Politics & Government

Lawmakers take step to reform NC medical examiner’s office

North Carolina’s lawmakers will spend an additional $1 million to begin fixing the state’s troubled medical examiner system while a legislative committee studies what other steps are needed.

Critics contend the $1 million included in the recently approved budget will fall far short of addressing deep-seated problems in the state’s system for investigating suspicious deaths. But top lawmakers say they hope the study will lead to more significant changes down the road.

“I suspect there will be legislation and hopefully a funding guideline,” said Sen. Ralph Hise, a Mitchell County Republican who co-chairs the committee that oversees appropriations for health and human services. “We need to drill down and see what actual funding is needed.”

Hise said he’ll lead a legislative oversight committee that will make recommendations to the full session that starts in January.

An Observer investigation published in May found that medical examiners rarely go to death scenes and sometimes don’t look at bodies in cases they handle. The state requires no training and seldom disciplines examiners who break the rules. The state also conducts fewer autopsies than better-regarded systems, which experts say makes it harder to determine the correct causes of death.

For the living, the effects can be devastating. Widows can be cheated out of insurance money. Families may never learn why their loved ones died. Killers can go free.

Sen. Louis Pate, a Lenoir Republican who co-chairs the appropriations committee with Hise, said he found the Observer’s findings “very disturbing.”

“I do think it’s critical that we do this study,” he said.

The legislative study might examine how other states handle death investigations, Pate said. The Observer found that other states spend far more than North Carolina on their systems, often requiring that medical examiners get training and visit death scenes.

Hise said the study committee will analyze such things as medical examiners’ pay, qualifications and oversight, in addition to the system’s long-term funding needs.

The panel will also examine whether to merge the state crime laboratory and the state medical examiner’s office into a single independent agency.

The committee will enlist the help of the 14-member Program Evaluation Division, which typically spends four to six months studying an agency or issue before publishing recommendations for legislators to consider.

McCrory wanted more

The state and its counties spent $8.3 million on the system last year.

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.

In his May 13 budget proposal, Gov. Pat McCrory requested $1 million more for the system. He increased his request to $2 million the week the Observer published its series.

The governor said at the time that $2 million is needed to shore up a long-neglected system. He made it clear that the state’s roughly 350 medical examiners need better training and higher pay.

But increasing funding for the N.C. Department of Health and Human Services, which oversees the medical examiner’s office, is not an easy sell in Raleigh. In recent months, lawmakers have grilled Dr. Aldona Wos, the department’s secretary, about problems in her agency. A Senate plan would remove the state Medicaid office from the department, which has been criticized for its oversight of the program.

In arriving at the $1 million figure, Senate President Pro Tem Phil Berger and House Speaker Thom Tillis said they decided to accept the governor’s original request.

“We accepted the formal proposal,” Tillis told reporters last week. He did not elaborate.

DHHS spokesman Kevin Howell previously told the Observer that 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, he said, would be “critical” to further develop the training program and to implement it statewide.

Big job, little pay

Medical examiners are called in to investigate when the stakes are highest: suspicious, violent, accidental and unattended deaths. Those account for about 10,000 of the roughly 75,000 deaths in North Carolina each year.

Most medical examiners are full-time doctors who perform death investigations on the side. The state pays them just $100 per case – and no mileage – so experts say there’s little incentive for examiners to get up at night or travel to death scenes.

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 investigation found four instances in which medical examiners missed or misread key evidence in what later turned out to be cases of murder or manslaughter.

Experts elsewhere say the North Carolina system – among the most poorly funded in the nation – has been starved of the resources needed to ensure prompt, accurate rulings.

Some point to a Boone hotel, where the system’s failures allowed a serious public health threat to persist.

After Daryl and Shirley Jenkins died at the Best Western last year, it took the state medical examiner’s office about six weeks to find the cause: leaking carbon monoxide. Even then, the information wasn’t made public until 11-year-old Jeffrey Williams died of the same cause – in the same hotel room.

Staff writer Gavin Off contributed.