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Reporters Discuss Investigation Of State Medical Examiners Not Doing Their Job

Mai Le

This week, a Charlotte Observer investigation finds that medical examiners in much of the state are failing at their jobs. In some cases, they are reaching wrong conclusion on the causes of death, and in many cases – they just aren’t diligent. The Observer found thousands of cases in which examiners regularly close cases without following recommended practices. This series is called Fatally Flawed, and two of the reporters for this series, Ames Alexander and Fred Clasen-Kelly joined us.

Kevin Kniestedt: First,  give us a recap of what you’ve found.

Ames Alexander: I mean a lot of what happens in North Carolina is nothing like what you would see in the TV crime dramas. The medical examiners here are often skipping very basic steps when they investigate suspicious deaths. Ninety percent of the time they’re not going to the death scenes. One out of every nine times they’re not even going to examine the body. And when older people die, they’re even more likely to take shortcuts. A lot of this is really a function of poor funding and accountability. Medical examiners are really only paid $100 for each case that they take. It’s not much money, but they get paid that whether they examine the body or not. They’re required to examine the body, but a lot of the time they don’t. The state doesn’t pay for training, doesn’t require training. North Carolina is one of the most poorly funded systems in the country, and the result of that is that we do a lot less autopsies than a lot of the leading systems.  

KK: Fred, what sort of guidelines or rules are these examiners supposed to follow?

Fred Clasen-Kelly: Well the most basic part of the job is, when a suspicious or violent death occurs, they’re supposed to go look at the body. Look at the front and back, and look for signs of trauma, gunshots, stab wounds, anything that would indicate a sort of unnatural death, and to jot down their findings. They come up with a report that they send to the state. They’re supposed to decide whether or not there is enough mystery surrounding the death for there to be an autopsy, and there are rules regarding when they should order an autopsy. What our series found is that a lot of times, those rules aren’t followed. There are cases that should have been autopsied that were not autopsied. There were instances where they did absolutely not look at the body by choice.

KK: So what’s the process to become a medical examiner? These are largely doctors, right?

AA: That’s right. The Chief Medical Examiner picks from a list of people who are recommended by the local medical board. Their first choice is doctors, but if there are no doctors who raise their hands, they can also ask nurses or EMT’s.

KK: So what’s the motivation for them to raise their hand and decide to do this? I mean they are doctors and nurses who are already busy people. So with it being $100 a case, what’s their motivation?

FCK: Well back in the late 1960s when the system started, there were fewer doctors in North Carolina and it was a largely rural state. A guy named Dr. Paige Hudson helped start the system. He essential would call on his friends and people he knew in the medical community, and they agreed to help him out. There was a certain amount of status to it back then. You would get a title: County Medical Examiner. It was a system that could work back then because the state was so much smaller. But what we are finding is as North Carolina becomes more urbanized and has a bigger population, it’s harder and harder for volunteers to do this job. So what you see when you look at who is a medical examiner, is that many of them have been a medical examiner for 20, 30, or 40 years, and their older and either about to retire and leave the medical profession totally, and there is no one behind them replacing them who is younger. You hear a lot of them say that being a doctor today is a lot different that being a doctor when they started.

KK: Once they’ve accepted this role, it doesn’t seem like there is a whole lot of accountability to go out and look at these bodies.

AA: Right, right. I mean we’ve found thousands of cases where the medical examiners didn’t follow the rules. The most basic being examine the body. One out of ten cases they did not do that.

KK: The numbers were pretty good in Mecklenburg County weren’t they?

FCK: They were, but it is a little bit of a different system here, because the county provides $1 million a year in funding the system which allows them to hire professional investigators that can handle a caseload and assist with autopsies. It has also allowed the county to hire three forensic pathologists.

KK: Why would a medical examiner accept a case if they aren’t going to go do it?

AA: That’s a good question. I guess if you are going to be cynical about it, you could maybe think that money could have something to do with it. If you’re just going to fill out a quick form it is a quick way to make $100 bucks.  

Ames Alexander and Fred Clasen-Kelly are reporters for the Charlotte Observer. To read there report, click here.