How a medical examiner’s office transformed to address migrant death

Amid a shortage of forensic pathologists, Arizona’s Pima County has identified thousands of those who lost their lives in the Borderlands.

When Dr. Gregory Hess, chief medical examiner at Tucson, Arizona’s Pima County Office of the Medical Examiner, offered to show me around the facility at the end of June, I didn’t expect to end up standing in the parking lot at the back of a semi-trailer. As he pushed open the back door's long bar lock, I noticed a paper sign taped to the metal, with the letters “B.B.T.” hand-drawn on it in bone-shaped lettering. “The Bone Box Trailer” Hess said.

He opened the door and pulled out an access ladder. “Don’t be a risk management problem — don’t fall,” he deadpanned as I stepped onto it. I steadied myself, wrapping my fingers around the inner edge of the open door, whose hot metal attested to the heat that morning: 96 degrees Fahrenheit. 

 

NOTE: This story contains sensitive images of human remains.

The trailer’s nickname made sense once we got inside. It was filled with stacked cardboard boxes. Hess opened one that held a human skull, pelvis and femur, along with a Ziploc bag containing a cellphone, a Mexican voter’s ID, and a wallet containing a few pesos. Everything about this — the fact that the remains were skeletal, that they were unidentified, and that there was such a need for extra storage — would be unusual in an ordinary medical examiner’s office. Hess, however, is no ordinary medical examiner.

He became Pima County’s chief medical examiner in 2011, when deaths at the nearby border were rapidly rising. The challenge of confronting the staggering number of people who perish in the Borderlands has required his office to transform the way the work of a medical examiner has, historically, been done.

Boxes of unidentified remains of missing migrants are stacked against the walls of the “Bone Box Trailer” outside of the Pima County Office of the Medical Examiner in Tucson, Arizona.

Over the past two decades, the combination of increasingly extreme heat and border enforcement policies that funnel migrants deep into the Sonoran Desert has killed thousands of people in southern Arizona. The complex process of identifying their remains has prompted the office to innovate, increasing its technical capacity and helping create an affiliated organization that supports the families of the deceased. By turning this difficult work into a group effort, the office has set a standard globally for addressing border-related migrant deaths.

It hit us over the head like a brick, like a bunch of bricks, that there was a change occurring.

Dr. Gregory Hess is the Chief Medical Examiner at the Pima County Office of the Medical Examiner in Tucson, Arizona. Over the last 20 years, the office has led the way in working tirelessly to identify missing migrants.

A MEDICAL EXAMINER’S OFFICE fills a necessary role: Medical professionals like Hess are employed by local governments to determine the cause of sudden deaths or deaths when there is no other doctor on the case, and to identify deceased individuals. The bodies of people who die in car crashes, homicides and suicides, as well as from natural deaths that happen at home, all go to the medical examiner’s office. Unlike the migrants found in the desert, those bodies are almost always recently deceased, full-body cadavers, and in the majority of cases, there are next of kin available to identify them.

The Pima County Office of the Medical Examiner began to coordinate its response to migrant death in May of 2002, when 14 people — 13 migrants and a suspected guide who remains unidentified to this day — died in the desert southeast of Yuma, Arizona, on a 115-degree day. They were found more than 50 miles from the highway, headed in the wrong direction. 

Lindsay Hairston, morgue supervisor, tags a body in the morgue’s cooler.

 

“It hit us over the head like a brick, like a bunch of bricks, that there was a change occurring,” said former Chief Medical Examiner Bruce Parks, Hess’ predecessor. “And the numbers kept going up.”

Since then, the office has classified 3,600 deaths in its electronic records system as “Unidentified Border Crossers.” They have identified about 66% of them, according to forensic anthropologist Bruce Anderson. (Forensic anthropologists study bone, whereas medical examiners are pathologists, doctors who specialize in soft tissue.) That rate is much higher than those of Borderlands medical examiners in Texas or California. There are a number of reasons for this, including the small population and low resource base of many border counties. Sudden deaths in Texas and in parts of California are processed by either a justice of the peace or a coroner, both of whom are elected officials rather than medical doctors. 

The Pima County Office of the Medical Examiner catalogs all possessions that are recovered and use what they can in the hopes of identifying the missing migrant. Right, a rosary, a phone number, a COVID vaccination card (from Guatemala), a few pesos, and a cell phone were all that were recovered with one individual who was found this year. (Personal details have been blurred.)

 

Every family’s home I’ve visited, they have a box or binder full of an archive about what happened. It’s a massive, massive amount of labor. Their work has prompted us to do what we do now.

Activists in those states and beyond admire Pima County's work. “In terms of identifications, treating loved ones and remains with dignity and compassion, and making data and information available, Pima County is the pacesetter globally,” said Geoffrey Boyce, a geographer in Earlham College’s Tucson-based Border Studies program whose research makes use of data from Hess’ office.

DNA is the surest way to make an identification. It’s also still a relatively new technology. When Anderson was in graduate school, he said, there was no way to extract DNA from bone. He first encountered the technology in the early 1990s, while he was working for a government lab focused on identifying Vietnam War dead. By now, cutting a small piece of bone for DNA processing is a key part of handling remains. DNA from bone has helped the Pima County Office of the Medical Examiner make hundreds of identifications. Still, the cost of processing the samples, which must be sent to a private lab, remains a major obstacle. The office is constantly writing grants for more funding, and the cubes of bone routinely wait for years before they are sent away.   

Dr. Bruce Anderson and University of Arizona anthropology student intern, Emma Brewer, examine the skeletal remains of two individuals who were found murdered outside of Tucson, Arizona, more than 20 years ago. Anderson and Brewer will prepare samples for DNA testing that will hopefully help to identify the remains as those of two young men - one of whom is thought to have been a migrant from Mexico or Central America - who went missing at that time.

Robin Reineke, a cultural anthropologist, has helped make it possible to match those DNA samples with samples from family members. In 2006, as a first-year anthropology graduate student, Reineke began working alongside Anderson at the office. She still remembers the conversation that sparked their collaboration: “He said, ‘Yes, I’m happy to mentor you, but I need help.’”

In terms of identifications, treating loved ones and remains with dignity and compassion, and making data and information available, Pima County is the pacesetter globally.

At the time, Anderson had “hundreds of handwritten reports” based on phone calls with families searching for a loved one. Reineke organized them and created a database. In 2013, she and three of her colleagues co-founded the Colibrí Center for Human Rights to bolster their efforts, storing the data more securely, communicating with the families of the deceased, and collecting DNA swabs from relatives, which can be matched against bone samples to make identifications.  

Those efforts are rooted in a shared sense of responsibility and political will. Parks spoke of Anderson’s “great ideas about how to proceed in uncharted waters” and the way he sought, from the start, to handle migrant death cases with compassion. Anderson, for his part, gave credit to Parks and Hess for their willingness to allow forensic anthropologists to participate in the investigation process. Families’ persistence in resolving their cases, said Reinecke, also motivated the office to stay committed.

Notes about a skeleton being examined by Dr. Bruce Anderson and intern, Emma Brewer.
Emma Brewer carefully fits two cranial fragments together during a skeletal exam.

“The families investigate. They research. They interview people. They collect data. Every family’s home I’ve visited, they have a box or binder full of an archive about what happened. It’s a massive, massive amount of labor. Their work has prompted us to do what we do now,” she said.

Anderson told me he used to think that when the migrant deaths reached a certain number, they would stop. “When the numbers hit 1,000, they’ll get Washington's attention, and they’ll stop it,” he remembered thinking. He kept thinking that way for five years, until Reineke finally convinced him that no number of deaths would be high enough to attract Washington’s attention.           

Yet despite the urgent need for medical examiners, there is a nationwide shortage of them. There are only 500 full-time, board-certified forensic pathologists in the country. Government salaries are not competitive with other medical specialties' pay — the average salary of $225,000 is less than half of an orthopedic surgeon’s average first-year pay of $546,000 — and most prospective doctors prefer to avoid autopsies. Additionally, the job’s interplay with the legal system, said Hess, can be painful.           

But those in the office see a silver lining. “It’s not just sitting at a desk or microscope all the time. It’s not a pristine white-coat environment,” said Parks. “It’s a more blue-collar type of work, work with your hands. You’re in the thick of it, trying to help the community.”

 

Caroline Tracey is the Climate Justice Fellow at High Country News. Email her at [email protected] or submit a letter to the editor. See our letters to the editor policy.