Long Wait For Death Certificate Adds To Widow's Pain
Since last year, when her husband died unexpectedly in a Davidson County hospital, Francine Braun Wolberg’s grief has given way to anger over the long wait for answers.
Her husband suffered from early onset Alzheimer’s but was otherwise healthy before going to the Thomasville Medical Center for mental health treatment. State Chief Medical Examiner Dr. Deborah Radisch performed an autopsy on June 12, 2014, the day after he died.
But months later, there was still no death certificate listing the cause of death.
That meant Wolberg couldn’t collect survivor’s annuity payments needed to pay college tuition for the couple’s youngest daughter. She questioned the hospital about what happened. But she couldn’t take legal action without a cause-of-death ruling.
So Wolberg made calls and wrote state officials to find out why her husband died. More than 15 months after Mark Wolberg’s death, she still doesn’t have an explanation.
The state medical examiner’s office finally issued a ruling in September that he died of undetermined causes. The results came soon after The Observer began questioning why the case had been delayed.
“It has been cruel,” said Wolberg, who lives in Winston-Salem. “This should be an embarrassment to the governor, the legislature and the medical examiner’s office. I don’t know if this is malfeasance, but it is inhumane.”
Across North Carolina, families are enduring lengthy waits to find out how loved ones died.
The N.C. Office of the Chief Medical Examiner is responsible for investigating suspicious, violent, accidental and other unnatural deaths.
The time it takes to finalize a case can hold up life insurance payments. It can stall police investigations. And it sometimes leaves grieving families tormented by unanswered questions and unsure whether they can file lawsuits.
North Carolina authorities don’t consider cases past due until they are at least six months old, or 180 days.
That’s far longer than recommendations by the National Association of Medical Examiners (NAME), which sets standards for the profession. It says states and counties should complete 90 percent of autopsied cases within 60 days.
North Carolina closes only 33 percent of autopsied cases in that time frame, according to an Observer analysis of state data for 2001 through mid-2013. The average wait for cases with an autopsy is 97 days.
“That type of thing should not happen,” said Dr. Gregory Schmunk, a nationally known forensic pathologist and past president of NAME. “I would anticipate that is from a lack of manpower. You’re dealing with a broken system.”
Backlog of cases
Wolberg’s case illustrates what can happen in North Carolina’s troubled system when old cases linger.
Radisch, the pathologist, told Wolberg she was struggling with a backlog of 80 to 90 investigations.
On Sept. 3, Radisch sent Wolberg an email apologizing for failing to finish the case before going on vacation.
“I will get to it as soon as I can, but I continue to perform autopsies and have numerous administrative duties and consults that must, unfortunately, require my immediate response, severely limiting my ability to work on my cases,” Radisch wrote. “I am usually only able to work on my ‘old’ cases on Sundays, so I cannot make much progress. This is a complicated case, and I may not, at the end, even have a satisfactory answer for you.”
Dr. Randall Williams, who oversees the medical examiner’s office in his role as the state’s deputy secretary of Health Services, declined to answer questions about Wolberg’s case. But officials say they are planning to hire a grief counselor to work with families who are waiting for answers.
A sudden death
Wolberg says her late husband deserved better.
For 33 years, Mark Wolberg worked at the Veteran’s Administration clinic in Winston-Salem as an admissions coordinator. Early-onset Alzheimer’s forced him to retire at age 58. Described as quiet and kind, he was a passionate UNC basketball fan, having attended the school. He doted on two daughters and ran up to 7 miles on weekends.
But the effects of Alzheimer’s took an emotional and mental toll in his final months. He needed drugs to control combative behavior linked to the disease. A state report says he suffered a psychotic episode before he was admitted to Thomasville Medical Center on June 3, 2014.
To monitor him and wean him off a new medication, a doctor recommended he stay for three weeks in a geriatric psychiatric unit, his wife said.
Wolberg visited him in the hospital every day. She noticed a slow decline. He seemed sluggish and could barely walk, she said.
On the eighth day, a nurse called and told Wolberg her 60-year-old husband was dead, citing a sudden heart attack.
A nurse wrote in her notes that Mark Wolberg was fine when she checked on him at 5:30 a.m. But by 6:40 a.m., his heart had stopped beating.
A report shows Mark Wolberg was treated with Risperdal, a drug approved by the federal Food and Drug Administration for schizophrenia and bipolar disorder. Doctors have prescribed the medication for other conditions, including dementia, a symptom of Alzheimer’s.
The FDA, however, says that treating patients suffering from dementia-related psychosis with Risperdal increases the risk of death. It requires the manufacturer to include a “black box” warning label on the package describing the risk and telling the user the drug is not approved for the illness.
A spokeswoman for Novant Health, which owns the Thomasville Medical Center, declined to answer questions. The hospital released a written statement that does not address the treatment Mark Wolberg received.
“While patient privacy laws prevent us from discussing the specifics of a patient’s care plan, Novant Health had conversations with Mrs. Wolberg 15 months ago in an effort to help her reach some closure as she awaited an official report from the medical examiner’s office,” the statement said.
If a person’s cause of death is clear, death certificates are processed relatively quickly.
But most delays happen when cases are sent to the state Office of the Chief Medical Examiner for further investigation. These include homicides, suicides and other unnatural deaths.
Pathologists review reports compiled by local medical examiners and perform autopsies when they believe it is necessary to determine how someone died. Many of 11,000 cases investigated by medical examiners each year languish for months.
Matt McCall, register of deeds for Iredell County, grew so upset over how long it took to get death certificates that he sent the governor’s office a letter in 2013 on behalf of one family. He said his office regularly receives complaint calls from survivors waiting for death certificates to collect life insurance payments or simply find closure.
“It’s awful playing middle man for the state,” McCall said.
McCall tracked 19 medical examiner cases in Iredell County from January to May. The average wait was about 107 days, McCall said. That’s significantly better than 2014, when the typical wait was 155 days.
State makes changes
Williams said he empathizes with mourning families who want information immediately. But time-consuming blood tests and other circumstances mean families must sometimes wait for autopsy results and final death certificates, he said.
Thorough examinations are necessary because autopsies can help solve crimes, Williams said.
North Carolina is taking steps to reduce delays, Williams said. The state office has been short-staffed through much of its history, but added two new full-time pathologists to the Raleigh office to fill vacancies in 2014 and plans to hire another next year. With additional staffing, each pathologist performs fewer autopsies.
Eventually, Williams said, the medical examiner’s office wants to reduce wait times enough to meet the NAME standards for completing autopsied cases.
A long wait
In the Wolberg case, delays finalizing the autopsy report led to hardships for the family.
Monthly survivor’s annuity payments took nearly eight months to arrive. The couple had invested in the plan in case one of them died, but Mark Wolberg’s employer wouldn’t accept his widow’s claim without a death certificate listing the cause of death.
Wolberg had stopped working as a marketing consultant to care for her husband full-time. Her youngest daughter was still in college.
She received annuity payments only after an aide for U.S. Sen. Richard Burr, R-N.C., intervened on her behalf. The aide contacted the U.S. Office of Personnel Management and persuaded officials to make an exception for Wolberg.
North Carolina requires that wrongful death lawsuits be filed within two years of a person’s death. Wolberg said the delay has eaten away most of that time because attorneys would not consider her case without receiving the autopsy results. She would not say if she still plans to file a lawsuit.
The state medical examiner’s office sent her family the autopsy results on Sept. 25.
Radisch, the chief medical examiner, ruled that the cause of death was undetermined. She wrote that she found no signs of trauma or drug toxicity. Several possible causes could not be substantiated by an autopsy, the report says.
Wolberg said medical examiners aren’t the only ones at fault. Blame also lies with lawmakers who fail to adequately fund the office and demand accountability, Wolberg said.
“Anyone with a husband or wife could end up in this situation,” Wolberg said. “It’s pathetic. A citizen in 2015 should not have to beg. Why would this be such a bottom-of-the-barrel priority?”