North Carolina’s troubled system of mostly volunteer medical examiners would be transformed into a staff of trained, full-time death investigators under a new bill in the General Assembly.
The architect of the legislation, Sen. Jeff Tarte, a Mecklenburg County Republican, says he would like to phase out the state’s roughly 350 part-time medical examiners over a five-year period. They would be replaced by 40 to 60 professional death investigators.
The state’s examiners – mostly doctors and nurses who look into deaths in their spare time – are supposed to determine the cause of suspicious and violent deaths, such as shootings, suicides and auto wrecks. Their findings are used to help solve crimes, identify public health threats and settle life insurance payouts.
But examiners fail to go to death scenes in 90 percent of the cases they investigate. Tarte’s proposal would require that the new, trained investigators visit death scenes except in certain circumstances, such as when people die in hospitals or nursing homes, or under hospice care.
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The state would also hire more forensic pathologists, and increase fees for autopsies.
Tarte said he hopes the bill will produce a “transformational” change.
“(A death investigation is) a core function,” he said. “We’ve got to stop doing it in backwoods fashion.”
The legislation comes in response to a Charlotte Observer investigation, which found that medical examiners often skip basic investigative steps, casting doubt on the accuracy of thousands of their rulings.
In 1 of every 9 deaths, medical examiners violate a state requirement to examine bodies.
Unlike current examiners, the new investigators would be required to get certification from the American Board of Medicolegal Death Investigators.
They’d be placed at one of five regional offices and within a state system that Tarte said would work toward national accreditation.
During the transition to a new system, the state’s current part-time medical examiners would work in conjunction with the new full-time professionals, Tarte said.
Pay for the part-timers would rise from $100 to $250 per case. Counties usually pay that fee.
The state would also appropriate money to establish a forensic fellowship at each of the regional autopsy centers at Wake Forest University, in Winston-Salem, and East Carolina University, in Greenville. Those positions, Tarte says, would ensure that the state doesn’t experience a shortage of trained pathologists.
In recent years, the state has struggled retaining pathologists, forcing some in the main office in Raleigh to perform more than 250 autopsies a year – heavy caseloads that experts say can lead to mistakes.
Dr. Deborah Radisch was among those with heavy autopsy caseloads. She did more than 400 autopsies in 2010, the year she became the state’s chief medical examiner.
Staffing shortages left some families waiting more than a year to find out how a loved one died.
Tarte’s bill would require the chief medical examiner conduct no more than 100 autopsies per year. He said that would help the chief medical examiner focus on her most important job: overseeing the system.
The system includes regional autopsy centers that will see the fees paid to them increase from $1,250 to $2,800 – an amount that state officials have said would cover the actual cost of conducting most exams.
Pay for the full-time death investigators will likely start at about $50,000 a year, Tarte said. To be eligible, candidates would be required to hold an associate degree or higher in a medical field.
Tarte said the medical examiner’s office could set up criteria for others without a medical degree – such as paramedics – to qualify for the job.
Funding the changes
Tarte, who co-chaired a legislative committee last year that examined ways to improve the system, said the fellow senators understand that death investigations are “a core service the state must provide.”
But state officials will have to grapple with the cost. Tarte expects that the new system would cost between $25 million and $40 million a year – compared with about $10 million today.
In addition to that, millions more would be needed to modernize some autopsy facilities – a key requirement for obtaining national accreditation.
Tarte said he hopes to achieve his plan with minimal added cost to taxpayers. The state Department of Health and Human Services – with a budget of roughly $19 billion – would be asked to adjust its priorities to provide the vast majority of the additional money, he said.
“I’m sure they’re going to fidget all the way to the bank,” he said of DHHS leaders.
Dr. Patrick Lantz, a forensic pathologist at Wake Forest Baptist Medical Center, called Tarte’s plan a “good start” but pointed to several potential problems. He questioned whether 40 to 60 full-time medical examiners could effectively cover the state, and said they might need to be supplemented with trained, part-time medical examiners.
North Carolina has one of the most poorly funded medical examiner’s offices in the country. A 2007 national survey found the average state medical examiner agency spends $1.76 per capita. North Carolina spends only about 93 cents per capita on its system.
A spokeswoman for Sen. Phil Berger, R-Rockingham, said the president pro tem needed to look at the bill’s details. But Berger believes reforming the office “has caught the attention of the legislature.”
Ryan Tronovitch, spokesman for Gov. Pat McCrory, said the governor and DHHS were also reviewing Tarte’s bill.
McCrory’s most recent budget proposal seeks $3.7 million in new funds to fix the medical examiner system. That proposal would boost state funding for the office from $6.3 million last year to $10 million, an increase of almost 60 percent.
Tarte said examiners’ work has profound implications.
“... Everyone is entitled to know how and why somebody passed away, particularly if it’s criminal and particularly if you’ve got an insurance claim,” Tarte said.
He referred to the case of Fred Lookabill, a Wadesboro man whose death was ruled natural – until funeral home workers heard shotgun pellets fall onto a metal embalming table. He also spoke of Larry Green, a Franklin County man who was zipped into a body bag even though he was still living.
The state recently awarded $425,000 to the family of Green, who was left paralyzed and with severe brain damage.
“The philosophy and policy need to change to turn this into a state-of-the-art medical examiner system statewide,” Tarte said. “All the silliness needs to stop.”
Staff writer Gavin Off contributed.
Reform bill on N.C.’s medical examiner system would:
▪ Replace roughly 350 volunteer medical examiners with 40 to 60 full-time, trained death investigators.
▪ Assign investigators to one of five regional offices.
▪ Require investigators to visit death scenes, with some exceptions.
▪ Increase the number of forensic pathologists.
▪ Limit the number of annual autopsies for pathologists.