The Rest of the Story
Advancements in the Office of Chief Medical Examiner
November 23, 2015
85,212 people died in North Carolina in 2014 and the North Carolina Medical Examiner System conducted 11,302 investigations and performed 3,882 autopsies during that year. The Office of the Chief Medical Examiner in North Carolina is committed to investigating deaths deemed to be in the public interest and governed by stature. Our goal is to help all citizens of North Carolina by assisting the criminal justice, civil justice and public health systems. We are further aware that we often deal with families and friends at a time of great loss and are committed to helping them during this time. The present system was created in 1967 by an act of the General Assembly. Subsequent General Assembly Study Groups in 2001 and 2014 provided recommendations so that the OCME office was able to issue its April 1, 2015, Report on Achieving National Accreditation for the North Carolina Office of the Chief Medical Examiner. We move toward this goal intentionally and with great purpose to meet the needs of a growing state and to always strive to improve our service to citizens of North Carolina. With the signing of the state budget on September 18, 2015, by Governor McCrory, in addition to ongoing quality improvement, markers of improvement in the office of the Chief Medical Examiner include:
- January 2015 – All forensic pathologists throughout North Carolina are performing less than 250 autopsies per year in 2014 which meets National Association of Medical Examiners NAME standards.
- February 2015 – Hiring of Public Health Epidemiologist for OCME’s office to compile data including an annual report as per NAME standards.
- April 2015 – National Accreditation of North Carolina’s Toxicology Lab in Raleigh which performs all toxicology tests for the entire state and is required by NAME.
- May 2015 – Hiring of a Training Coordinating Specialist and required attendance at annual regional seminars to standardize training in all 100 counties of 450 Local Medical Examiners approved by the Chief Medical Examiner.
- June 2015 – Hiring of Deputy Chief Medical Examiner bringing total of 16 Board Certified forensic pathologists regionalized in four centers spread throughout the state (Raleigh, Charlotte, Winston Salem and Greenville) to achieve full staffing. All of these forensic pathologists belong to the National Association of Medical Examiners with two on the Board of Directors and two presenting and one moderating at the recent national convention in Charlotte. In addition, the Deputy Secretary of Health Services is a member of NAME. There are only about 500 board certified forensic pathologists in the entire United States. We continue to perform a small percentage of autopsies at five other sites in state but have moved medicolegal autopsies to four regional centers to be performed by forensic pathologists.
- September 2015 – With funding from General Assembly, by having academic affiliation at three of the state’s sites, there will be a constant emphasis on training of fellows in forensic pathology which allows us to maintain excellence by teaching best practices in the performance of autopsies. In addition, all second-year medical students at UNC-Chapel Hill and residents from Duke, ECU, UNC-CH and Wake Forest Baptist Medical Center receive training at the state’s institutions. Recent legislation approved fellows for ECU and Wake Forest Baptist. Our hope is that these fellows will help us meet future work force issues.
- September 2015 – General Assembly authorizes funding for Electronic Death Registration System to expedite the release of death certificates.
- September 2015 – Funding from General Assembly authorizes increase of fees paid to Local Medical Examiners, pathologists and for transportation.
- October 2015 – Recruiting of a Family Support Specialist to answer families’ and others questions about preliminary findings before a final autopsy report is filed which may be awaiting lab tests. This person also is a resource for families as they grieve and helps them navigate to resources available to them.
- October 2015 – Recruiting of an Agency Legal Specialist to decrease administrative duties of the forensic pathologists.
Ongoing challenges as we move forward:
- Turn-around time for final reports which we are constantly monitoring and believe will improve now that we are fully staffed with 16 forensic pathologists.
- Standardization of Local Medical Examiners training and death scene investigation in all 100 counties. The newly required training program will improve this. Surveys of other states reveal a diversity of approaches to this aspect of investigation. A site visit to learn from Maryland’s Medical Examiner system is part of our quality improvement.
- New facilities in regional centers and another new regional center to meet the growing population in North Carolina.
- Future funding requests to fulfill all requirements for NAME accreditation.
We have a great appreciation for how important these services are to the people of North Carolina and a sensitivity for them at times of loss and remain committed to helping people during this time.