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INTRODUCTION

A number of events have occurred affecting the medical examiner system since our last communication with you. These include personnel changes at our office as well as a number of legislative actions of direct bearing to the system.

Legislative Changes Personnel Body Transportation Medicolegal Seminar

Toxicology Specimen Collection Kits Supplemental Death Certificates Contact Us

Firstly and perhaps most importantly, an increase of $25.00 was approved for the statutory medical examiner fee. This was introduced by Senator Purcell and, in spite of difficult financial times, passed in both Houses and was signed into law by the Governor. It was effective as of the date of ratification so by the time you receive this newsletter the fee for each investigation conducted will be $100.00. We would like to have gotten more but this was, in our opinion, probably the best that we could have done. The fact that it passed with apparently little or no opposition is recognition of the value of your services to your counties. (NCGS 130A-387)

A second bill of interest to the ME system was one clarifying the public record status of photographs taken during autopsies. Prior to passage of this legislation such photographs, at least those taken by the Office of the Chief Medical Examiner, had been ruled as being public records by the North Carolina Attorney General's Office. As such, copies had to be furnished to anyone requesting the same and willing to pay the reproduction fee. The passage of this legislation, House Bill 1543, codifies the right of any interested party to view such photographs but limits who may receive actual copies. The bill also allows the use of autopsy photographs for teaching purposes if they are suitably anonymized. We do not believe that this legislation will have any significant effect on our current medical examiner practices since those individuals or agencies that ordinarily had been obtaining autopsy photographs, i.e., prosecutors and law enforcement investigators, are allowed to receive same under the new legislation and requests from other parties have been extremely rare. Curiously, the bill did not include defense attorneys as entitled to copies and we are seeking clarification from the Attorney General's office. The status of written reports of autopsy remains unchanged - the OCME furnishes copies to any requesting party. The law becomes effective December 1, 2005. (NCGS 132-1.8, 130A-389, 130A-389.1)

Another statutory change of which the OCME had not been aware until its passage involves authorization for autopsy. This amendment allows an individual who has a health care power of attorney for another person to allow that authority to continue after death and to authorize donation and/or autopsy examination with precedence over any family members. This would not appear to have any significant potential impact on the operation of the medical examiner system. This law becomes effective October 1, 2005. (NCGS 130A-389(b))

A number of personnel changes have occurred at the OCME. Dr. Aaron Gleckman who had come to us from California three years ago has returned to the west coast. We are pleased to report that Dr. Cynthia Gardner who had most recently been practicing forensic pathology in Cincinnati, Ohio, has replaced him. Last year's fellow Dr. Christopher Gulledge has joined Dr. Michael Sullivan and our forensic fellow from the year before, Dr. Thomas Owens, at the Mecklenburg ME Office. Dr. Ken Snell who had been in the Charlotte office with Dr. Sullivan and had been our fellow three years before has taken the job as Deputy Chief Medical Examiner in the Shelby County Medical Examiner's Office in Memphis, Tennessee, which is now headed by another former fellow, Dr. Karen Chancellor. Our fellow this year is Dr. Dina Trobbiani who has been a pathology resident at Duke.

In the toxicology laboratory Dr. Jeri Miller, our Deputy Chief Toxicologist, has left State employment to take a position at RTI. Dr. Diana Garside has now assumed the role of Deputy Chief. Mr. Matt Lambing who had worked in our office as an analyst some years ago has returned as the Laboratory Manager. In our Child Fatality Prevention Team area Dr. Edith Kocis, a Pediatrician, is now serving as Medical Director and Ms. Krista Ragan has come on board as research associate.

To offset some of the rising costs of fuel and other expenses, an increase in our body transportation mileage fees was obtained to allow us to continue to provide these services. If you need to find a transporter we now have a feature on our web page www.ocme.unc.edu that allows you to locate transporters who have agreed to provide services in your area by county rather than by region.

Our next medicolegal seminar is scheduled for the weekend of the 10th of June, 2006. We do not yet have a formal program but we will have the update presentation on mass fatality incident processing that we didn't have at the last seminar. This is particularly timely given recent events. We urge you to reserve this Saturday on your schedule and visit us in Chapel Hill. As always we will attempt to keep the fees as low as possible.

After years of working with them, I am sure that some of you will be reluctant to give up the little white plastic prepaid mailing containers that we have been sending out for over 30 years. The postal system, however, at times has difficulties with these and we have always needed something different for the pathologists to send in their samples. We will be forwarding to you, before too long, new collection kits/mailing containers. As with the current ones they will be pre-paid and pre-addressed but will allow for, in the case of the medical examiner kit, the mailing of two specimens at once and in the case of the pathology kit, several liquid specimens as well as a solid tissue specimen. Keep your eyes on your mailbox for further news in this regard. Along this line I would also remind you, particularly the medical examiners, to be sure that you get a good sample on every case that you investigate whether you think it may be relevant or not. I would also urge you to draw those blood specimens in the case of non-autopsy cases from either subclavian or femoral sites saving thoracic sticks for a last resort. I would also ask you to, whenever possible, obtain a second blood specimen from an alternative site or an alternative sample such as urine in any case where the possibility of a positive alcohol result may prove legally significant, particularly those trauma deaths where an autopsy is not conducted. We have had a number of cases in the last few years where a positive alcohol result on a thoracic stick was challenged. Arguments were made that they could have been contaminated by gastric contents released by trauma. If a second separate sample from a different site or an alternative sample had been available to test, these allegations could have been more easily refuted. The new toxicology submission kits will make the forwarding of two samples simpler.

When an original death certificate needs to be amended either because it has "pending" as cause or manner or for some reason the cause or manner needs to be changed, a supplemental death certificate is issued. In many instances we forward the supplemental to the medical examiner after the receipt of the autopsy report or toxicological studies. Some of you like to go ahead and issue your own supplementals after receiving that information. Please remember, if you issue your own you should make a copy of that supplemental andforward it to us as well. Otherwise, we do not know that you have taken care of the matter and will ultimately end up either sending you a supplemental when you have already filled one out or generating another one directly from here, leading to confusion at the health department as to whose supplemental they should accept.

Office of the Chief Medical Examiner
Campus Box 7580
Chapel Hill, NC 27599-7580