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NC Senate wants investigation of medical examiners

Concerned about problems within the state’s medical examiner’s office, North Carolina senators have requested a formal review of the way the state investigates suspicious deaths.

The Senate’s budget, passed last month, calls for the nonpartisan research unit to investigate the medical examiner’s system.

The 14-member Program Evaluation Division typically spends four to six months studying an agency or issue before publishing recommendations for legislators to consider.

Sen. Ralph Hise, R-Mitchell, said he requested the review after learning that the failures of the medical examiner’s office went beyond three deaths in a Boone hotel room last year.

“We’re coming to realize that there’s a structural defect within the medical examiner’s office,” Hise said.

Last spring, it took 40 days for the state to complete blood tests after two people died in a Best Western hotel in the mountain town. The tests showed carbon monoxide poisoning, but the information was not made public until after an 11-year-old boy died in the same room.

Dr. Brent Hall, the medical examiner who investigated the hotel deaths, later resigned. Hise said he was struck by how difficult it was to find someone to replace Hall. The state has yet to replace Hall, a medical examiner spokesman said. Cases are being handled by medical examiners in surrounding counties and by Wake Forest Baptist Medical Center in Winston-Salem.

Hise said he was also troubled by what he learned from a recent Observer investigation, which found:

•  North Carolina pathologists perform autopsies in 40 percent of the cases they investigate, far fewer than pathologists in leading medical examiner systems.

•  Medical examiners don’t go to death scenes in 90 percent of the cases they investigate.

•  Despite failing to view bodies in one of every nine deaths – a violation of a state requirement – medical examiners still get paid.

“That’s a lack of oversight,” said Hise, who co-chairs the Senate committee that oversees appropriations for health and human services, including the medical examiner system.

Sen. Louis Pate, R-Lenoir, the committee’s other chairman, said the Observer’s investigation “raised the red flag” on the medical examiner’s office.

“There are bound to be improvements that can be made, and we want to get to the bottom of it,” Pate said.

A day after the series, Gov. Pat McCrory asked lawmakers to increase funding for the office.

Evaluating the office

If the N.C. House and Gov. McCrory accept the Senate’s request, as expected, an evaluation would likely begin next year, said John Turcotte, director of the Program Evaluation Division.

One division staff member would work on the project full time and two others would help. They’d analyze medical examiner data and interview staff members and leaders.

“We’re like management consultants that go in uninvited,” he said. “Most of the projects that we’ve done, they’ve been on topics where the Legislature has exhausted all other alternatives.”

In 2001, after a previous Observer investigation, a legislative study group made nearly two dozen recommendations on how to improve the state office.

Recommendations included mandatory training, hiring professional investigators and seeking national accreditation. Most weren’t implemented.

“With some exceptions, that’s the problem with study committees that the General Assembly has had for many years,” Turcotte said.

Unlike a study committee, the evaluation division is a permanent, independent unit able to conduct follow-up investigations.

In recent years, the division reviewed ways the University of North Carolina system can improve and reduce campus operation costs, and how the state Department of Health and Human Services monitors prescription drugs.

In both evaluations, the division produced about 50 pages of background, findings and recommendations.

Turcotte said an examination of the medical examiner’s office would be difficult because of its complexities.

“You’re dealing with physicians, and you’re dealing with law enforcement and justice,” Turcotte said. “You’re dealing with an emotional subject, and it’s statewide.”

Improving the system

North Carolina’s system for investigating suspicious, violent and accidental deaths is made up of roughly 350 medical examiners, most of whom are full-time doctors. They’re paid $100 per case and asked to determine the manner of a person’s death and whether bodies should be autopsied.

Autopsies are typically performed by pathologists in Mecklenburg County, Raleigh, Winston-Salem or Greenville, N.C.

The state spent about 84 cents per capita for its medical examiner system last year – less than half the national average.

Last year’s budget – composed of state and county tax dollars – totaled $8.3 million. Two weeks ago, McCrory asked lawmakers to give the medical examiner’s office an additional $2 million.

The family of Jeffrey Williams, the 11-year-old from York County, S.C., who died of carbon monoxide poisoning in the Boone hotel, applauded the governor’s efforts. But family members want more.

“...We would most definitely support this formal review,” said Jeffrey’s mother, Jeannie Williams. “We hope their review would identify where the medical examiner’s system needs improvements ... to prevent another family from going through what we have.”

In an emailed statement, Dr. Deborah Radisch, who became the state’s chief medical examiner in 2010, said she welcomes the review.

Reporter Elizabeth Leland contributed.

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