NC medical examiner system is woefully short of investment

May 22, 2014 

In a thorough five-part series that just concluded, The Charlotte Observer offered the most exhaustive look ever at North Carolina’s medical examiner system. The Observer’s findings, which ran in The News & Observer, revealed an understaffed, underfunded and woefully inadequate system that is an absolute embarrassment to the state.

Action must be taken, and soon.

Just consider some of The Observer’s reporting: North Carolina’s medical examiner system isn’t even nationally accredited. No training is required for medical examiners. The state spends less than half the amount per capita on medical examiners that many other states spend. In the vast majority of cases investigated, medical examiners do not even go to the death scene.

The ramifications of an inadequate system are many, but one is that, absent a thorough investigation, the real cause of a person’s death could go undiscovered. If an examiner doesn’t go to a death scene, inflicted wounds might be missed and the death given a more routine cause in a report. A system that falls short cheats the deceased, his or her family and possibly law enforcement, which means everyone.

To be fair, state Chief Medical Examiner Deborah Radisch and her office can’t be blamed for all inadequacies. She’s hostage, after all, to budget limitations that make it difficult, at best, for medical examiners to do what they need to do.

Without seeking national accreditation, the state continues a system in which doctors or other health care professionals are paid $100 a case, a ridiculously small sum for the work involved. And though North Carolina’s population is 9.8 million and Maryland’s is 5.9 million, this state spends $8.3 million annually on the medical examiner system while Maryland spends $10 million. (The Maryland system is considered an example of the craft at its best.) And that’s the case despite North Carolina’s having 2,000 more cases to investigate every year.

The Observer spoke with experts who offered clear recommendations for what needs to be done in North Carolina. First up is to require training for all medical examiners. That would include not just scientific guidelines but protocol for investigations.

Examiners in accredited states recommend as well that examiners visit death scenes. As one examiner in another state said, “Police are looking at the death differently: Is it a crime or not? We’re trying to figure out what caused the death.”

And what about investigation? North Carolina requires little and needs to hire full-time, professional investigators instead of doctors to interview witnesses and compile reports. Without them, as The Observer found, the thoroughness of investigations varies from county to county. That’s unacceptable.

And there should be more investment, which would mean more autopsies, an effective way of getting to the real causes of death.

The state’s system is simply suffering from a clear case of long-term neglect. North Carolina should set as a standard national accreditation and settle for nothing less. Whatever funding is necessary to get to that standard should be allocated. Now.

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