State budget boosts pay, training for medical examiners

The newly minted $21 billion state budget doubles the pay for North Carolina’s medical examiners and, for the first time, sets aside money for mandatory training.

The spending plan tries to address some of the shortcomings in the state’s dysfunctional system for investigating suspicious and violent deaths, officials said.

Medical examiners – mostly doctors and nurses who look into deaths in their spare time – are supposed to determine the cause of deaths that happen under mysterious circumstances.

But unlike states and counties with leading medical examiner systems, North Carolina requires no training for hundreds of on-the-ground investigators.

North Carolina pays medical examiners $100 for each case, no matter how much or how little work is involved. Under the new budget, the fee will rise to $200 per case beginning Oct. 1.

An Observer investigation last year found that medical examiners routinely skip basic investigative steps, raising questions about the accuracy of many rulings. Medical examiners fail to go to death scenes in 90 percent of the cases they investigate and sometimes don’t even look at the bodies.

In response to the Observer series, legislative leaders and Gov. Pat McCrory vowed to focus on the problems. The General Assembly’s special oversight subcommittee last year found “serious and significant performance issues” with the current system.

Shelly Carver, a spokeswoman for Senate President Pro Tem Phil Berger, said the new budget is a step forward.

“The final budget makes substantial investments throughout the medical examiner system to ensure that our county medical examiners are better trained and better paid,” Carver said.

The changes come more than two years after the system’s failures played a role in the death of 11-year-old Jeffrey Williams of York County in a Boone hotel. He died two months after a Washington state couple were found dead in the same room at a Best Western. State officials took about six weeks to produce the toxicology tests in the first case, which involved a test that experts said could be completed in less than 20 minutes. Even after the state medical examiner’s office learned that Shirley Jenkins of Longview, Wash., had a lethal level of carbon monoxide in her blood, authorities did not alert local police or fire investigators until after the poisonous gas killed Jeffrey in the same room.

State Sen. Jeff Tarte, a Mecklenburg County Republican, worries that this year’s reforms fail to address many of the system’s problems.

Tarte introduced a bill that would have traded the roughly 350 part-time medical examiners for a staff of trained, full-time death investigators. Tarte wanted to phase out the current system over a five-year period and hire 40 to 60 professional death investigators stationed across the state. His proposal would have required investigators to visit most death scenes.

But General Assembly leaders balked at the cost of Tarte’s proposal, an estimated $80 million over the next 10 years.

Tarte said he’s pleased lawmakers took some steps but feels the changes don’t go far enough.

Medical examiners still won’t be required to visit death scenes, which experts say is key to finding out how someone died.

“Right now, we have still got it (the investigative process) backwards,” Tarte said.

Training gets boost

Experts say a competent system is important to grieving families, who depend on timely death investigations to close estates and collect life insurance payments after relatives die. Police need accurate reports to help solve crimes. The Observer found four recent cases where medical examiners failed to detect homicides.

The new state budget provides:

▪ $100,000 a year for mandatory training.

State Chief Medical Examiner Dr. Deborah Radisch has said training is vital to improving consistency in death investigations. It remains unclear how the state will conduct the training, a challenge since medical examiners are spread across the state. A spokeswoman for the state Department of Health and Human Services, which oversees the medical examiner’s office, did not return phone calls.

▪ $250,000 a year to pay for two forensic pathology fellowships, with one performing autopsies at East Carolina University, the other in Winston-Salem.

▪ Nearly $2.2 million to replace and upgrade the medical examiner’s information system, which contains a database with details about each case the state investigates.

More needs

State officials say medical examiner funding will now rise from $8.6 million in fiscal year 2015-16 to $10.4 million the following year.

But North Carolina still provides less money than states and counties with accreditation from the National Association of Medical Examiners, which sets standards for the profession. They typically spend about $3 per capita, according to a study, while North Carolina usually spends less than $1 per capita.

Last fall, North Carolina administrators laid out a list of needs for the system that tops $50 million.

Lanier Cansler, DHHS secretary under Gov. Bev Perdue, said convincing lawmakers to make that kind of investment won’t be easy.

“There is not a lot of political pressure,” Cansler said. “Unless there is something that causes (bad) publicity, it is not a priority. These things don’t get day-to-day attention unless there is a problem.”

This story was originally published September 21, 2015 at 2:00 AM with the headline "State budget boosts pay, training for medical examiners."