The Office of the Chief Medical Examiner asked staff last year not to autopsy the bodies of hundreds of people who died in suspicious or unexpected circumstances, lowering the use of the state’s best tool for determining an exact cause of death.

A June 2013 memo, obtained through a public records request, outlined the types of cases that pathologists in Raleigh should not autopsy on a regular basis.

Included were the bodies of people older than 40 in apparent natural deaths, victims of alcohol or cocaine poisoning, or those whom police believe committed suicide with a gun or by hanging.

The memo contradicts part of the state’s own guidelines, which call for autopsies on everyone from homicide and hit-and-run victims to bodies that have been charred or skeletonized.

Autopsies are considered the surest way to determine a specific cause of death. An autopsy costs roughly $2,800 and is performed by a pathologist earning around $180,000 a year.

“Due to staffing and budgetary issues at (the Office of the Chief Medical Examiner), it is imperative to thoroughly triage case calls,” the memo reads.

‘A big, big, big problem’

Reducing autopsies is a dangerous move for a state that already performs fewer autopsies than the nation’s best offices and that relies on about 350 untrained local medical examiners to initiate most investigations.

The order to eliminate more autopsies has raised concerns among some law enforcement and medical officials.

Franklin County Sheriff Jerry Jones said he has seen the state’s autopsy rate drop over the years. He watched a once-valuable tool for police investigations “just deteriorate.” It seems, he said, that North Carolina doesn’t care what – or who – is killing people.

“It’s a big, big, big problem to me,” Jones said. “It’s gotten worse. I respected the medical examiner’s office 10 years ago.”

The memo seems to have accomplished its goal.

In 2005, pathologists at the medical examiner’s headquarters in Raleigh autopsied bodies in 38 percent of suspicious cases, data show. The office oversees roughly 30 counties in central North Carolina with some 4,300 deaths a year.

By 2012, the rate dipped to 32 percent – or about 1,400 autopsies.

In the six months following the memo, it dropped to 25 percent. That’s the lowest rate of all the state’s major autopsy centers and far from the top-performing systems, which autopsy about half of their suspicious cases.

Kevin Howell, a spokesman for the medical examiner’s office, declined to answer specific questions about the order – including whether it’s still being followed – and said the overall guidelines for autopsying bodies have remained the same.

Howell acknowledged chronic staffing shortages, which had led some pathologists in recent years to perform hundreds more autopsies annually than what’s recommended.

Performing more than 250 a year can lead to shortcuts and mistakes, experts said.

‘There are consequences’

The 2013 order to limit autopsies came during a trying time for the medical examiner’s office.

After years of battling large caseloads, the Raleigh office last year lost two leading forensic pathologists. One was fired after the state investigated him for mishandling evidence in a murder case.

No charges were filed against the former deputy chief medical examiner, but the case eventually spawned a whistleblower lawsuit against the state.

According to an Observer review, both departing pathologists left more than 100 unfinished cases, which the remaining staff – including Chief Medical Examiner Dr. Deborah Radisch – had to complete.

Radisch, who works in Raleigh, oversees the state medical examiner’s system, which had a budget of about $8.3 million in 2013.

The Raleigh office was also dealing with the tragedy in Boone last year. The Observer reported that it took 40 days for the office to complete blood tests after two people died in a Best Western hotel. The tests showed carbon monoxide poisoning, but the information was not made public until after an 11-year-old boy died from the poisonous gas in the same room.

Autopsies can help expose such health risks and safety concerns. They showed the need for collapsible steering columns in vehicles and building requirements for cribs, said Dr. Victor Weedn, chairman of forensic sciences at George Washington University.

Weedn said the restricted autopsy guidelines could cause North Carolina to miss murders, public health threats or simply fail to provide grieving families with accurate information. Doing so could cheat families out of life insurance payments.

“There are consequences in terms of lives,” Weedn said.

There are also consequences for police. Without an autopsy, law enforcement can “easily go down the wrong road,” said Jones, the Franklin County sheriff.

“If you accept unacceptable behavior, it becomes accepted,” he said. “And that’s exactly what’s going on in the medical examiner’s office.”

‘Going to get caught …’

Franklin, northeast of Raleigh, is one of the counties that sends bodies to the medical examiner’s main office for autopsy. Other counties send them to East Carolina University in Pitt County, Wake Forest Baptist Medical Center in Winston-Salem, the Mecklenburg County Medical Examiner’s Office or smaller facilities.

For years, Mecklenburg has had some of the highest autopsy rates in the state. But that figure dropped to 32 percent of medical examiner cases in 2013, behind only the state’s main office.

With Raleigh’s decreasing rate came fewer autopsies in cases involving likely suicide, a manner of death that sometimes masks murders.

Autopsies on likely suicide victims dropped from 30 percent in 2001 to 20 percent in the months after the memo, an Observer analysis shows.

“They’re going to get caught with egg on their face with the suicide presumption,” Weedn warned.

In two cases after the memo was issued, medical examiners ruled the deaths were suicides due to carbon monoxide poisoning. The bodies were buried without an autopsy, according to state records.

But toxicology tests afterward showed the victims didn’t have a lethal level of the poisonous gas in their bodies, forcing pathologists in Raleigh to change the cause of death to a more vague “inhalation of products of combustion” for one of them and “asphyxia” for the other.

Dr. Patrick Lantz, a longtime forensic pathologist at Wake Forest Baptist Medical Center, said the two likely died of suffocation, since newer cars emit more carbon dioxide and less carbon monoxide.

But Raleigh pathologists should not have assumed that was what happened, he said.

“In cases like that, you would still want to do an autopsy,” Lantz said.

‘Impossible to get justice’

Jones, the Franklin County sheriff, said medical examiners should closely review suspected natural deaths of people as young as 40. Without an autopsy, it’s hard to know whether they died of natural causes, a drug overdose or poison, he said.

In the six months after the memo, pathologists in Raleigh autopsied about 10 percent of people older than 40 who were thought to have died of natural causes, an Observer analysis found. That’s down from 29 percent in 2001.

Almost any medical examiner would be appalled by the decision to routinely decline such cases, said Tom Clark, a former North Carolina pathologist and current chief medical examiner in Pierce County, Wash.

“There is no way to know what they’re missing,” said Clark, adding that reducing autopsies could cause the state to miss a huge number of drug overdoses.

Weedn, a pioneer in DNA testing, said states typically perform autopsies on people much older than 40 in apparent natural deaths. He called the Raleigh office’s effort to prioritize when to perform autopsies “a calculated risk.”

It’s especially risky given that North Carolina largely depends on untrained medical examiners to investigate suspicious and unexpected deaths. These examiners, usually full-time doctors or nurses, conduct investigations during their off hours.

They’re tasked with finding the details of a case and deciding whether to contact pathologists about a possible autopsy.

But an Observer investigation found that medical examiners rarely go to death scenes and sometimes violate a state requirement to view the body.

They often rely on police for information and sometimes fail to interview witnesses or family members of the deceased.

“The worst thing you can do is have a very low autopsy rate and have very poor investigations,” Lantz said.

Lawmakers said they would propose legislation when the General Assembly reconvenes in January that would address problems within the medical examiner’s office.

Chris Morgan, who spent seven years working homicide investigations for the Raleigh Police Department, said fewer autopsies mean more cases could fall through the cracks.

Chances are, men like him – 62 years old, 6-foot-1 and 350 pounds – wouldn’t get a second look from the medical examiner’s office, said Morgan, who retired in 2004 as lieutenant of major crimes. That’s troubling, he said, considering how many enemies he’s made during his police career.

And the public loses, Morgan said.

“Two things you always try to get for the victims are truth and justice,” he said. “And if you don’t know the truth, it’s impossible to get justice.”

A questionable ruling

Autopsies can provide closure to families and leads on cases to police.

In July 2013, Julian Henderson’s girlfriend found him dead, face down in the front yard of his home in Caswell County on the Virginia line.

Henderson was an energetic 67-year-old, said neighbor John Long. Sure, the former newspaper photographer had heart problems a decade ago and was on pain medication, but he had just passed a physical, Long said.

The day Henderson died, local medical examiner Keith Harris viewed his corpse. Harris noticed small wounds on Henderson’s arm and legs, documents show. On his neck, Harris saw Tardieu spots – marks on the skin that can indicate strangulation or asphyxiation.

He called a medical examiner official in Raleigh.

“She concurred that the death was most likely natural and the fall preceded a major cardiac event,” Harris wrote in his report.

Henderson’s body was sent to a nearby funeral home. His eye was so badly damaged that workers advised family members not to view the corpse, remembers Henderson’s son, Jon.

Henderson’s body was cremated without an autopsy.

That, friends and family said, turned out to be a mistake.

About a week after the death, Teresa Burnette, Henderson’s girlfriend, was caught stealing from his home, police records show. She left with antiques, farm equipment and computer hardware and software, among other items, according to a September 2014 indictment.

Burnette, 54, is awaiting trial on felony larceny charges.

Harris, the medical examiner, said he has since second-guessed not ordering an autopsy.

Knowing of any problems Henderson may have had with Burnette “would have changed things,” he said.