NC medical examiner system needs repair

Aldona Wos, secretary of North Carolina’s Department of Health and Human Services, has sounded the appropriate degree of impatience with the flawed medical examiner system she inherited.

It is mind-boggling that this long after a 2001 report cited ways that examinations needed to be improved, virtually none of the recommendations has been implemented.

How can that be?

“The system,” Wos told a legislative group looking at ways to improve death investigations, “has been ignored and diminished.”

That is putting it mildly.

The Charlotte Observer investigated and reported on the woeful state of medical examinations in North Carolina earlier this year. The findings were shocking.

They included the fact that pathologists in the state’s chief medical examiner’s office in Raleigh were doing more than 250 autopsies a year. Experts said that’s a number almost guaranteed to lead to mistakes, and it has.

In addition, with most medical examiners being doctors and nurses, the pay of $100 per case is much too low. Not surprisingly, medical examiners don’t even go to death scenes in 90 percent of the cases and in at least 1 of every 9 deaths don’t fulfill a state requirement that they view the bodies of the deceased.

That can mean wrong diagnoses on causes of death, which can lead to families not being able to collect insurance payments they are due. And a bad determination on the cause of death obviously can result in a faulty criminal investigation in the case of a homicide.

But there are other problems.

Dr. Deborah Radisch, the state’s chief medical examiner, says some examiners are not trained well because there is not enough money to provide training. “No matter who you appoint,” she said, “I don’t care how smart a doctor or how smart a nurse you are, you have to be trained to do this.”

It must drive Radisch, an outspoken and admirably determined official, up the wall when she compares North Carolina’s underfunded, training-deprived system with a state such as Virginia, where there are four regional examiner centers that oversee investigations and perform autopsies.

Another headache for Radisch: Some 19 percent of North Carolina autopsies are done by general pathologists, who deal mainly with natural disease and not violent deaths that always are more complicated to investigate. She wants every autopsy performed by a board-certified forensic pathologist. That’s how it works with systems that are nationally accredited, which North Carolina’s is not.

And no wonder. The state spends 93 cents per capita on death investigations, when the average in state systems is $1.76 per capita. The higher average enables state offices to send people adequately trained to virtually every suspicious death scene to look for clues. North Carolina is a long way from being able to do that.

The Charlotte Observer’s investigative series did push the General Assembly to seek an independent investigation, the results and recommendations of which are supposed to be ready early next year.

Wos has had her troubles at DHHS, but this is a situation in which she had a problem of too long-standing dropped into her lap. She deserves credit for trying to raise awareness of it and for not pulling any punches in talking about how dire the problems are.

It also would be worthwhile, for DHHS and other agencies, to try to find out where in the state bureaucracy earlier recommendations for improvements stalled. When the state spends the money and time to come up with a report on how to improve something like medical examiners’ offices and it just falls by the wayside for 13 years, an explanation is needed.

This story was originally published September 30, 2014 at 6:58 PM with the headline "NC medical examiner system needs repair."