Buncombe County medical examiner warns staffing shortages delay death investigations

A death in Buncombe County can now mean weeks or months of waiting for a certificate, a cremation, insurance paperwork or a final answer about cause of death. As the state’s medical examiner system strains under staffing shortages, that delay is landing in Asheville funeral homes, county offices and grieving households.

The North Carolina Office of the Chief Medical Examiner handles deaths from injury or violence, along with natural deaths that are suspicious, unusual or unattended by a medical professional. That workload is growing harder to absorb. Nearly 40 of the state’s roughly 340 medical examiners left their jobs in the past year, and North Carolina’s average time to complete or close a case has been reported at more than 200 days.

In Buncombe County, the pressure is easy to see in the caseload. Paula Case, a Buncombe County medical examiner, said the county can see 25 to 50 death investigations in a month. With so few people covering so many cases, examiners can be forced to move across county lines, leaving some deaths waiting longer for review than local families expect or deserve.

Those delays ripple through the rest of the system. Death certificates in Buncombe County are issued through the Register of Deeds, and when medical examiner review slows down, cremations and funerals can be pushed back. Insurance claims, probate and estate matters can also stall while families wait for the paperwork that confirms how a loved one died.

The backlog also carries public-safety consequences. When a death is suspicious or unclear, autopsy and investigative work can help law enforcement and prosecutors decide how to move forward. Slow case closure means slower answers for criminal investigations and, in some cases, slower public-health response when a death pattern needs to be understood.

The strain in Western North Carolina is not abstract. Since 2021, Mission Hospital has released at least 111 bodies to funeral homes before the legally required medical examiner review, underscoring how fragile death-handling oversight has become in Buncombe County. Families elsewhere in North Carolina have reported waiting nearly a year for official cause-of-death findings, a reminder that the shortage is about more than vacancies. It is about whether North Carolina can still deliver a timely, humane and reliable system for determining why people died.