The autopsy suites in the new state lab in Raleigh expanded the capacity of the Office of State Medical Examiner. The new facility opened in early 2013.
The autopsy suites in the new state lab in Raleigh expanded the ability of the Office of State Medical Examiner to do more case of the Office of State Medical Examiner. The new facility opened in early 2013. Photo credit: Rose Hoban

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By Rose Hoban

In a scantly attended committee meeting Monday, legislators essentially agreed to do what they’ve not been willing to do for the past few years: spend money.

In the second and final meeting of a legislative subcommittee looking at pervasive problems in North Carolina’s medical examiner system, legislators said they were willing to appropriate funds to get the system up to national standards.

DHHS Sec. Aldona Wos (in white) makes the case for improving the state’s medical examiner system. She was joined at the General Assembly by (r to l) Division of Public Health Director Penny Slade-Sawyer, State Medical Examiner Deborah Radisch and Division of Public Health Deputy Section Chief Lou Turner. Photo credit: Rose Hoban

In answering whether the committee’s fervor was caused in part by embarrassment over a scathing series of articles in the Charlotte Observer on shortcomings in the medical examiner system, subcommittee chair Sen. Jeff Tarte (R-Charlotte) responded with a blunt, “Yes.”

But Tarte and others also drove home the point repeatedly that providing a proper diagnosis of death, a correct death certificate and reliable information to law enforcement when called for is an essential state service. Several legislators called the medical examiner system a “basic function of government.”

“It’s like providing water for our citizens,” said Sen. Tommy Tucker (R-Waxhaw). “The dignity of having a correct medical certificate should be required by the state.”

“What we want to do is give the [medical examiner’s office] the resources necessary to have a high-functioning, high-performing department,” Tarte said.

But the final tab could be as much as tens of millions of dollars. It is not yet clear how much will be asked for or how much will be given.

Starting with the basics

While North Carolina has at least 440 registered medical examiners around the state, most are volunteers who usually have other jobs, such as emergency-room physicians or emergency medical technicians.

State Medical Examiner Deborah Radisch said one of the most immediate needs is to get all of those county medical examiners some training.

“What we want to do is bring everyone who is in the system up to speed to make sure they’ve all had the same training,” Radisch said. “I don’t care how long they’ve been a medical examiner, I want them all to have the same initial orientation training.”

Lou Turner, who oversees the state medical examiner’s office and the state forensic lab, estimated that the cost for training all those volunteers would be at least $170,000. That would include hiring a trainer, developing a curriculum and paying for travel for the medical examiners from more remote locations.

“One reason we’d like a face-to-face training is so these medical examiners don’t have to take a lot of time away from their jobs to do this training,” Turner said. “Requiring the training is also a nice buy-in to the system that they currently don’t have.”

Radisch said she’s been researching training regimens in other states, some of which require as much as a week of training in a central location. She also said many procedures vary from state to state, so it would be hard to find an “off-the-shelf” curriculum, and that the lessons would have to be developed locally.

“We have a lot of really talented, smart medical examiners and forensic pathologists in North Carolina already who can work on the training and who we’ll be inviting and insisting on participating in the training,” Radisch said. “This is an improvement for the entire system.”

Reliable ‘boots on the ground’

But given that almost all of the state’s medical examiners are volunteers, they often don’t leave their other jobs to go to the scene of a death, as was found in the Charlotte Observer series.

“You say [that] with the current system, you have 435 boots on the ground. Those are part-time – if they pick up the phone and if they show up – boots on the ground,” said Rep. Justin Burr (R-Albemarle), with an annoyed tone. “I think it’s an exaggeration to say there’s 400-some boots on the ground if they’re only there when they pick up the phone and if they decide they can show up if they can get away from their other obligations.”

That’s why Radisch has asked that state lawmakers approve raising the rate for medical examiners to induce those volunteers to reliably go to death scenes.

The autopsy suites in the new state lab in Raleigh expanded the ability of the Office of State Medical Examiner to handle more cases. The new facility opened in early 2013. Photo credit: Rose Hoban

Currently, medical examiners receive $100 per case, which has not increased since 2005.

“You have to go observe the body.… They have to travel to the scene, they have to complete the examination of the body, they have to complete the paperwork, and there’s a lot of additional investigation and reporting and calling,” Radisch explained. “Oftentimes, if the case goes in for an autopsy and one of the forensic pathologists needs additional information, they call back to the medical examiner and they’re required to get more information.

“It’s not just a one-and-done situation.”

She asked for an increase to $250 per case, part of which is covered by counties.

Radisch and Turner also recommended hiring “medicolegal death investigators” who would be tasked to go to death scenes to initiate investigations, as is done in other states.

Based on national guidelines, 50 of these death investigators would be needed to cover North Carolina. They would be trained in investigative techniques and would work with county medical examiners.

“If we added them, the cost would be about $57,000 per person out of the box. So the total would be $2.1 million in recurring costs,” Turner told the committee.

That suggestion got some pushback from lawmakers on the Senate side.

“I’m in favor of using [emergency medical technicians] because they’re wonderful, great volunteers,” Tucker said. “They’re there to save lives, but also too they’re people in the community who have, for lack of a better word, the stomach to inspect a corpse.”

Bringing NC up to national standards

Where the costs start to really add up is in the need for certifying the state’s four centers for autopsies.

Currently, Turner runs the new medical examiner’s office and state forensic lab under the same roof in Raleigh. The state medical examiner’s office contracts with the Mecklenburg County medical examiner’s office to do autopsies, along with contracts for pathology services at Wake Forest University and East Carolina University.

While the office in Raleigh is new and up to national standards, the other offices need help to get accreditation from the National Association of Medical Examiners. Radisch said the facility in Mecklenburg County needed some upgrades; that would be a shared cost between the county and the state.

But the facilities at Wake Forest and ECU are both old, too small and located in places where it’s impossible to expand them. So they’ll need to be built anew at a price tag of about $24 million.

Some legislators questioned the need for accreditation, but Radisch made it clear getting a national stamp of approval is necessary. For one thing, the federal government is on the verge of requiring accreditation for forensic pathology services. And without accreditation, Radisch said, it’s hard to hire qualified personnel.

“If I were younger, I wouldn’t look at an office to go to that wasn’t [National Association of Medical Examiners] accredited or wasn’t close to being accredited,” she said.

Radisch got support from Department of Health and Human Services Sec. Aldona Wos and from House lawmakers.

“The can has been kicked down the road for years and years and years.… That means the price is going up and it’s going to cost more to fix the problem,” said Burr. “This, unfortunately, is a prime example of that, where it’s going to take a little investment to make sure we get this critical service of state government up to par and make sure it’s where we need it to be.”

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