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As N.C. struggles, nation’s top medical examiners meet in Charlotte

Dr. Gregory Schmunk, former president of the National Association of Medical Examiners, questions the way North Carolina pays for investigations into suspicious deaths. “If your medics and firefighters were paid per ambulance run, I don’t think the system would last long at all,” he says.
Dr. Gregory Schmunk, former president of the National Association of Medical Examiners, questions the way North Carolina pays for investigations into suspicious deaths. “If your medics and firefighters were paid per ambulance run, I don’t think the system would last long at all,” he says. mhames@charlotteobserver.com

As North Carolina’s medical examiner system struggles to overcome problems, members of a national group focused on improving investigations into suspicious deaths have converged on Charlotte for their annual conference.

Meeting at the Westin hotel from Friday through Tuesday, more than 400 members of the National Association of Medical Examiners (NAME) will attend an array of educational sessions, ranging from “sudden death in the young” to “the explosive effects of lightning.”

An Observer investigation, published last year, found that N.C. medical examiners routinely skip crucial steps when they look at suspicious deaths, raising questions about the accuracy of many rulings.

North Carolina’s system isn’t accredited, but the conference comes as the state seeks accreditation from NAME for the main medical examiner office in Raleigh. That would mean it would have to meet minimum operating standards.

You’re only going to get one shot at the investigation. You’re only going to get one shot at the autopsy. You want to be able to give it 100 percent.

Dr. Gregory Schmunk, past president of the National Association of Medical Examiners

It also comes less than two weeks after lawmakers approved a state budget that increases pay for the state’s part-time medical examiners from $100 to $200 per case, and for the first time, sets aside money for mandatory training.

Dr. Gregory Schmunk, a past president of NAME who is in town for the conference, said the changes approved by the legislature are an improvement. But he predicts that problems will persist if the state continues to rely on part-time medical examiners who aren’t required to visit death scenes.

“Do you want people who remove your appendix or perform heart surgery doing it on a part-time basis?” asked Schmunk, who serves as chief medical examiner for Polk County, Iowa, which includes Des Moines. “Wouldn’t you rather have someone who is full-time and continually trained?”

“State of improvement”

Dr. Randall Williams, North Carolina’s deputy secretary of health services, said he and other officials who oversee the state medical examiner’s office will attend the conference. So will 12 of the state’s 16 forensic pathologists.

“I’m always open to learning from other states,” said Williams, an obstetrician who began his state job in July. “We are in a constant state of improvement.”

Among other things, the Observer’s investigation found that examiners don’t go to death scenes in 90 percent of their cases and sometimes violate a state requirements to examine the bodies.

Money has been a key obstacle. North Carolina has one of the nation’s most poorly funded death investigation systems.

Most medical examiners have other full-time jobs but conduct death investigations in their off-hours. They’re paid on a per-case basis, whether they visit death scenes or not.

That’s not how it works at many medical examiner systems with NAME accreditation. They hire trained, full-time investigators who visit death scenes, inspect corpses, interview witnesses and gather other information.

State Sen. Jeff Tarte, a Mecklenburg County Republican, introduced a bill earlier this year that would have traded the roughly 350 part-time medical examiners for a staff of trained, full-time death investigators. His proposal would have required investigators to visit most death scenes.

But Tarte’s fellow lawmakers balked at the cost, an estimated $80 million over the next 10 years.

Schmunk, the former NAME president, questions whether North Carolina should continue its heavy reliance on part-timers.

“You’re only going to get one shot at the investigation,” he said. “You’re only going to get one shot at the autopsy. You want to be able to give it 100 percent.”

Vast knowledge required

Despite the grim nature of their work, medical examiners routinely show their senses of humor. In a raffle to raise money for NAME’s non-profit foundation, the prizes on display Friday included the “chop shop” – a bag of candies shaped like body parts.

But their jobs are no joking matter. Through their investigations, medical examiners often help catch killers, identify health threats and ensure that families get life insurance payments.

Dr. David Fowler, who serves as NAME’s vice president and as Maryland’s chief medical examiner, said the association’s conferences are crucial to helping examiners attain the vast knowledge required of their profession.

“If you take every disease process known to man – and layer on it all the ways people can die an unnatural death – that constitutes the body of knowledge and the type of cases we investigate on a daily basis,” Fowler said. “...We have a very specific set of skills. But we must have broad knowledge to base our conclusions on.”

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