Experts say North Carolina should take these steps to improve the system:
Unlike leading states and counties, North Carolina requires no training for medical examiners.
In Maryland, new hires must receive certification from the American Board of Medicolegal Death Investigators. They go through a two- to three-day orientation and spend 300 hours as “apprentices” before they are in the field alone.
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In New Mexico, on-call investigators must attend a weeklong training session plus regular refresher courses.
In Oakland County, Mich., new investigators spend their first six months in “basic training” following veteran investigators.
“If you do not implement a full degree of professionalism, something will be amiss,” said Dr. Ljubisa Dragovic, chief medical examiner for Oakland County. “If you want people to do good work, they have to know how.”
Visit death scenes
The Observer found North Carolina medical examiners go to death scenes about 10 percent of the time even though experts say it is a crucial investigative step.
States and counties with leading systems require investigators to attend most, if not all, suspicious death scenes. They say scenes often offer clues that make death rulings more precise. Investigators inspect the body, take pictures and collect other information.
Dr. Andrew Baker, chief medical examiner for Hennepin County, Minn., said he believes autopsy results are easier to interpret when combined with site evidence.
North Carolina medical examiners often count on law enforcement for that information. That is contrary to national best practices.
“Police are looking at the death differently. Is it a crime or not?” Baker said. “We’re trying to figure out what caused the death. Is there a public health threat?”
North Carolina uses busy doctors or other health care professionals as medical examiners. Paid $100 per case, many can’t or won’t go to scenes or view bodies during their work hours or in the middle of the night.
Nationally accredited offices often hire full-time, trained investigators to visit death scenes, interview witnesses and compile reports. In North Carolina, only Mecklenburg and Wake counties have professional investigators.
Dr. Victor Weedn, a professor of pathology at George Washington University in Washington, said there is an inherent weakness with using doctors as investigators in their off hours. The role “is not their top priority,” Weedn said, and receiving $100 per case is “not a great motivator.”
Hiring full- or part-time investigators brings accountability, Weedn said. “You can say these are my standards.”
Increase spending and autopsies
Nationally accredited systems typically spend between $2.50 and $3.50 per capita. North Carolina spends 84 cents per capita. That means the state performs fewer autopsies, considered the most reliable tool in death rulings. The Observer gathered data from a dozen accredited medical examiner offices and found that all performed autopsies in a significantly higher percentage of cases than North Carolina.