Read the original article on the Charlotte Observer website.
When autopsy backlogs in North Carolina threatened Union County officers’ ability to prosecute drug overdose cases, they opened their own center to continue their yearslong drug purge amid state delays.
A temporary autopsy center that opened in the bottom of a Monroe hospital Dec. 17 is the ninth regional center in the state. It’s also one county’s latest attempt to combat two issues plaguing the state: drug deaths and autopsy delays.
The North Carolina General Assembly since its 2023 session has given Union County $22 million to open the South Piedmont Regional Autopsy Center under oversight from the Office of the Chief Medical Examiner. The county soon hopes find a permanent building to better host eight more counties and get the proper accreditation to help with the toxicology reports backlog, too.
Autopsy and toxicology backlogs have been caused by increasing overdose deaths and too few forensic pathologists, a Charlotte Observer investigation revealed last year. They leave grieving families and investigating law enforcement waiting too long for answers.
For Union County, those delays were made worse when the Office of the Chief Medical Examiner moved Union County’s autopsies from Mecklenburg County — less than an hour away — to Wake County — about three hours away — in 2022.
The switch was supposed to help with backlogs, but transportation time coupled with the Raleigh center’s staffing shortages created more delays, said Tony Underwood, the chief deputy of operations with the Union County Sheriff’s Office.
Each Raleigh pathologist, the Observer previously reported, completes, on average, 557 autopsies each year. That’s more than twice the number recommended by a national accrediting group, Department of Health and Human Services Secretary Kody Kinsley previously told the Observer.
“Bottom line, plain and simple, the medical examination system is in crisis,” Kinsley said.
The Raleigh autopsy center told Underwood it does not “routinely do full autopsies in suspected drug overdose cases,” he said in an interview with the Observer.
Mecklenburg’s center did, Underwood said.
The change became a problem for Union County law enforcement.
The sheriff’s office and Union District Attorney Trey Robison were charging and prosecuting drug dealers who sold deadly substances to people even before a state law paved the way to do that.
A 2019 bill introduced a “death by distribution” charge to North Carolina, allowing dealers to be charged with killing someone by selling or giving them the drug that killed them. It is largely regarded as a “hard-to-prove” charge, but Union County is among the top counties pursuing and prosecuting it, according to nonprofit research by the Fentanyl Victims Network of North Carolina.
Union County, Underwood said, had been charging dealers with second-degree murder before “death by distribution” was introduced.
That meant Union County officers were routinely requesting autopsies and toxicology reports in almost every overdose case.
But in Raleigh, they sometimes needed to have “probable cause” that a crime was committed to request an autopsy, Underwood said. Toxicology reports, which show what substances were in a person’s system when they died, typically give probable cause.
But state toxicology reports are finished more slowly than autopsy reports, sometimes taking months or years to be completed.
In 2023 in Raleigh, the medical examiner’s office had just one forensic toxicologist to certify all drug casework, the Observer previously reported.
Union County’s temporary autopsy center is a step in the right direction, said Barb Walsh, the founder and executive director of Fentanyl Victims Network of North Carolina. But North Carolina really needs more toxicologists, she said.
Walsh, whose daughter died after unknowingly drinking from a water bottle that had fentanyl in it, had to wait five months to learn what killed her daughter in 2021.
“And I thought that was awful,” she said, “but I am consistently getting calls from families that are waiting 10 and 12 months.”
From 2019 to 2023, according to the state health department, North Carolina experienced a 26% increase in cases. That was “undoubtedly influenced by the 69% increase in suspected drug overdose cases,” spokesperson Hannah Jones wrote in an email.
“Another regional autopsy center is a welcome addition to the NC Medical Examiner System to help with the many cases that come through,” she wrote.
In 2025, Underwood said, the sheriff’s office is seeking accreditation to expand its toxicology lab — which is currently used to test blood from impaired drivers — to be able to test blood from those who died from an overdose or fentanyl poisoning.
