Saying that North Carolina’s medical examiner system has “serious and significant performance issues,” lawmakers Monday recommended major reforms, including requiring training for examiners and increasing their pay.
But at least one legislator – Sen. Tommy Tucker, R-Union – warned that the state “does not have pots of gold” to fix the problems.
The medical examiner’s office is under scrutiny for operating a system in which examiners skip basic steps when investigating homicides, suicides and other suspicious deaths. The system has been poorly funded for years.
A five-part Observer series published in May found that medical examiners don’t go to death scenes in 90 percent of their cases. They also violate a requirement to view the bodies in 1 of every 9 deaths.
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Faulty investigations can allow criminals to go unpunished and leave grieving families without insurance payouts.
During a two-hour hearing, a legislative oversight subcommittee recommended rebuilding or replacing buildings at regional autopsy centers, increasing the reimbursement per autopsy, and building new facilities in the southeast and western parts of the state.
Legislators said they are appalled that medical examiners sometimes fail to view bodies and promised to propose legislation when the General Assembly reconvenes in January.
Currently, doctors and nurses serve as medical examiners and investigate cases in their off-hours. They are rarely disciplined for taking shortcuts.
When officials at the Office of the Chief Medical Examiner suggested waiting until 2016 to finalize a report on replacing the volunteers with full-time professionals, lawmakers objected. They said any delay in completing the study beyond early next year is “unacceptable” and ordered a report by March 2015.
In one tense exchange, state Chief Medical Examiner Dr. Deborah Radisch said she wanted to postpone studying the possibility of hiring full-time investigators while officials begin training the current medical examiners.
“We have 470 boots on the ground,” she said. “They need training. We have people who can be brought up to a higher standard. … I don’t want to be set up to fail.”
State Rep. Justin Burr, R-Stanly, interrupted, saying, “We’ve already passed that (point).”
Burr repeatedly noted the state’s failures after an elderly couple died in a Boone hotel room in April 2013. The local medical examiner, Dr. Brent Hall, did not warn the state toxicology lab in Raleigh about the circumstances, and it took six weeks to determine that leaking carbon monoxide killed the couple. In June 2013 11-year-old Jeffrey Williams died of carbon monoxide in the same room.
“I understand training, but the medical examiner in Boone, what were his qualifications?” Burr asked rhetorically. “He was a pathologist. He had training and it didn’t save that little boy’s life.”
Burr said the state’s system for investigating suspicious deaths should not depend on volunteers. He added: “It’s not really 470 boots on the ground. They are part-time. It’s … if they have the time and if they decide to show up.”
After the newspaper’s series, Gov. Pat McCrory promised to make changes. Legislators later approved an extra $1 million for the medical examiner’s office – half what McCrory requested.
Monday’s recommendations from the legislative subcommittee will now go to the Joint Legislative Oversight Committee on Health and Human Services for consideration.
Many of the ideas are similar to the suggestions experts proposed more than a decade ago, after a previous Observer investigation.
Among the recommendations:
• Mandate minimum training for medical examiners. Unlike states and counties with leading death investigation systems, North Carolina currently requires no training.
• Raise the fee paid to examiners to $250 per case. Examiners receive only $100 per case, which gives them little incentive to drive to death scenes and take other steps to ensure cases are thoroughly examined.
• Spend money to replace aging autopsy centers in Winston-Salem and Greenville and help pay for renovations to the Mecklenburg medical examiner’s office.
Lawmakers’ proposals did not include a requirement that medical examiners view bodies in each case, but State Sen. Jeff Tarte, R-Mecklenburg, said they should enact a new law.
When examiners do not take such a routine step, “the optics are egregious,” Tarte said.
Department of Health and Human Services Secretary Aldona Wos disagreed. She and Radisch said there are circumstances that sometimes prevent medical examiners from inspecting the bodies. Sometimes hospitals and other institutions fail to call medical examiners before bodies are buried or cremated, Radisch said.
Even with the $1 million lawmakers added earlier this year, North Carolina spends only about 93 cents per capita on its system. That’s far less than most systems with accreditation from the National Association of Medical Examiners, a group that sets guidelines. They typically spend about $3 per capita, according to a recent study.
Last month, DHHS proposed a reform plan that would cost the state about $6 million more per year. One-time expenses under that plan would total about $53 million.
At Monday’s hearing, Tucker, the Union County Republican, warned officials they may get less money than they want.
Tucker said that achieving national accreditation in government is usually expensive. He asked whether the state could bolster the medical examiner system without attaining that goal.
“I am trying to get y’all up to standard without all the bells and whistles,” Tucker said.
But he later suggested lawmakers take money from reserves designated for Medicaid. The state had set aside about $186 million that it would not need to spend, Tucker said. The Medicaid money, however, could only go toward one-time expenses, such as a building, rather than recurring expenditures.
Burr, the Stanly Republican, bristled at the suggestion the state would not spend what’s needed.
“This is a core function of government,” Burr said. “I think it’s a priority. When you have been kicking the can down the road for years and years, it means the price is going up. This is a prime example of that. We have got to step back and look at the long term.” Reporters Ames Alexander and Gavin Off contributed.