Major fixes on medical examiners’ system stalling in General Assembly

Budget proposals by the House, Senate and Gov. Pat McCrory would enhance the state medical examiner system and increase fees paid for autopsies, Here, Judith Page, an autopsy technician, cleans up after performing an autopsy at the state medical examiner’s office in Raleigh.
Budget proposals by the House, Senate and Gov. Pat McCrory would enhance the state medical examiner system and increase fees paid for autopsies, Here, Judith Page, an autopsy technician, cleans up after performing an autopsy at the state medical examiner’s office in Raleigh. cseward@newsobserver.com

An ambitious plan to overhaul North Carolina’s dysfunctional medical examiner system is in jeopardy in the General Assembly.

Budgets approved by the Senate and House call for some improvements. That guarantees the state’s approach to investigating suspicious deaths will change. But those enhancements probably won’t be as dramatic as some lawmakers and experts had hoped.

A plan to reform the system – introduced this year by Sen. Jeff Tarte, a Mecklenburg County Republican, has been largely ignored by Senate budget writers.

Tarte’s plan would replace many of the state’s part-time medical examiners with 40 to 60 trained, full-time professionals during the next decade. He also proposed that investigators be required to visit death scenes except in certain circumstances, such as when people die in hospitals or nursing homes, or under hospice care.

Tarte said a well-designed system is critical to families, who depend on proper death investigations to close estates and collect life insurance payments after relatives die. Police also rely on them. In at least four recent cases, medical examiners failed to detect homicides, an Observer investigation last year found.

The state’s medical examiners – mostly doctors and nurses who look into deaths in their spare time – are supposed to determine the cause of suspicious and violent deaths.

But an Observer investigation last year found that medical examiners routinely skip crucial steps, raising questions about the accuracy of death 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.

“There’s a huge cost for screwing up, as we’ve seen,” Tarte said.

But Senate leaders have balked at paying for Tarte’s proposal, an estimated $80million over the next 10 years.

Shelly Carver, a spokeswoman for Senate President Pro Tem Phil Berger, said Tarte’s reform proposal “assumes a perfect-world scenario with unlimited resources.”

“But objectively, I think most folks would agree the Senate budget makes significant additional investments in the Office of the Chief Medical Examiner that should help address many of the concerns raised by the Observer,” Carver said.

Tarte said he may push a separate bill this year to establish a pilot program involving two to five full-time death investigators in Raleigh. That could pave the way for the changes he’s seeking, he said.

If major changes aren’t enacted, it won’t be the first time lawmakers missed an opportunity to reform the system.

In 2001, a legislative study committee recommended that North Carolina improve death scene investigations, mandate training for medical examiners and hire trained death investigators. None of those recommendations were adopted.

Tarte said he’s determined to reform the system this time, even if it takes a few years.

“My commitment is to see that vision come to life. Period,” he said.

What’s proposed

For now, the budgets proposed by the Senate, House and Gov. Pat McCrory call for the following changes:

▪ Training medical examiners.

The state does not require medical examiners to be trained and rarely disciplines them when they break the rules, the Observer found. The Senate and House budget proposals would require training, and provide $100,000 a year to pay for it. McCrory’s budget would also fund a training program.

▪ Increasing pay for medical examiners and autopsy centers.

Medical examiners are paid $100 to investigate each case, and state leaders say that has made it difficult to attract candidates. The budgets approved by McCrory and the Senate proposed increasing the fee to $250.

The House budget would increase it to $200.

The Senate and House budgets would raise the fees paid for autopsies to $2,800 and $1,750, respectively. McCrory sought to increase the fee to $2,250 after two years. Autopsies cost about $2,800 each.

The state and counties pay $1,250 and autopsy centers are responsible for the rest.

“You can’t ask (us) to subsidize the state,” said Dr. Patrick Lantz, a forensic pathologist at Wake Forest Baptist Medical Center.

In most cases, counties will be responsible for paying the additional fees.

▪ Appointing at least one medical examiner per county.

The Senate’s budget calls for at least two medical examiners per county. The House proposal calls for at least one.

“There should be no excuse for the inability to site-visit those types of (suspicious) deaths,” said Sen. Tommy Tucker, a Union County Republican.

In the weeks ahead, a legislative conference committee will resolve differences between the House and Senate budgets.

The cost of mistakes

But the Senate and House proposals, if adopted, would do little to address a key problem – the failure of many medical examiners to visit death scenes.

Lantz, the forensic pathologist, said visiting death scenes is “very important.”

“Things can actually get missed if a trained medical person does not go there and look at the body and look at the scene,” he said.

A Johnston County medical examiner didn’t go to the scene in 2010 when 80-year-old James “Tom” Cooper was found in a pool of blood in his kitchen. The medical examiner concluded that Cooper died of a heart attack, but an autopsy found that he’d been bashed in the head with what appeared to be the blunt end of a hatchet.

Fred Lookabill’s 2007 death also got little scrutiny – until shotgun pellets fell from his body onto a metal embalming table.

Concluding that the 71-year-old Wadesboro man had died of natural causes, a medical examiner sent Lookabill’s corpse to the funeral home without removing his shirt. As they prepared to embalm Lookabill’s body, funeral home workers found a shotgun wound in his back. His killer was never found.

Gayle Hildreth, Lookabill’s daughter, called the legislature’s proposals “a foot in the right direction.” Requiring training for medical examiners should help, she said, but the system needs full-time investigators who are bent on getting at the truth.

“You need to put everything you can into finding the right answer,” she said. “ … It’s too important to families to let a mistake go. Nobody should have to go through this.”

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Senate budget proposal

▪ Appoint at least two volunteer medical examiners per county.

▪ Expand medical examiner training.

▪ Create two forensic pathology fellowships.

▪ Upgrade equipment.

▪ Increase per-case fees for medical examiners from $100 to $250.

▪ Increase autopsy fees from $1,250 to $2,800

▪ Senate representatives said proposed changes would increase funding for the medical examiner's office by 35 percent (to $7.6 million) in fiscal year 2015-16 and by 63 percent (to $9.3 million) in 2016-17. Those changes include money from the state and counties.

House proposal

▪ Appoint at lease one volunteer medical examiner per county.

▪ Expand medical examiner training.

▪ Create two forensic pathology fellowships.

▪ Upgrade equipment.

▪ Increase medical examiner case fees to $200.

▪ Increase autopsy fees to $1,750.

Gov. Pat McCrory’s proposal

▪ Create 14 paid, full-time death investigators.

▪ Expand training.

▪ Create two forensic pathology fellowships.

▪ Upgrade equipment.

▪ Increase case fees for medical examiners from $100 to $250.

▪ Increase autopsy fees to $2,250.

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