When people think about public safety, they often think about police officers, prosecutors, courts, prisons, or emergency responders. Less attention is usually paid to the systems working behind the scenes, including medical examiners. But in cases involving suspicious, sudden, violent, or unexplained deaths, that system can be central to understanding what happened to an individual, and whether justice can move forward.
That is why North Carolina’s forensic autopsy backlog deserves attention.
An autopsy is a medical examination of a body after death. Pathologists conduct autopsies to determine how and why a person died. There are generally two kinds: clinical autopsies and forensic autopsies. Clinical autopsies are typically used to better understand deaths from natural causes or medical conditions. Forensic autopsies are different. They are performed when a cause of death is possibly criminal or connected to a legal investigation. Law enforcement, coroners, medical examiners, or judges may order this type of autopsy.
In other words, forensic autopsies are not just paperwork. They can help answer whether a death was an accident, suicide, homicide, overdose, or the result of some other circumstance. They can also provide evidence in criminal cases, address public health concerns, and offer victims’ families answers during one of the worst moments of their lives.
North Carolina’s Office of the Chief Medical Examiner is under real strain. Despite funding increases and legislative support, the office remains backlogged due to several pressures, including a national shortage of forensic pathologists, opioid-related deaths, and a sharp increase in subpoenas requiring experts to testify in person. The office has also seen a significant increase in subpoenas, adding yet another demand on an already limited workforce.
The staffing numbers help show the challenge. Of 71 state-funded positions in 2024, 63 were filled, including 11 forensic pathologists. At the same time, North Carolina’s daily medical examiner caseload was 38 percent above the national average.
This is not a problem unique to North Carolina. Other states, like Mississippi and West Virginia, have also faced autopsy backlogs and shortages of forensic pathologists. But the fact that this is a national problem does not make it any less serious for North Carolina families, prosecutors, law enforcement, or communities waiting on answers.
The public safety concern is straightforward. The delays in forensic autopsies can slow down death investigations. When an autopsy report is pending, law enforcement and prosecutors may be waiting for information that helps determine the direction of a case. In suspected homicides, overdose cases, child deaths, deaths in custody, or other suspicious circumstances, the cause and manner of death can matter enormously.
The impact on victims and families is just as important. When a family loses someone unexpectedly or violently, they are already facing grief, confusion, and shock. Waiting months for an official answer can compound that pain. A delayed autopsy report can also delay legal proceedings, insurance matters, benefits, and other practical steps that families may need to move forward.
This is not a simple problem with a single cause. Lawmakers have already approved additional funding, and the office has taken steps to improve efficiency. In 2023, the office laid out a plan to improve operations, and lawmakers approved $2 million in additional funding, a 160 percent increase from five years earlier.
But the continued backlog shows that something isn’t working. North Carolina is facing capacity problems across several parts of the public safety system, from law enforcement staffing to behavioral health resources to the ongoing toll of addiction. The forensic autopsy backlog fits within that broader concern: systems meant to protect the public and support victims cannot function well when stretched beyond capacity. When forensic autopsies are delayed or incomplete, investigations can lose valuable time, leaving law enforcement without key evidence needed to identify suspects, support charges, and ultimately improve case clearance.
Forensic autopsies help establish facts, support investigations, and help prosecutors and law enforcement do their jobs. Most importantly, they can help families understand what happened to someone they loved. North Carolina should treat the backlog as a public safety and victim services issue, and as a reminder that justice depends not only on what happens in the courtroom, but also behind the scenes.