he said. “The county is going to have to purchase me a cooler because more often than not our space here is full. That’s never been the case before.”

The growing burden of death is not isolated to coroners. It is perhaps most stark for Dr. Michael Arnall, the only forensic pathologist who serves La Plata, Montezuma, Archuleta, San Juan and Dolores counties.

Arnall performs all of the autopsies for the five counties; coroners are elected officials and often are not medically trained forensic pathologists, as in the cases of La Plata, Montezuma and Archuleta counties, though Smith and her three deputies are certified death investigators through the Colorado Coroner’s Association and Smith is certified nationally through the American Board of Medicolegal Death Investigators.

While not every coroner’s case results in a postmortem examination, autopsies in Southwest Colorado are about 70% above the region’s historic average, Arnall said.

“I keep in touch with (Dr. Huser) and she asks how things are going. When I say we’re up to 170 cases, she’s quite surprised,” Arnall said.

Like the county coroners, Arnall has tagged the increase as a recent phenomenon.

“It’s been percolating, but I think it’s in the last three or four years,” he said.

Why deaths have been increasing so dramatically in the last few years is unclear, but Centers for Disease Control and Prevention provisional mortality data reflects what county coroners and forensic pathologists are seeing on the ground.

La Plata, Montezuma and Archuleta counties have each seen notable increases in annual deaths since 2018, with deaths inching higher every year. Statewide, Colorado has seen a similar trend with annual deaths increasing linearly since 2000.

“It’s a larger population, more people moving in, more people coming through,” Smith said.

Data from the CDC shows a similar relationship with deaths increasing in all three counties as populations have increased over the last two decades.

But according to Deavers, the surge in deaths should not be solely attributed to population growth.

“Population really doesn’t make that big of a difference. The rule of thumb (is) 1% of the population will die a year,” he said. “That means that we would have had to have 3,000 people move into our area to increase it that much, which we haven’t had.”

On closer look, annual deaths increased at a faster rate than population in all three counties, according to CDC and U.S. Census Bureau data.

Deavers attributed more deaths to both COVID-19 and the broader effects of the pandemic, though the COVID-19 cases seen by all three coroners have been relatively low.

“Post-COVID-19 everybody’s losing their damn minds,” he said.

The Montezuma County Coroner’s office averages four to five fatal vehicle crashes per year, but last year it had 17, he said.

“Alcoholic liver cirrhosis, liver failure, has increased,” Deavers said. “People started drinking like crazy whenever COVID-19 hit.”

Deavers had nine cases of liver failure in December alone.

Arnall said both population and the pandemic have contributed to rising deaths, as do a range of other issues, including tourism.

“It’s essentially related to our population, but you have to remember we have a significant transient population because of our tourists,” he said.

When a tourist dies of a heart attack on the Durango & Silverton Narrow Gauge Railroad, an example Smith gave, that person ends up incorporated into La Plata County’s mortality statistics.

Visitors make up a number of those who die in La Plata County and Southwest Colorado each year, including the approximately three visitors who die by suicide while in Durango each year, Arnall said.

But death can be complex, and Bishop has not found a causal link between growing mortality and causes of death.

Liver failure, heart disease, cancer and vehicle accidents are among the top causes of death that Deavers sees in Montezuma County, and which are reflected in the Colorado Department of Public Health and the Environment’s vital statistics cause of death data for the three counties.

Smith has handled two vehicle accidents, three homicides, three suicides, nine COVID-19 deaths and three overdose deaths through the end of February. The La Plata County Coroner’s Office has had 45 cases so far in 2022, 45% higher than the same time last year.

For the county coroners and Arnall, more death means more work and a need for greater resources.

“I’m on call all the time for the coroner's office,” said Bishop, who owns a construction company.

During the day, Bishop works construction full time, but he remains on call for the coroner’s office. He wakes up every morning at 5 a.m. and goes to bed at 11 p.m. He has a few deputies who can help if he leaves for vacation, but he carries a charged phone 24/7.

“It’s not the kind of job that people are lining up to get. They don’t realize exactly what all we do, how many calls we take and just how often I am out at people’s houses in the middle of the night picking up the deceased,” he said.

Even with such a busy schedule, Bishop does not feel overwhelmed.

“I speak a lot with La Plata County and Montezuma County, and they have been way more overloaded than me,” he said. “I wouldn’t say that I’m overloaded at this point, but I’m definitely working more hours.”

Before this year, Deavers did not have money in his budget to hire an assistant. He was left to do the expansive list of job duties coroners are asked to do by himself, including contacting next of kin, preparing bodies, comforting families, coordinating with law enforcement and district attorneys, preparing required state death reports, assisting with autopsies, sending out toxicology reports and testifying in court, among others.

Deavers hired a part-time assistant for the first time this year, though that has not done anything to alleviate the influx of bodies.

“(I’m) stretched extremely thin,” he said. “I have a little bit of coverage off and on during the weekends, but at least now I have somebody to cover at night for me so I can get some rest.”

Arnall has also seen his workload explode. The only board-certified forensic pathologist in the region, he must perform an ever-growing list of autopsies.

By Arnall’s estimate, he performed about 170 cases last year in Southwest Colorado, and that number continues to inch upward toward the National Association of Medical Examiners’ recommended maximum of 250 autopsies per year by a single pathologist.

“Recently, we had a situation where I went over to Cortez on Monday for three autopsies, Wednesday for another autopsy and Friday for three more autopsies,” he said.

Locally and nationally, a severe forensic pathologist shortage has left Arnall and other medical examiners facing extraordinary caseloads as death counts grow.

The United States has an estimated 500 practicing board-certified forensic pathologists, according to a 2020 article published in The American Journal of Forensic Medicine and Pathology.

A 2015 report published in Academic Forensic Pathology found that the U.S. needs at least 1,280 accredited pathologists.

In Southwest Colorado, limited resources further complicate the work of Arnall and the county coroners.

All autopsies for the five-county region are performed at the Montezuma County morgue in Cortez. La Plata County previously contracted with Hood Mortuary in Durango to conduct its autopsies at its facility, but in October 2021, the county transitioned to Cortez as deaths outstripped the capacity of the mortuary.

La Plata County has been building its own morgue and is currently finishing the final touches with the goal of opening this year.

“The pragmatic situation is it’s gotten so busy that Cortez made their own morgue and now Durango is in the process of making their own morgue,” Arnall said.

Even as soaring deaths strain county coroners, they remain dedicated to their work.

Deavers appreciates helping families understand the death of their loved ones so they can find closure. He also takes solace knowing that those he cares for are treated with respect and care.

“In a small town like this, I know a lot of people,” he said. “It’s my neighbors, my friends and my family that I’m dealing with. It’s comforting to know how they’re treated after they pass and make sure they get the best care possible.”

Smith’s own experiences with loss, losing two husbands to medical problems and a son to a car crash, have both prepared her and affirmed why she enjoys comforting grieving families.

“I like being able to help the families go forward,” she said. “... I've been there and that helps.

“I love my job,” she said.

For all three coroners, their work supporting Southwest Colorado’s communities outweighs the overload they face.

“I do enjoy the work,” Bishop said.

“Being here for my community is definitely the reason why I do the job,” he said.

ahannon@durangoherald.com