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Ever since the Fort Bend County Medical Examiner’s Office was founded in 2019, county leaders knew it would need to expand and build its facility on plentiful land.

There was a simple logic to it, after all. Fort Bend County is one of the fastest-growing counties in America and, with a bigger population, would come a greater need for all sorts of services and more cases for investigators with the medical examiner’s office to handle, according to Stephen Pustilnik, the county’s chief medical examiner.

Little did county officials realize, however, that the need to expand would come even sooner than expected, Pustilnik said.

“Because Fort Bend County is growing so rapidly, we built in an area with enough land to handle 30-plus years of growth,” he said. “However, our initial calculations were based on the number of cases we’d gotten over the last five years.”

Fort Bend County, as investigators would soon discover, had no uniform policy for reporting deaths before the arrival of the medical examiner’s office in 2019, Pustilnik said. And that meant that many actual deaths hadn’t been accounted for in those initial calculations, he said.

In 2018, for instance, data showed the county received about 900 calls for service for a medical examiner, according to Pustilnik. But in the medical examiner’s first year of operation, it received about 2,100 total calls, he said.

The county is in the middle of a $1.7 million expansion to the medical examiner’s facilities near the county fairgrounds, at 3840 Bamore Road in Rosenberg, according to Pustilnik. Last week, the commissioners court approved spending $100,000 to begin some work on the project, according to county documents.

The goal is to complete the project by 2023, Pustilnik said. The expansion will add a third office building that will include space for additional personnel as well as several other functions, such as space for an emergency operations center or classrooms and more, he said.

County leaders had been eying the possibility of adding a medical examiner’s office as early as 2014, when planning began for what it would take to build, Pustilnik said.

Texas law stipulates that any county with a population greater than 1 million must have a medical examiner, according to the county. Between 2010 and 2020, the county’s population increased from about 585,400 up to about 822,800, according to numbers from the U.S. Census Bureau.

Construction crews first broke ground on the facility in December 2018, according to the county.

“This new facility will enable us to provide medical examiner services to the county with little change in cost, but with a significant improvement in the quality and timeliness of those services,” then-County Judge Bob Hebert said at the time.

Shortly after beginning work, Pustilnik noticed that, based on data about cases, Fort Bend County’s death rate was significantly lower than counties around it, he said. 

At first, he wondered if perhaps that’s because so many county residents get transported to the Texas Medical Center and thus die outside the county’s jurisdiction, he said.

But then he learned that, for decades, police agencies, hospitals and other facilities across Fort Bend County had been handling dead bodies themselves, without reporting them to the local justices of the peace, who were tasked with overseeing some of the medical examiner’s duties prior to the creation of a medical examiner’s office, Pustilnik said.

“Our 10-year expansion plan was blown up on Day 1,” he said.

As of last year, the county’s medical examiner received a little more than 700 cases directly and received another 2,000 calls for service from surrounding counties, Pustilnik said. But based on calculations, that number is still low – the county should have about 3,000 cases per year, he said.

It’s important that the county still work on its reporting system, because investigators can glean much about public health and safety with better data, he said.

“There’s especially a terrible paucity in reporting for hospices, nursing homes and hospitals,” he said.

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