Faulty NC medical examiner system needs a fix, legislators say

by Fred Clasen-Kelly, Ames Alexander and Jim Morrill, News and Observer, May 24, 2014.

Gov. Pat McCrory and lawmakers are promising a review of North Carolina’s troubled medical examiner system following an Observer series showing that examiners conducted thousands of faulty investigations into suspicious deaths.

Several influential legislators said they want to know why medical examiners skipped crucial steps while looking into deaths. They said they may propose legislation to address the problems.

“The people of North Carolina deserve better,” said state Rep. Donny Lambeth, a Forsyth County Republican and co-chairman of the House appropriations subcommittee for Health and Human Services. “Clearly, that’s one thing we have got to fix.”

McCrory agreed. He told the Observer Friday that the medical examiner system has “been ignored for far too long.”

An Observer investigation published last week 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 leading systems, which experts say makes it harder to determine the correct causes of death.

The stories also showed that families were left with unsettling questions about how their loved ones died. Survivors said faulty death rulings prevented them from immediately collecting life insurance payments they deserved. And in at least two cases, medical examiners gave the wrong cause of death in suspected murders.

McCrory has asked lawmakers for an additional $2 million to improve the system, $1 million more than his initial budget proposal on May 13. The money would go toward training, regional autopsy centers, transportation and supplies.

McCrory also called for an increase in the fee paid to local medical examiners, from $100 per investigation to $250.

But that money, if approved, will be a mere “stopgap measure,” McCrory said.

“We’re pleased with our first steps, but we also recognize there’s more to go,” he said. “I also do think we need to do a total long-term policy review in the long session (2015).”

Department of Health and Human Services Secretary Aldona Wos told the Observer the program is in need of more education, more funding and more staff. She recalled her surprise when she got her first briefing from the state’s chief medical examiner’s office, shortly after becoming secretary in 2013.

“I was shocked at the problems and challenges they were facing,” she said.

State Rep. Justin Burr, an Albemarle Republican, said the problems need to be “addressed immediately.”

“What I see in your stories is eye-opening and concerning,” said Burr, who chairs the House appropriations committee and the joint legislative oversight committee on Health and Human Services.

Burr said he would push for more money for the medical examiner system. He also said he planned to meet with Wos and others to determine what steps need to be taken.

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. But North Carolina spent less than half that last year – about 84 cents per capita.

‘Very disturbing’

North Carolina’s 350 appointed medical examiners are called into action on the hardest cases: suspicious, violent, accidental and unattended deaths. Those amount to about 10,000 of the roughly 75,000 deaths in the state each year.

Examiners are responsible for determining whether suspicious deaths in their counties result from homicide, suicide, accidents or natural causes.

They also decide which cases should go to pathologists for autopsies.

Most medical examiners are doctors and nurses who conduct death investigations in their off hours. The state requires no investigative training.

The Observer series, entailing the most comprehensive analysis of state death rulings ever conducted, found that examiners have regularly closed cases without following recommended practices.

They don’t go to death scenes in 90 percent of cases they investigate. And in one of every nine deaths, they ignore a state requirement to examine bodies. Deaths of the elderly receive even less scrutiny.

State Sen. Louis Pate, a Mount Olive Republican and co-chairman of the Senate appropriations committee for Health and Human Services, called the newspaper’s findings “very disturbing.”

“I do believe we’ll be looking into it … and if procedures aren’t carried out well, we’ll want to find out why,” Pate said.

State Sen. Tommy Tucker, a Union County Republican and member of the oversight committee for Health and Human Services, said lawmakers will need time to figure out how to improve the system.

“North Carolina should do a better job for the families of deceased citizens,” Tucker said. “Somebody needs to be held accountable for the erroneous information being put out to the families.”

House Speaker Thom Tillis did not respond to requests for interviews. Senate President Pro Tem Phil Berger declined to comment, saying he had not had time to read the series.

No view, no pay?

Lawmakers agreed that the $100 fee paid to local medical examiners is little incentive to conduct thorough investigations.

If the fee is raised to $250 per case, counties would likely shoulder most of the financial burden. Under current law, counties usually pay the fee. If the legislature raises the fee, counties would have to pay about $1.2 million more each year, based on an average of 10,000 deaths. The state would pay about $300,000 more each year.

The state and counties spent about $8.3 million for the medical examiner system in fiscal year 2013.

The Observer discovered that medical examiners collected their $100 fee for many death investigations in which they violated the state requirement to view bodies.

The worst performance came in Chatham County, west of Raleigh, where medical examiners failed to view bodies in almost 60 percent of cases since 2001.

Sen. Valerie Foushee, a Democrat who represents Chatham and Orange counties, said she was “shocked” to see the numbers, and said she would try to learn more about what is happening in Chatham.

Burr, the Albemarle Republican, said that if the state chooses to increase the fee paid to medical examiners, as McCrory proposes, the state should take measures to ensure they aren’t paid unless they view bodies.

“I don’t understand why we’re paying someone if they don’t perform their duties,” Burr said.

REPORTERS ELIZABETH LELAND AND GAVIN OFF CONTRIBUTED.