ASHLAND — Health and emergency medical services officials have said there is not enough space to store dead bodies in Ashland County.

There are many reasons for this, but at the forefront is a spike in deaths during winter months and the ongoing COVID-19 pandemic, officials said. 

Further, a lack of clear contingency plans across all sectors of emergency preparedness when storage space is full has left bodies in limbo.

“It’s not one thing,” Ashland County Emergency Management director Mark Rafeld said of the body storage issue. “It’s a multiple-pronged perfect storm.”

High death rate 

In any given year, Ashland County sees spikes in deaths during the winter months. The total death count from 2007 to 2022 for the month of January, for example, is 879, whereas the total death count for that timeframe in June is 669.

But deaths in recent months have been higher than the typical yearly spikes. 

“While this seasonally this is the time of year we’d see an increase in deaths, there are excess deaths from COVID that are driving these problems,” said Dr. David Tomchak, who is a member of the county’s health board. 

UH Samaritan Medical Center in Ashland has two cold storage spaces for hospital use, UH Samaritan emergency preparedness and community outreach manager Steve Carroll wrote in an email to Ashland Source. 

These two spaces also double as the county morgue.

“The hospital can and does provide morgue space for other needs that originate within the county as part of the Hospital and Ashland County Mass Fatality plan,” Carroll explained.

“This has been a shared understanding for many years involving hospital leadership, Ashland County EMA office, The Ashland County Coroner’s office and other agencies that are responsible for decedent management.”

The county morgue is holding space for bodies awaiting organ or tissue donation, and more generally is holding space while next of kin is being contacted to elect a funeral home, said Beth Jackenheimer, who has been the coroner’s office investigator for 10 years. 

If someone were to die in a car crash, for example, the body can be sent directly to a funeral home or to the morgue.

“That is totally a 50-50 thing,” Jackenheimer said. “It just really depends how quick next of kin is contacted and found, and whether they’re picking a funeral home or if we need to buy time.”

Autopsies are not done in Ashland County. Bodies being autopsied are sent to the Cuyahoga County Medical Examiner’s Office, Jackenheimer said.

A symptom of body storage issues can be seen in the operations of Ashland Emergency Medical Services, which is often the health entity left waiting with dead bodies when it is unclear where they can be stored. 

At the start of the COVID-19 pandemic, EMS began declaring deaths from cardiac arrest in the field in an attempt to relieve some of the workload for hospital staff dealing with high death rates. This change had been effective throughout the past few years — until recently, EMS captain Tyler Smith said. 

“In the last couple of weeks it hasn’t worked out well because we’ve ended up staying on scene for multiple hours,” Smith said. “It takes the medic unit out of service for that amount of time.”

A medic unit typically waited maybe an hour for a body to be picked up by a funeral home or the coroner’s office transport service. Wait time increased to upwards of three hours this winter. 

“We only have four medic units in the city,” Smith explained, “so taking a medic unit out of service for hours just doesn’t work well for our response model.” 

As a result, EMS stopped declaring deaths in the field early February. While this has largely stopped long wait times for medic units, it has not resolved the issue at large.

“We’re just now transporting to the hospital, and as much as it stinks, making it the hospital’s problem,” Smith said, referring to staff resources and figuring out what to do with the body.

EMA director Mark Rafeld said body storage and transport remains a delicate balance. 

“The concern is also that if we would have some kind of a mass fatality event on top of all of this, we would be in a real pickle,” he said. “I don’t know how else to put it. We’d be against a wall in trying to figure out what to do — could be a bus crash, could be just a simple automobile accident.” 

Space not sole problem

Delays in body transportation are not solely due to storage availability. Another cog involves physicians signing death certificates, which in some recent cases has taken several weeks.

Alex Roberts, president of Roberts Funeral Home, has seen the problems caused by death certificate delays first-hand. Roberts Funeral Home has a morgue in its Wooster location, which can hold 12 people. 

“By far, the largest obstacle we face in keeping the (funeral home) morgue clear is the slow turn around of death certificates by the doctors,” Roberts said. “We have had many times where it takes the doctor 7-10 days to sign a death certificate.”

Generally, a person will be in the morgue for three to five days, Roberts said. 

Funeral home morgues are used for those awaiting cremation, whereas a person can be placed in a casket if they are being embalmed for burial. Three circumstances must be met before cremation — 24 hours must pass from the time of death, a cremation authorization form must be completed by the next of kin, and a doctor must sign the death certificate. 

There are a plethora of reasons why signature delays could be happening, said Dr. David Tomchak. 

Signing death certificates is one item on a doctor’s priority list. 

“It’s not an acute problem when you’re dealing with the urgency in front of you,” Tomchak said.

Tomchak said he, personally, makes signing death certificates a priority but values accuracy above all. Vital statistics registrar/ administrative assistant Lauren Jeffery said she has encountered situations with inaccurate or incomplete death certificates, such as a failure to include a cause of death, which also delays the transportation of bodies. 

Tomchak suspects doctors are likely not aware of the issues delayed death certificate signings cause because those issues occur outside the doctors’ purview, in places such as funeral homes.

Tomchak also said patients are often handed off to various physicians throughout treatment, therefore it may be unclear who is responsible for signing death certificates. 

Rafeld said at times the coroner has signed certificates, in lieu of the attending physician who worked on the patient.  

Another cog has to do with finances. 

Ashland health commissioner Vickie Taylor said some families have had difficulty paying funeral costs following the latest COVID-19 surge this winter. 

“A lot of those COVID deaths were surprises to families, so they weren’t prepared,” Taylor said, specifically regarding the costs that go along with illness and death. 

Federal assistance is available. The Federal Emergency Management Agency will provide up to $9,000 for COVID-19 related funeral expenses, under the Coronavirus Response and Relief Supplemental Appropriations Act of 2021 and the American Rescue Plan Act of 2021.

But the assistance is a reimbursement, Taylor explained, so the family of the deceased must cover the costs upfront.

Inclement weather, specifically recent snow storms, have also delayed burials, the coroner’s office said. 

“It’s a compounded mess is what it is,” Rafeld said. 

Contingency planning

Solutions for the most evident part of the problem — storage space — are underway. Ashland EMA has an informal agreement with the Richland County Coroner’s Office for additional cold body storage. 

“We have, at this point, a gentleman’s agreement,” Rafeld said of the partnership. “We have no formal written policy or commitment to that. It’s an option that is available to us.”

Bodies can also be shipped within the hospital system, but that presents logistical challenges with tracking, Rafeld explained.

These ad hoc options are currently available, he said, but not all emergency services are aware of these options, or in what order they should be pursued when issues arise. 

On Feb. 16, there will be a mass fatality preparedness meeting between local funeral homes, the coroner’s office, hospital and health department, during which Rafeld said these processes and extra storage options will be discussed. The meeting is not open to the public, he said.

During Ashland’s February board of health meeting, Rafeld and board members discussed investing in more storage space in the county, including a portable storage rack, which can hold up to eight bodies, for an estimated cost of $50,000 or the county building/acquiring a morgue building separate from the hospital. 

Health centers and coroner’s offices in Ohio and across the country have used portable morgues during the pandemic. Some coroner’s offices in Ohio had already relied on portable morgues for body storage before the pandemic, specifically to keep pace with deaths from drug overdoses. 

Funding would be needed to make this an option for Ashland. 

Rafeld requested funds from the county commissioners to purchase a portable morgue at the start of the pandemic but it was turned down, both he and county commissioner Jim Justice confirmed. 

Justice said at the time of Rafeld’s request the commissioners determined that morgue capacity was sufficient. Justice is aware EMA is considering the need for additional space now, but no action is imminent at this time, he said.

County commissioners elsewhere have approved the use of COVID-19 relief funds for the purchase of portable morgues, as well as to build and renovate permanent structures. 

Rafeld and others said they anticipate body storage to become a less pressing issue day-to-day, as the death rate in the county decreases with the typically yearly ebb and flow and COVID-19-related deaths dip. 

“But that doesn’t mean that we’re going to stop looking at what problems we do have and be able to solve them moving forward,” Rafeld said.

The rise in deaths will likely come again next winter, and a spike in deaths at any point in the year, whether from a mass casualty event or COVID-19, remains a concern for EMA and other health entities in the county.

“We can always use more space for the county,” Rafeld said of body storage, “even if it’s just a couple spaces.”

Ashland Source will provide updates as more information becomes available.