N.C. Medical Examiners

In Maryland, careful probes produce better results

They gathered around the battered corpse seeking answers about the man who was hit by a train.

Why was he lying on the tracks? Was it an accident? Did someone murder him?

A trained death investigator had gone to the scene to inspect the body, interview police and take photographs.

Then forensic pathologists inspected the corpse and analyzed the information.

The scene – on a cold January day in one of America’s most violent cities – offers a glimpse into how to properly investigate suspicious deaths.

The Observer visited the Maryland Office of the Chief Medical Examiner because it is considered one of the nation’s most respected operations.

Maryland sends trained investigators to all death scenes across the state. Violent shooting deaths get extra attention. The office works with law enforcement to identify gang members. It alerts public health officials to threats such as carbon monoxide.

North Carolina’s network of about 350 local medical examiners, operating virtually as volunteers, is partly modeled after Maryland’s office.

But North Carolina doesn’t offer the same protections.

An Observer investigation reveals medical examiners have little or no training, rarely go to death scenes and sometimes don’t even view bodies – basic steps in a competent investigation. Autopsies, considered the most reliable tool to find out why someone died, are performed far less often than in Maryland.

Experts say North Carolina should embrace practices from Maryland and other offices accredited by the National Association of Medical Examiners.

NAME sets standards for investigating suspicious deaths, performing autopsies, training and facilities. North Carolina is not accredited.

“Accreditation proves you have put enough in place to ensure good results,” said Dr. David Fowler, chief medical examiner for Maryland. “When the inevitable error occurs, it shows you it’s an aberration.”

North Carolina officials acknowledge the need for changes.

State Chief Medical Examiner Deborah Radisch said her office can’t operate like a system that spends more money. Maryland spends $1.97 per capita on its death investigations. The national average is $1.76 per capita, according to a 2007 survey by the National Association of Medical Examiners.

North Carolina spends less than half that – about 84 cents per capita.

In his May 13 budget proposal, Gov. Pat McCrory asked lawmakers for an additional $1 million to improve suspicious death investigations. The state and counties spent $8.3 million on the medical examiner system in fiscal year 2013.

Earlier, Radisch had said North Carolina officials plan to bolster training and make other moves to produce stronger investigations. In recent months, her agency has offered higher pay to recruit and retain forensic pathologists who conduct autopsies. It also hired a full-time death investigator in Raleigh.

“There are multiple improvements that can be made, and we’re in the process of making those improvements,” Radisch said.

‘We’re the eyes and ears’

One morning in January, forensic pathologists, field investigators and others at Maryland’s office swing into their daily ritual.

Hours earlier, workers had transported 12 bodies to the office. Among the cases: a teen who collapsed while exercising, a woman with a history of mental illness who may have shot herself in the head, and a decomposed body found in a home.

The forensic pathologists and field investigators walked from corpse to corpse. They looked over the bodies and read about the deceased. Photographs from the death scene flashed on nearby monitors.

One floor down, forensic investigator Aaron Hearn waited by the phone for the next unexplained death. The office had seen 16 homicides in the previous two weeks.

Hearn is one of 11 professional investigators who examine deaths in Baltimore, where about one-third of Maryland’s suspicious deaths occur. The city has one of the highest murder rates in the country, with roughly 230 homicides last year.

For a salary of about $40,000 a year, Hearn visits death scenes, inspects corpses, interviews witnesses and gathers other information.

His role is vital. Forensic pathologists use the reports and photographs that investigators compile on each case to help determine the cause of death.

On-call investigators look into suspicious deaths outside Baltimore. Hearn oversees their work, making sure they ask key questions, interview witnesses and collect enough information.

A wall near Hearn’s desk is plastered with pictures of gang tattoos. Hearn and other investigators are documenting all tattoos in their cases to help state police identify gang members and track gang violence.

“We’re the eyes and ears for the doctors here,” Hearn said.

Co-workers call Hearn “Mr. Hollywood” because he has served as a technical adviser on television shows such as “The Wire” and “Homicide.” Producers from “Homicide” used his case files to develop plots, they said.

But Hearn said working as a death investigator in one of the country’s most violent cities is serious business.

He recalled going to a home where an elderly woman was found stabbed to death. A man wielding a knife darted from under a bed. He ignored police orders to drop the weapon.

Moments later, Hearn said, officers shot the suspect to death. “The blood sprayed and I had to duck out of the way,” he said.

Unrealistic expectations?

In North Carolina, only Mecklenburg County and the state chief medical examiner’s office in Wake County have full-time death investigators.

But even in Mecklenburg, investigators visit death scenes in only 11 percent of cases.

Most of the state counts on full-time doctors and other medical professionals to do investigations in their off hours. They are paid $100 per case.

Radisch, the North Carolina chief medical examiner, said replacing local medical examiners with professional death investigators is unrealistic because there isn’t enough money.

“Our goal is to get people as close to death investigators (as possible) in the system we’re working under,” Radisch said.

Given the lack of training, that can be difficult.

Judith Tintinalli said she became a North Carolina medical examiner to serve her community.

The former chair of UNC Chapel Hill’s Department of Emergency Medicine said she took the position “with no instruction other than Web resources to read the statutes.”

In May 2013, Tintinalli resigned after a year as a Chatham County examiner. As an emergency room doctor who worked the night shift, she could put only limited time into the medical examiner job. She feared being sued.

“You can’t expect somebody to have a full-time job, fall asleep at 3 a.m. and get a call at 4 a.m. and …do a good job,” she said.

Dollhouse training

Much of the six-story building that houses the Maryland medical examiner’s office is what you would expect: refrigerated rooms with bodies, high-tech equipment and the sterile feel of a hospital.

But in Room 417 it changes. Eighteen glass-enclosed dollhouses depict real-life death scenes from the 1930s and 1940s. They include detailed miniatures of a man shot to death, another hanging and a couple dead in a bedroom.

Frances Glessner Lee, a millionaire heiress, built the dollhouses to help advance investigation into suspicious deaths and donated them to Harvard University.

When school officials planned to throw them out, a medical examiner took them to Baltimore.

Now, the medical examiner’s office uses them to train forensic investigators and police on how to make detailed observations at death scenes.

Nearby is another surprise. The “Scarpetta House,” a donation from author and former Observer reporter Patricia Cornwell. It’s a full-scale replica house named for Kay Scarpetta, a character in Cornwell’s novels who is a medical examiner.

The training room is decorated with furnishings, including a stove, refrigerator, bed and living room with furniture. Officials create death-scene scenarios using a mannequin.

In Maryland, full-time investigators must seek certification from the American Board of Medicolegal Death Investigators, a widely recognized training program. The office also requires investigators to complete an apprenticeship under seasoned investigators before they go out on their own cases.

In the past, North Carolina’s medical examiner office offered an annual training seminar, but examiners had to pay their own way to attend. Officials suspended the training last year because they lacked money. They hope to restart the seminar with money in the governor’s budget proposal.

Radisch said she would like the state to require standardized training for medical examiners to bring more consistency to how cases are investigated. Forensic pathologists scattered around the state would help train medical examiners in their regions.

Experts from other states said training is a cornerstone of any competent death investigation system.

Investigations vary

In Maryland, every medical examiner case is handled in the Baltimore office.

A team of forensic pathologists inspects each corpse in the morning. They meet again in the afternoon to discuss findings from autopsies.

Only forensic pathologists make rulings about the cause of death.

Fowler said the approach means Maryland has “consistency” in its death investigation system. That means investigations follow guidelines set by the office and cause-of-death rulings do not vary from county to county.

In North Carolina, where no training is required for medical examiners, they issue preliminary cause-of-death rulings and request autopsies. A forensic pathologist reviews their findings.

The Observer investigation found wide variations from county to county in how suspicious deaths were investigated.

For example, since 2001 the percentage of bodies autopsied in medical examiners’ cases varied from 19 percent in Johnston County, near Raleigh, to 72 percent in Mitchell County, which sits in the mountains.

Radisch said she doesn’t like to compare death investigation systems in different states.

She noted that Maryland, with 24 counties, is much smaller than North Carolina, which has 100 counties.

“They have the luxury of doing everything in one county,” she said. “It’s manageable because it’s all centered in Baltimore.”

But asked whether North Carolina should radically alter its death investigation system, Radisch and other state officials acknowledged it was built for a time when the state was smaller and less urban.

“We work well under our system, and you’re trying to say that we should maybe have another system,” Radisch said. “And we might not disagree with that.”

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