Calling the medical examiner’s system broken, Gov. Pat McCrory asked lawmakers last month for an additional $2 million to improve the way the state investigates suspicious deaths.
McCrory said the new money would be a stopgap measure for shoring up a long-neglected system. He made it clear that the state’s roughly 350 medical examiners need better training and higher pay.
An Observer series in May reported that untrained medical examiners across the state often fail families and imperil justice with faulty rulings, and that some pathologists juggle autopsy caseloads far above the recommended level.
But the House and Senate budgets that were approved in recent weeks didn’t reflect the governor’s proposal. Each chamber allocated a $1 million increase – half of what McCrory requested.
Josh Ellis, spokesman for the governor, said Tuesday that McCrory is still pushing for the extra $2 million for the Office of the Chief Medical Examiner.
“The governor stands by his original proposal,” Ellis said. “We’re going to continue to push for the priorities that were in the governor’s budget.”
This week, legislators are trying to agree on a final budget, attempting to reconcile differences between the two chambers. It’s unclear if legislators will increase the amount for medical examiners.
A spokeswoman for House Speaker Thom Tillis, R-Mecklenburg, said the House’s recommendation of an additional $1 million to the medical examiner’s system “shows we see this as an important need.”
But critics say that the proposed $1 million increase – or even twice that, as McCrory has requested – isn’t enough to fix the problems.
“If this is the only step they’re planning on taking, it’s going to be woefully inadequate,” said Dr. Patrick Lantz, a forensic pathologist at Wake Forest Baptist Medical Center.
Last fiscal year, the state provided $4.4 million to the medical examiner’s office. Counties added $3.9 million more for a total budget of $8.3 million.
A 2007 study found that the average state medical examiner system spent $1.76 per capita on its death investigation system. Last year, North Carolina spent less than half that – about 84 cents per capita.
“I feel bad for North Carolina,” said Dr. Gregory Davis, a Kentucky forensic pathologist who used to work with Lantz in Winston-Salem. “It breaks my heart to hear the medical examiner’s office is not getting what it needs.”
The need for change
North Carolina relies on hundreds of appointed medical examiners, most of whom are full-time doctors, to investigate sudden, accidental and violent deaths during their off hours.
The Observer’s investigation found that medical examiners often fail to follow crucial investigative steps, raising questions about the accuracy of thousands of death rulings.
Medical examiners don’t go to the death scene in 90 percent of the cases they review. In 1 in 9 deaths, they violate a state requirement to look at the bodies.
The state performs autopsies in 40 percent of medical examiner cases, fewer than many nationally accredited systems. Despite the low rate, staffing problems have caused 11 pathologists in recent years to perform more than the recommended number of annual autopsies – a situation that experts say increases the chances of mistakes.
“The worst-case scenario is what we have right now,” Lantz said. “You have local medical examiners not looking at the body or going to the scene, and you have a low autopsy rate on top of that.”
$2 million for more training
Kevin Howell, spokesman for the medical examiner’s office, said a $1 million increase would pay for supplies, help develop a training program for medical examiners and provide a stable source of funding for regional autopsy centers.
“The second million dollars in funding is critical to further develop the training program and to implement it across the state,” said Howell, adding that the money would also help support fellowship programs to train new forensic pathologists.
Even though the House and the Senate budgets call for an increase of $1 million, Rep. Becky Carney, D-Mecklenburg, said the amount could increase as the budget heads for final passage.
McCrory told the Observer earlier that he “wouldn’t be disappointed” if legislators added more than his requested $2 million.
“It’s been ignored for far too long,” he said. “And we’re pleased with our first steps, but we also recognize there’s more to go.”
In an interview last month, Dr. Aldona Wos, head of the N.C. Department of Health and Human Services, said she recognized problems within the medical examiner’s system after she took office last year. DHHS oversees the medical examiner’s office.
Wos said she was concerned about a lack of training and funding.
“We need greater education, greater oversight,” Wos said.
Along with the $1 million increase, the Senate's budget also calls for an independent review of the medical examiner’s office.
After its investigation, the Program Evaluation Division would make recommendations to lawmakers about how the system could be improved.
Reporters Ann Doss Helm and Ames Alexander contributed