Acknowledging that North Carolina’s medical examiner system has been chronically understaffed and underfunded, state officials on Monday told lawmakers of a plan to overhaul the way the state investigates suspicious deaths.
The program needs more investigators, training and money, officials with the state Department of Health and Human Services told a legislative panel that is studying ways to improve death investigations.
“… The system has been ignored and diminished,” DHHS secretary Wos told the committee, which oversees the department.
The medical examiner’s office has struggled with overworked pathologists and medical examiners who fail to perform basic investigative steps.
An Observer investigation published this year found that medical examiners routinely take shortcuts when probing suspicious deaths. Medical examiners don’t go to deaths scenes in 90 percent of their cases, and they violate a state requirement to view the bodies in 1 of every 9 deaths.
Faulty investigations can compromise criminal investigations and leave families without the insurance payments they deserve.
During a four-hour hearing Monday, lawmakers grilled state officials about why the decades-old problems haven’t been fixed. They questioned why DHHS had not brought the issues to their attention before the Observer series.
“I have the feeling of being irritated, being here in 2014 based primarily on a journalism article...,” said State Sen. Tommy Tucker, R-Union County. “In death, people should have the dignity to receive a correct death certificate.”
In sometimes tense exchanges, state administrators said they have pleaded with lawmakers for more money but were ignored.
At one point, an official read through nearly two dozen recommendations from a 2001 report on how to improve investigations. Almost none of them were implemented.
The state system isn’t accredited by the National Association of Medical Examiners, but DHHS officials say they are trying to change that. Accreditation will require significant changes and substantially more money.
Dr. Lou Turner, a DHHS official who helps oversee the medical examiner’s office, said the agency is considering whether to add 50 death investigators. The salaries and benefits would cost $2.8 million, she said.
State Chief Medical Examiner Dr. Deborah Radisch told lawmakers more training money is needed.
“No matter who you appoint, I don’t care how smart a doctor or how smart a nurse you are, you have to be trained to do this,” she said.
Most medical examiners are doctors and nurses who perform death investigations on the side. The state pays them $100 per case, which experts say is little incentive to get up at night or travel to a death scene.
The Observer found that the state doesn’t require examiners to be trained or to visit death scenes, even in homicide cases. And when medical examiners break the rules, they’re rarely disciplined.
Sen. Tucker criticized Radisch and other medical examiner leaders for waiting so long to ask lawmakers for help. Radisch, who previously worked as associate chief medical examiner, assumed the agency’s top job in 2010.
“I am disappointed,” Tucker said. “Every one of these questions was raised in 2001.”
DHHS officials on Monday proposed that the state increase the fee paid to medical examiners from $100 to $250 per case.
But Tucker questioned why agency leaders didn’t do that earlier. “It’s amazing to me,” he said.
Wos defended Radisch, saying she has been busy doing autopsies and taking other steps to keep the understaffed system afloat.
DHHS: We’re making progress
The Observer’s investigation found that pathologists in the state’s chief medical examiner’s office in Raleigh routinely do more than 250 autopsies a year – heavy caseloads that experts say can lead to mistakes.
After the series, the General Assembly asked an independent research unit to examine ways to improve the system. The legislature’s Program Evaluation Division should wrap up its study and recommendations in early 2015, said Director John Turcotte.
Legislators also approved an additional $1 million for the medical examiner’s office. The money represents a roughly 24 percent increase in state funding for the system.
Lawmakers credited the Observer for bringing the issue to the attention of politicians. But, said Sen. Don Davis, D-Greene: “It shouldn’t take the media to encourage us to be visionary.”
Wos, who was appointed to run DHHS in 2013, said the department has made progress on hiring, reducing caseloads, and fixing problems in a regional autopsy system “that was at risk of falling part.”
But Tucker criticized Wos, saying her department has been at the center of several controversies, including computer problems that last year left thousands of families waiting months for food stamps.
Search for solutions
North Carolina has one of the most poorly funded medical examiner systems in the country.
Even with the additional $1 million, North Carolina spends about 93 cents per capita on death investigations. That’s significantly less than most states. A 2007 study found that the average state medical examiner system spent $1.76 per capita on its death investigation system.
Many leading systems send trained, professional investigators to the scene of every suspicious death to search for clues.
Radisch pointed to Virginia’s well-regarded medical examiner system as a possible model for North Carolina. There, four regional centers oversee investigations and perform autopsies.
Radisch said her goal is to have every autopsy performed by board-certified forensic pathologists, as nationally accredited systems do. Now, she said, 19 percent of autopsies in the state are done by general pathologists, who specialize in natural disease, not violent deaths.
Under the DHHS plan, state officials would pay to expand Mecklenburg County’s office and to build new offices in Winston-Salem and Greenville. They would also open two new autopsy centers in the eastern and western parts of the state.
Lawmakers referred to the largely ignored 2001 report and promised that they would not let history repeat itself. Sen. Jeff Tarte, R-Mecklenburg, cited personal examples. He said his father drowned at age 49. His mother was killed at age 65 in a car crash. And his sister died at age 36 of complications from a hospital-acquired infection.
“The status quo is completely unacceptable,” he said.