CONCORD, NC (WBTV) - The case of a Concord man who died in October 2015 has highlighted the continued reliance of North Carolina medical examiners on law enforcement agencies to determine a person's cause of death.
By law, medical examiners are supposed to conduct their own investigations into an individual's death when the circumstances leading to the death are unclear. The investigation must be complete before a person can be cremated or embalmed.
But the family of Cecil Boykin are left with unanswered questions more than two years after his death because they say, the medical examiner who investigated Boykin's death did not conduct an independent investigation and ignored their pleas to dig deeper.
Cecil Boykin was found dead on the floor of a bathroom at his home on the morning of October 10, 2015. In his death report, the medical examiner wrote he was found with an electrical cord around his neck.
Police ruled Boykin's death a suicide before his brother, Billy, and mother could arrive at his home.
"Their mind was already made up," Billy Boykin said of the officers investigating his brother's death.
Medical examiner relied on police
Billy Boykin said he tried to ask police to make sure an autopsy was conducted, which would confirm whether Cecil Boykin actually hung himself or died of other causes.
What the Boykin family didn't know, though, was that the decision of whether to conduct an autopsy was the responsibility of the Cabarrus County Medical Examiner, who was never told of the family's wishes.
Under state law, an autopsy may be conducted at the request of the family of a deceased person. But by the time the Boykins reached Sylvia Collins, the medical examiner who investigated Cecil Boykin's death, she had already completed her investigation and he had already been cremated.
Records show Collins ruled Boykin's death a suicide based solely upon what police told her.
"Per police investigation [Concord Police] this is a suicide. No foul play at scene," Collins wrote.
Collins reiterated her reliance on the Concord Police Department's determination that Boykin's death was a suicide in a phone call with Billy Boykins.
"[The police] assured me it was a suicide," Collins told Billy Boykin by phone. "We don't normally do autopsies on suicides."
Collins' death investigation report shows she did a physical exam of Cecil Boykin and drew blood and urine. A toxicology report shows Collins only had Boykin's urine tested for alcohol, which came back negative.
Regional, state officials point to police, too
When WBTV tried to ask questions about why Collins relied on police to determine the cause of Cecil Boykin's death, multiple levels of the state's medical examiner system gave different versions of the same, confusing answer.
In North Carolina, the Office of the Chief Medical Examiner is responsible for overseeing the statewide system that investigates deaths and conduct autopsies as needed.
In addition to the OCME's office, which conducts autopsies, there are three regional autopsy centers where pathologists perform exams for a group of regional counties. The Mecklenburg County Medical Examiner's Office is responsible for performing autopsies for a five-county region, including Cabarrus County.
When a reporter first called the Mecklenburg County ME's Office to ask why Cecil Boykin's death report attributes the cause of death finding to the police and not the county medical examiner's own investigation, a staff member told us we would have to call police.
Later, a spokesman for the county medical examiner said his office couldn't provide any information because it did not conduct an autopsy.
"I would have to refer your request for an interview about this case to OCME or perhaps to the Concord PD, who was the investigating Police agency in this case," Bill Fish, a spokesman for the Mecklenburg County Medical Examiner's Office said.
North Carolina's chief medical examiner, Dr. Deborah Radisch, did not respond to multiple emails for this story seeking clarification on whether it is proper for a medical examiner to rely upon police to reach a cause of death determination and asking who, if anyone, is reviewing death investigation reports to ensure a proper investigation has been conducted.
A spokeswoman for the North Carolina Department of Health and Human Services, the cabinet agency that oversees the Office of the Chief Medical Examiner, also did not address whether it was proper for a medical examiner to rely upon a police investigation to reach their cause of death determination. The DHHS spokeswoman did, however, refer a reporter back to the regional autopsy center.
"What constitutes 'contested' and whether or not an autopsy will resolve the issue depends on communication between the medical examiner and the pathologist(s) at the applicable regional autopsy center," DHHS spokeswoman Kelly Haight said.
During a phone call with a WBTV reporter, Haight also suggested the station reach out to the local police department and, when pressed for an additional explanation as to why medical examiners were relying upon police to reach a cause of death determination, said she could not answer the question because she was not a medical examiner.
Haight did not provide any additional information in response to multiple follow-up emails from WBTV seeking an interview with the chief medical examiner and additional details about North Carolina's medical examiner system.
Lawmaker points to 'arcane' system
North Carolina Senator Jeff Tarte (R-Mecklenburg) said the specific case illustrated by Boykin's death and his family's efforts to have the medical examiner investigate more closely, is an illustration of the system problem plaguing North Carolina's medical examiner system.
"We have a number of people, autopsies that need to be performed and we just don't have the capacity to do it," Tarte said, pointing to the fact that the system has largely stayed the same over a period of decades in which the state's population has ballooned.
"It's not broken, it's arcane," Tarte said of the medical examiner system. "It's so far outdated, it's unbelievable; mainly understaffed."
Tarte has, for years, attempted to get more funding to overhaul the system but, he said, it's hard to convince his colleagues in the legislature to address a problem that mainly affects a constituency that often no longer has a voice.
"I don't mean to be trite about this but there are not a lot of dead people screaming about having their autopsy done. But there's families that, literally, when there is something potentially nefarious that might me, it isn't justice delayed, it's justice never delivered," Tarte said.
Billy Boykin will always have questions about whether his brother actually hung himself or if his death was caused by someone else. Because of that, he said, the system failed him and his family.
"It failed my brother," he said. "And, most likely, more people. We can't be the only ones."