EDITORIAL: A matter of dying

May 23--Everyone dies, but it matters how. North Carolina medical examiners are supposed to answer that question, yet they fail too often.

It has taken an exhaustive investigation by The Charlotte Observer to uncover some of the flaws in the state's system of accounting for death.

The stories are jaw-dropping:

-- A Harnett County man was ruled to have died in a car accident until a funeral home worker found four stab wounds in his back.

-- A Cherokee County woman had to have her husband's body exhumed and an autopsy done to show his cause of death after learning the medical examiner, a nurse practitioner, ruled a heart attack killed him. The real cause was blunt trauma as a result of a car crash. Two life insurance policies paid only in the case of accidental death.

-- A Massachusetts man visiting a friend in Asheville shot himself with the friend's handgun. The men had been drinking and horsing around with the weapon. Police investigated and decided the death was accidental. The local medical examiner called it an accident but was overruled by the associate chief medical examiner for the state, who classified the death as a suicide. The man's wife, refusing to accept that conclusion, had to get a ruling from an administrative law judge, who declared that a finding of suicide required evidence of intent, which was lacking in the case.

It matters, deeply, to survivors whether a death was accidental or a suicide. The cause of death can also determine how an insurance claim is settled, or whether a crime was committed.

Cause of death lies at the heart of a dispute between High Point University and the mother of a student who died two years ago. The Office of Chief Medical Examiner said it was a drug overdose. The mother's lawsuit alleges that her son received injuries in a beating that contributed to his death.

In that case, an autopsy was conducted and a detailed report was filed. While that's not necessary in every death, a medical examiner's work still ought to be trusted as a thorough physical investigation leaving little room for question. Most of the time, that's true. But it's easy to see how mistakes and omissions can happen.

As the Observer reports, medical examiners don't always follow the routine requirements of their job. That includes, in more than 10 percent of cases, not even examining the body. In other words, medical examiners often draw their conclusions without conducting a medical examination. And it's rare when they visit the place of death, where they might be able to put other facts into context.

Why not? One reason is that medical examiners are paid only $100 per case and can't afford to spend much time on each job. This is much less than what most states provide. North Carolina's overall budget for medical examinations is less than half the national average per capita. If our state doesn't think the work is worth more than that, why should it get good work?

In his proposed budget, Gov. Pat McCrory recommended raising the fee to $250, providing training for medical examiners and boosting funding for three regional autopsy facilities. All those steps should be approved by the legislature.

How we die is important. There are public health, financial, law-enforcement and emotional reasons for knowing. The state owes correct answers.

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