Yesterday, I mentioned that based on a two-year investigation by The Charlotte Observer, North Carolina’s system for investigating suspicious deaths is outrageously inadequate. In most of the state, death investigations are farmed out to part-time medical examiners–mostly doctors and nurses who investigate unusual and suspicious deaths on their own time. The state provides very little oversight, and doesn’t require any specialized training. It also found that many examiners fail to take steps that are considered rudimentary by experts in the field, such as examining the body or ordering an autopsy. In response, Governor Pat McCrory has called for reforms to the system in his new budget.
It turns out that medical examiners are even more likely to take shortcuts in cases involving senior citizens, based on The Observer’s analysis of death investigations from 2001 to 2013. For instance, medical examiners closed 11.1 percent of all cases without even looking at the body–an oversight considered a firing offense by several experts. However, in cases involving the deaths of people 75 and older, that figure jumps to 22 percent. Additionally, only eight percent of senior citizen deaths resulted in an autopsy, well below the statewide average of 40 percent.
To be fair, medical examiners across the country are less likely to perform autopsies on the elderly because they are more likely to die of natural causes. But when over 90 percent of deaths in a state–especially a state with 9.8 million people–don’t result in an autopsy, that should raise red flags. It’s even more stark at the county level; 40 of the state’s 100 counties went at least three years without an autopsy on an elderly person. As frightening as this is, it’s even more so when you consider North Carolina only spends 8.4 cents per capita on death investigations–far lower than the national average, and nowhere near what conventional wisdom would suggest for a state with more than 10 congressmen. That figure would be even lower if not for the two largest counties, Meckenburg and Wake–home to Charlotte and Raleigh, respectively. They are the only counties in the state that have full-time medical examiners funded by tax dollars. The other 98 counties farm out death investigations to the state-appointed part-timers. This system was implemented in 1971, when the state was still mostly rural. To put it mildly, it is not suitable for a state of North Carolina’s size.
These figures aren’t the only ones that concern advocates for the elderly. Whenever an infant, child or young adult in North Carolina dies suddenly and unexpectedly without a history of previous well-documented illness, state guidelines call for an autopsy. But those criteria don’t exist for the elderly. According to Laura Mosqueda of the National Center for Elder Abuse, this results all too often in elderly deaths going unscrutinized in situations that would trigger an all-out investigation if a child were involved. Additionally, hospitals and nursing homes are only required to report suspicious deaths. Mark Malcolm, the former chief medical examiner for Pulaski County, Arkansas–home to Little Rock–thinks that these facilities should be required to report all deaths, since all too often personnel at hospitals and nursing homes make fatal mistakes that go unreported.
With a system in which so few bodies are even examined and so few autopsies are conducted, it’s inevitable that egregious–and deadly–mistakes will occur. Hands down, the most egregious example of this is the case that brought North Carolina’s medical examiner system to public attention–the first of a series of deaths by carbon monoxide poisoning at a hotel in the mountain town of Boone. Last April, David and Shirley Jenkins both died in their hotel room, and their relatives immediately got suspicious–why would two perfectly healthy people just die out of nowhere, in the same room? Despite this, Watauga County’s part-time medical examiner, Brent Hall, didn’t put a rush on the Jenkinses’ toxicology tests. As a result, he didn’t receive the results until June. Compounding the problem, Hall never shared the results with local authorities. As a result, no one knew the Jenkinses had both ingested lethal amounts of CO until June 10–two days after 11-year-old Jeffrey Williams was killed and his mother, Jeanie, was nearly killed while both were staying in the very same room where the Jenkinses had stayed two months later.
Seen in this light, I have second thoughts about the initial reform proposals. Although they include measures for greater oversight, the prospect that any suspicious death could fall through the cracks has me thinking that it’s worth spending the money to require full-time medical examiners in each county. My mother is 73 going on 74, my father is 72 going on 73, and many of my aunts and uncles are approaching their 70s. I don’t want to worry about signs of foul play being missed when they die.
Darrell Lucus is a radical-lefty Jesus-lover who has been blogging for change for a decade. Follow him on Twitter @DarrellLucus or connect with him on Facebook.
edited by tw
