By Ted Clifford
Paula Case knows the job of a medical examiner wasn’t meant to be easy. Since 2021 she has driven up and down seven counties of western North Carolina investigating deaths that are sudden, violent, unexpected or simply unattended by a physician.
Like all local medical investigators in the state, Case, a registered nurse, is a part-time employee appointed by the Office of the Chief Medical Examiner. She is paid $200 per case whether it’s a natural death at home or a violent and complex homicide. The state supplies her with a toxicology kit, but she has to pay for everything else, from the gas in her car to basic personal protective equipment like goggles and the latex gloves she buys on Amazon.
Case does it because it’s a calling, she says, and a service to the families of the deceased. It means responding to the scenes of accidents, overdoses, suicides, and murder all hours of the day, every day of the year.
But on Thursday, Case and other medical examiners in Buncombe County told supervisors that they will be joining approximately 150 of the state’s medical examiners across 20 counties to take a coordinated, indefinite vacation beginning June 15. Their aim, they said, is to draw attention to pay that hasn’t increased in more than a decade.
Without them, a system that few people know exists will slow to a crawl. Without local medical examiners on the job, a backlog of bodies will build up in morgues and funeral homes, cremations will not be able to take place, and some death certificates — vital documents needed before a burial and to settle the deceased’s legal and financial affairs — will go unsigned.
“Delays in this work make a significant difference to families dealing with the death of a loved one, as well as to our health and criminal justice systems,” said a spokesperson for the Office of the Chief Medical Examiner (OCME), a division of the state Department of Health and Human Services, in an email to The Watchdog.
Lowest level in 10 years
As a result of a decade with no increase in pay, the number of local medical examiners has fallen to 259, down almost half since 2023 and its lowest level in 10 years, according to the OCME.
“As medical examiners, we kind of fall through the cracks,” Case said.
Attempts by the state legislature to pass a bill raising their pay stalled in 2024 and 2025. Unless something changes, the current effort seems destined for the same fate, medical examiners have told Asheville Watchdog.
The current provision to raise the pay of county medical examiners to $400 per case is attached to a bill known as Tyler’s Law, which would empower law enforcement to take additional investigative steps like testing all witnesses for gunshot residue before declaring a death a suicide.
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Medical examiners who spoke with The Watchdog said they worry that the two-part bill might be harder to pass than just the pay raise. And without an increase in their pay, the work is unsustainable, they said.
“I do this out of a sense of duty and a responsibility to my community,” said LeeAnn Canady, a medical examiner in Brunswick County. “But I am basically paying to do this job at this point. It’s essentially volunteer, especially after you factor in the increased cost of living.”
While OCME can dispatch employees from regional autopsy centers to fill in for the local medical examiners, it would strain an already overburdened system.
Dozens of Buncombe deaths investigated in typical month
While medical examiners do not investigate all deaths, the number of cases that Medical Examiners have been required to investigate has only grown.
In 2016, medical examiners investigated roughly 13 percent of the 91,354 deaths in North Carolina. In 2023, medical examiners responded to roughly 15 percent of the 108,000 deaths that occurred in North Carolina that year, according to the most recent data from the OCME.
In a given month, medical examiners will investigate between 25 and 50 deaths in Buncombe County, Case said. An investigation requires medical examiners to determine the cause and manner of death. It might involve taking blood samples, interviewing witnesses, and, in the case of unidentified people, taking fingerprints and DNA samples.
In these cases — which include unexpected deaths, car accidents, homicides and suicides — a medical examiner must sign the death certificate. Without that signature, an individual is not legally allowed to be buried and families can’t settle the deceased’s estate.
Medical examiners are also required to inspect the body and review medical records before signing off on all cremations.
Despite their critical roles in criminal investigations, public health, and the basic record-keeping required by the state, medical examiners said that it has been an uphill battle to get attention.
“Nobody wants to think about death,” Canady said. “But I also think that nobody has an understanding of what we do.”
Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Ted Clifford is The Watchdog’s investigative reporter focusing on healthcare. He can be reached at tclifford@avlwatchdog.org. The Watchdog’s local reporting is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/support-our-publication/.
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