Since 2001, Johnston County taxpayers have paid nearly $100,000 for shoddy death investigations.
But that could change after a recent meeting between county officials and the N.C. Office of the Chief Medical Examiner.
In Johnston, a largely rural county of 178,000 people southeast of Raleigh, leaders were concerned that one local medical examiner, Dr. Leslie Taylor III, had collected $88,000 for cases in which he did not perform one of an examiners most basic duties viewing the bodies.
In addition, officials were worried that Taylor was called to investigate too many cases where the victim almost certainly died of natural causes. Taylor attributed about 40 percent of the deaths he reviewed to heart disease, records show.
North Carolina medical examiners are usually assigned to investigate suspicious, unusual or unnatural deaths. They are required to look at the body before determining a manner of death and whether the body should be autopsied.
Now, Johnston officials are working on a plan that would ask family doctors to sign death certificates in cases of obvious natural deaths, rather than sending those bodies to a medical examiner, who is paid with tax dollars.
The change, which follows a Charlotte Observer investigation into problems within the state medical examiners system, could save Johnston residents thousands of dollars annually and shorten the time grieving families have to wait before funeral services.
Clearly were going to save some money, said Jeff Carver, chairman of Johnston County commissioners.
In an email, Taylor said the need for this change is self-evident, adding that it would be better for taxpayers and for him, the countys only medical examiner.
North Carolina relies on roughly 350 state-appointed medical examiners to investigate suspicious, violent and unattended deaths. Most are full-time doctors who do death investigations on the side. But examiners receive little training or guidance on how to conduct investigations.
Examiners are paid $100 per case, much of which comes from county coffers.
Data show Johnston lags other counties in many areas.
From 2001 to mid-2013, medical examiners there:
• Requested autopsies in only 19 percent of cases, the lowest rate in the state. Autopsies are the most reliable way to determine a cause of death. The lack of autopsies likely means the medical examiners in Johnston accepted too many cases of natural death, where an autopsy was not needed.
• Did not view bodies in 44 percent of cases among the highest rates in the state.
• Attributed 44 percent of deaths to chronic ischemic heart disease the nations No. 1 cause of heart attacks. The state average was 10 percent.
Watching nickels and dimes
On average, medical examiners review about 13 percent of deaths in North Carolina about 10,000 deaths a year.
Johnstons, however, reviewed 26 percent of deaths, the Observer found. And the county footed the bill.
Johnston paid medical examiners some $230,000 since 2001. Thats more than the county governments of Union and Cabarrus paid, despite larger populations.
Carver, who was unaware of the spending until the Observer series, said a new policy of sending cases of obviously natural deaths to family doctors could save taxpayers thousands.
If you take care of your nickels and dimes, the dollars will take care of themselves, Carver said. Thats one of the most important things we do.
Other counties face similar problems.
Medical examiners in Chatham, for instance, failed to view bodies in 60 percent of cases the highest rate in the state. Guilford County paid medical examiners $104,000 for cases in which bodies were not viewed from 2001 to mid-2013.
Commissioners in Chatham and Guilford didnt respond to interview requests.
Kim Robertson, Johnstons director for emergency services, said officials call the medical examiners office on all cases involving law enforcement. Shell soon meet with the Sheriffs Office and local police departments about revising that strategy, she said.
Putting primary care doctors in charge of signing some death certificates could ease families stress by releasing bodies directly to funeral homes.
We were all sitting in the room thinking we should probably have had this meeting before now, Robertson said.
That meeting took place at the Johnston Health Department earlier this month. Dr. Marilyn Pearson, Johnstons health director, was one of several county leaders who met with Dr. Deborah Radisch, the states chief medical examiner, and Dr. Lou Turner, deputy section chief of epidemiology.
Pearson said allowing family doctors to sign some death certificates could bring more accuracy to the states statistics, since family doctors are familiar with their patients health history.
The change could also effect what the county views as its most pressing health concerns.
Johnston uses North Carolinas death statistics to help determine its biggest health needs. The health departments top priority for 2010 through 2014: fighting heart disease.