When medical examiners are unsure about a case, they’re supposed to send the body to a pathologist for an autopsy – the most reliable method for determining cause of death.
But North Carolina does substantially fewer autopsies than leading medical examiner offices.
In the first nine months of 2013, pathologists in North Carolina performed autopsies in about 34 percent of medical examiner cases, down from 44 percent in 2001.
Autopsies of people who appeared to die from asphyxia plummeted 32 percentage points in recent years. Autopsies on those who died from gunshot wounds and hangings also declined sharply.
An Observer sampling of a dozen nationally accredited offices found all performed autopsies in a significantly higher percentage of medical examiner cases. All but two had rates of 50 percent or more. North Carolina, which did 34 percent last year, is not accredited.
Dr. Patrick Lantz, a forensic pathologist at Wake Forest Baptist Medical Center, says the state’s low and declining autopsy rates are a function of money. While the population and the number of suspicious deaths have increased in recent years, the number of pathologists conducting autopsies has declined.
In 2001, for instance, 21 pathologists regularly examined bodies for the state, compared with 18 in 2012.
National experts recommend that states perform at least one autopsy for every 1,000 residents each year. By that measure, North Carolina ought to be doing nearly 10,000 autopsies per year. But it typically conducts about 4,000.
Why the autopsy rate has been declining is unclear. The Observer found cases in which medical examiners failed to order autopsies when the rules said they should have. But some medical examiners said state officials have increasingly refused to do autopsies because of time and money.
“You have to do triage,” Lantz said. “The way things are, some things don’t get done.”
Former North Carolina Chief Medical Examiner Dr. John Butts, who retired in 2010, said officials perform autopsies in the most critical cases but “might not do one that is iffy.”
The quality of autopsies has also been threatened. In recent years, 11 North Carolina pathologists have done more than 250 autopsies annually – a workload experts say could result in shortcuts or mistakes.
State officials contend no pathologists are so overworked that they’re making serious errors.
Staff writer Fred Clasen-Kelly contributed.