I suppose the ultimate question is, as noted by others: what caused this idea to be shelved in decades previous, eg. the 60s, 70s, and late 80s?
I suspect that the sudden murder (with the 21st-c. bonus of cam footage going viral) of a young Buffy S. Witherspoon or two from the MSW programs of private universities will mean the end of this concept in the 2020s, but I sure hope I’m wrong.
The Coroner?!?! WTF does a doctor who specializes in dead bodies have to do with a mental health crisis?Originally Posted by WOLFIE
I’ve seen some weird shit, but that takes the cake.
I’m all for having mental health care professionals handle mental health care calls. I hope it works out for them and they come up with a model that can be used nationwide.
But I’m skeptical.
Formerly known as xpd54.
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Lon, I don’t know how that came to be. I have wondered myself. I am guessing here. Perhaps it was set up this way to have a functioning system. There will always be a coroner office for each county and there are deputy coroners.
It very well may vary from state to state, but here (GA) there is a difference between a coroner and a medical examiner.
The office of coroner is an elected position, and the position is responsible for determining cause and manner of death and taking possession of a deceased person's property if needed. They most likely are not a doctor. In fact, it's not uncommon for the coroner to be the local undertaker.
A medical examiner is a doctor and conducts autopsies. The state maintains a medical examiners office, and any county with a population of over 100,000 may choose to replace its coroner with a medical examiner.
Our current coroner in the county in which I work is a paramedic. I'm not sure what his deputy coroner does for a living. The previous deputy coroner worked for a local funeral home.
As far as a mental health order, here, those are obtained through the probate judge.
I had an ER nurse in a class. I noticed she kept taking all head shots. Her response when asked why, "'I've seen too many people who have been shot in the chest putting up a fight in the ER." Point taken.
There are only around 500 forensic pathologists in the United States. A county in Alabama close to me has a Coroner who is a Veterinarian.
Paging @Dr_Thanatos
eta: correct screen name
OK, let's have San Francisco start this up with one single problem: their homeless. That would be a win for everyone, no downside. Of course it would probably just show that this program isn't going to work.
With liberty and justice for all...must be 18, void where prohibited, some restrictions may apply, not available in all states.
Huh. Learn something every day. Here in OH you have to be a licensed physician to be eligible to run for Coroner.
Formerly known as xpd54.
The opinions expressed in this post are my own and do not reflect the opinions or policies of my employer.
www.gunsnobbery.wordpress.com
Death investigation is a state function. There are no national/federal death investigation systems, with the exception of the Office of the Armed Forces Medical Examiner (OAFME).
How your state's death investigation system functions is a combination of when it was founded, what changes were made over the years and how much money is involved.
Most states in the original colonies, used the English legal system as a model. For a brief, but important digression (And I feel certian that someone here can explain this better, but that's not as important right now), the English legal system was a combination of a county system, with a Crown system. (Analogous to Local/State and Federal govt) The counties had a "County Manager" the Reeve, who was responsible for overall management of the county. (The Shire's Reeve is what got mutilated into Sheriff.) However, the King was not convinced he was getting all of his tax money, so he sent a representative to each county to make sure that the crown was getting all of it's taxes that were due. That guy was known as the "Crowner" Because faking death was not an uncommon method of tax evasion, the Crowner became responsible for ensuring that anyone who was dead, was in fact, really dead and not faking. Again, English is a rough language, and Crowner became Coroner. One of commonly known phrases it "The Coroner is the only person who can arrest the Sheriff." If you look back at the English legal system, that makes perfect sense, the coroner was a representative of the crown, and his authority superseded the Sheriff, but he then had to explain to the King why he did what he did. (In today's law enforcement environment, that job is handled by state or federal agencies. Even still, some states have the Coroner as the back-up Sheriff if something goes wrong.)
When the english system was brought to the colonies, and then after the King was removed, the parallel nature of death investigation remained, with an elected coroner and Sheriff, but their functions changed. Depending on how the state's constitution reads, the coroner may be a constitutional officer or not, may be sworn law enforcement or not, and the requirements can vary wildly. You can see interesting variations across the country, In Texas the Justice of the Peace is responsible for death investigation, I believe Nebraska has the District Attorney combined with the Coroner and of course, California has the Sheriff/Coroner system.
Medical Examiner's didn't come along until around the turn of the century when Boston decided that maybe, having a doctor look at the decedent's was a good idea. But that physician was not allowed to do any procedures to the deceased, nor any other testing. It was just a test to see if a Doctor as a coroner was a good idea. The first "Real" medical examiner's office was in New York City, during prohibition. The coroner in Manhattan was so corrupt and useless that the plan was to replace him with a physician who could actually investigate and discover the underlying cause of death. Three finalists were identified, and each performed an autopsy for the deciding committee. (I have no idea what the committee planned on doing with that information). Incidentally, the coroner arrested all three candidates, because he didn't give permission for them to touch the body.
At any rate, the NYC-OCME rapidly became the model for both forensic pathology/death investigation and forensic toxicology. The book "The Poisoner's Handbook" is an interesting read about that era. There is also a PBS special which is different, but still interesting.
There was a period of time in the 40-60s where states began to attempt to reform the coroner model of death investigation. Some abandoned the coroner and transitioned to the medical examiner system. A number of states raised the requirements for being a coroner (Ohio is a good example, the coroner must be a physician), and some places just left it alone.
So History lesson aside, what does that mean for current death investigation.
There are good coroner systems, there are bad coroner systems. There are good ME offices, there are bad ME offices. Usually the funding will tell you which one you are going to get. (Not always, but usually) The biggest issue I have with the elected coroner system is that they can't be fired, just not re-elected. And nobody, except for law-enforcement and the DA knows whether they are actually doing a good job. Coroner's who are appointed, have forensic pathologists that they work with, and good investigation teams can do a fabulous job. (Clark County, NV. Great coroner's office). Elected coroner's with no oversight, and small budgets, make for an easy way to miss problems. Coroner's with a basic conflict of interest seems like a bad idea to me. (California, Texas, Nebraska) Coroner's without sufficient training is a basic problem. For example, Do you want someone with one week of training to decide whether or not your loved one is a suicide, an accident or a homicide? Or what happens when the Sheriff calls all officer involved shootings accidents, because the officer really did want to kill them? Or maybe the DA would really like to prosecute someone, so he calls the death a homicide instead of an accident? None of these examples are imaginary.
Death investigation suffers from population density issues. Metro areas with high case volumes, a dense population and a decent budget, the system works well. Rural areas with low case volumes, low population densities and no budget, it works poorly. This is primarily a funding issue. When I was in fellowship, NC was second lowest for per capita funding of their ME system, I think we collected 0.86$ per person in NC. Utah beat us, they only collected 0.85$ per person. In comparison, at the time, NM collected about 4.25$ a person. (This was quite a while ago.) So, baseline funding makes an enormous difference in the quality of the system; frequently, you actually get what you pay for.
The shortage of certified forensic pathologists is a different and related problem. Forensic pathology has usually been referred to as the "only fellowship in medicine that guarantees your salary will go down." So you are adding 1-2 years of training for a job that decreases your salary by about half, compared to private practice pathologists. This is not a job that you take because you "didn't do well in school." Nor is it a job that you get stuck in because you "couldn't talk to patients." Those of us in the field do it because it is our calling, not for the paycheck. I think most public safety and public health related jobs are like that. And even then, there are more FP's retiring than there are starting. For every three FP fellows, only 2 will actually begin a career in forensic pathology, because either, they hated it (Either dealing with mortality every day, or dealing with feces from politicians, lawyers and other doctors), or they could make so much more money doing something else. So our shortages are only getting worse. I'm looking forward to a retirement gig of reviewing cases for phat loot. It's a ways off.
So, to recap. Some coroner's are doctors, most are not. Ever single state is different, both for what types of deaths are handled by the death investigation system and who is responsible for doing the exam. Each state/county has different responsibilities and qualifications associated with the position. The requirements vary wildly. Some offices are good, typically ones with decent funding. Some offices are bad, usually poor ones, or when there is an inherent conflict of interest. And over the next 20-30 years, we're probably going to run out of physicians willing to do the job.
Back to the original topic: Firefighters and mental health professionals do not have legal authority to use force in CA to make a 5150 subject comply with their orders. Cops don't, either, but we can use force to arrest for delaying, obstructing or resisting an officer int eh performance of their duty.
It will be nice to see how the Fire guys handle being first responders, now.
This is a very interesting thread to me. And I thought our system was FUBAR. Here, cops can do an emergency involuntarily commitment on people for mental health reasons (and obviously use force if necessary). Fireman can’t. Some mental health professionals can.
So the guys with the least amount of medical/mental health training are the ones called upon to decide when someone gets “pink slipped” (the pink copy of the form stays w us and the original goes to the hospital).
Formerly known as xpd54.
The opinions expressed in this post are my own and do not reflect the opinions or policies of my employer.
www.gunsnobbery.wordpress.com
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