Apr 242013


Dr. William Oliver goes through the multiple autopsies suits down in the Morgue of Brody School of Medicine on April 23, 2013.   (Aileen Devlin/ The Daily Reflector)

Dr. William Oliver goes through the multiple autopsies suits down in the Morgue of Brody School of Medicine on April 23, 2013. (Aileen Devlin/ The Daily Reflector)

By Kristin Zachary

Wednesday, April 24, 2013

State cuts are forcing the medical examiner’s office in Greenville to drastically reduce the number of autopsies it performs and send about 400 cases to Raleigh, a move local officials said will limit education opportunities and hamper investigations.

Supplementary funds provided via a federal grant through the Office of the Chief Medical Examiner to East Carolina University will expire on June 1, officials said. After that, ECU would receive just $1,000 for each of the nearly 530 autopsies it performs annually. The procedures cost $1,731.

The Greenville office is one of four regional facilities in the state, with others in Charlotte, Jacksonville and Winston-Salem. The office in Winston-Salem has been operating at a loss for years, the director there said Tuesday.

Officials in Winston-Salem are hopeful a new bill to increase basic state reimbursement from $1,000 to $1,500 per autopsy will allow them to continue providing full service to 30 counties in western North Carolina.

The supplementary contract provided to ECU’s Brody School of Medicine totaled $322,000 a year, Dr. William Oliver, professor and director of ECU’s pathology department, said Monday.

He said the additional $600 to $700 per case supported the cost of performing autopsies to 24 eastern counties.

“That allows us to do autopsies for the state at just a very small loss,” Oliver said.

The local office was notified by an email from the OCME that as of June 1 the contract was not being renewed.

This 37 percent cut to the department’s forensic budget paralyzes the program, Oliver said, and the only option left is to reduce the service area from 24 counties to just two, Pitt and Greene.

‘Going out of business’

Investigations and trials already are delayed because of shrinking staff sizes and increasing case submissions to the state’s crime laboratory, Pitt County District Attorney Kimberly Robb said, and centralizing the medical examiner’s office will only exacerbate the problem.

“It’s unbelievable the ramifications this could cause,” Robb said.

The choices left for the Greenville office are to “go out of business gracefully or go out of business in chaos,” Oliver said.

As part of an effort to go out “gracefully,” Oliver said ECU and Vidant Medical Center agreed to spare Pitt and Greene counties for one year, absorbing the $731 per case not covered by state reimbursement law. Last year, Pitt had 125 autopsies conducted and Greene had seven.

Cases from the remaining 22 eastern counties — and overflow and complex cases from an additional five or six southern counties — will be handled at the OCME’s new facility in Raleigh, Oliver said.

“There are going to be some issues there because you’re going to have a much smaller number of pathologists doing many more cases in Raleigh, and they’re not going to have the ability or the time or the resources to coordinate the way they should,” he said.

The number of autopsies conducted each year at the central office was not available Tuesday. It was not clear how the facility would be affected by a heftier case load, as calls to official there were not immediately returned.

However, Robb said she expects homicide investigations and court cases to be hindered because it will take longer to determine cause of death and complete autopsy reports and create difficulties in scheduling medical examiners in trials.

If the one-year arrangement through ECU and Vidant is not extended or a statewide solution remains at large, law enforcement officials said the burden on their departments will be great.

“We’ll have to send a detective and an ID officer two hours away to be a part of the autopsy,” Sheriff Neil Elks said. “This will be an extra expense on the county and an extra toll on our investigators. It will slow the investigation process down because basically all day will be taken to go to Raleigh, to sit in on the autopsy and go home.

“This appears to be a step backward,” he said.


Expectations ‘inequitable’

North Carolina moved from an elected coroner system to a medical examiner’s system from the 1930s to the 1970s, and state officials decided to have a central office and leverage infrastructure already in place at large medical institutions and schools, contracting with the regional locations, Oliver said.

The central office originally was at the University of North Carolina in Chapel Hill, but was moved late last year to a larger facility in Raleigh. Regional offices were established at Wake Forest Baptist Health through Wake Forest University’s School of Medicine, in Greenville through ECU, and in Charlotte and Jacksonville.

“There are a lot of reasons that it’s good for ECU to have this program here,” Oliver said. Physicians and pathologists are trained and educated, he said.

“Having the medical examiner system here is of extraordinary benefit to the hospital because we are Level One Trauma Center,” he said. When an injured person is transported to Vidant and does not survive, “the question becomes oftentimes, ‘What could these trauma surgeons have done differently to save their lives?’ Oliver said.

“We can coordinate with the trauma surgeons to try to answer some of those questions,” he said. “We’re deeply involved in the quality control and quality assurance of the trauma surgeons. The same is true for other specialties as well. We help improve the treatment and hopefully the survivability of the next person.”

Many of the same benefits are evident in Winston-Salem, he said, where the office there is now considering its next steps.

Dr. Patrick Lantz, forensic pathologist and professor of pathology at Wake Forest, on Thursday requested additional funding from the OCME to break even on autopsies.

The office has three board-certified pathologists and conducted 714 autopsies last year at an individual cost of $1,742 and was reimbursed just $1,000 for each case, Lantz said. Since 1998, the cost has increased greatly, but the reimbursement has remained the same.

“We’re doing different tests we weren’t doing 15 years ago,” Lantz said. “We’re doing more advanced studies on the same figure that was set by law in 1998. It’s inequitable the state would be expecting us to subsidize something that is a state and county function.”

Preparing for the worst

Until now, the supplementary contract in Greenville kept the office from the hefty losses experienced at Wake Forest, Oliver said. The funding for that contract came from a Centers for Disease Control grant.

“Bottom line, what (the state medical examiner’s office) said is that grant funding was no longer available, and so they were cutting it,” he said. “They essentially made the decision not to provide that funding from in-house funds.”

Decreasing the number of cases handled locally by about 400 will “tremendously” reduce educational opportunities, limit training and leaves the staff in limbo, Oliver said. The board-certified forensic pathologist is one of four who perform autopsies at Brody.

With about 75 percent of cases being moved to Raleigh, there is not a need for the full team, which also includes Drs. Karen Kelly, M.G.F. Gilliland and Joe Pestener. Some of the pathologists will be redeployed in different areas in an attempt to keep them on board, Oliver said.

“We don’t want to shut down,” he said. “We’re bridging (the gap) because we hope things get solved and we can just go back to business as usual. But we’re preparing for the worst. Maybe they have some way the people in the central office will be able to handle all of this, but I don’t know what it is.”

‘A way out of this mess’

Moving cases to Raleigh is going to create a “terrible backlog” for law enforcement searching for answers and people waiting to bury their loved ones, Sen. Earline Parmon, D-Forsyth, said.

“If Raleigh has to pick up these other cases, it will result in a tremendous increase in an already overburdened system,” she said.

“It’s a real concern,” district attorney Robb said. “I’m so thankful ECU and Vidant have committed to this one-year agreement so we have time to try to figure out a way out of this mess.”

In hopes of easing the financial strain, Parmon in March introduced a bill to increase reimbursement fees from $1,000 to $1,500. Senate Bill 164, or “Autopsy Fee Increase,” passed its first reading on March 5 and was referred to the Committee on Finance, where it currently sits.

“If that were to pass, it would help a lot,” Oliver said. “But as I said, it costs us $1,731 to do a case; $1,500 still doesn’t close the gap. Though it might allow the Department of Health and Human Services to find the funds if they only have to make up $100,000 rather than $300,000.”

At Wake Forest, Lantz said he is following Parmon’s bill closely.

“Right now, what we’re doing is just monitoring Senate Bill 164 to see where that goes and also OCME and the DHHS to see if they’re able to increase funding to put us at margin,” he said.

If there is no solution, administrators at the department and hospital will “have to make a decision about whether it is something they can continue doing,” Lantz said.

“No one at ECU or at Wake Forest is trying to gouge the state and make a big profit or even any profit,” he said. “The counties and state just cannot expect nonprofit medical centers and pathology groups to subsidize the services. Unfortunately, the way the law is written, it almost has to come to a crisis before they do something.”


Contact Kristin Zachary at kzachary@reflector.com and 252-329-9566. Follow her on Twitter @kzacharygdr.

via The Daily Reflector.


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