Originally Posted by
Dr_Thanatos
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at the English legal system, that makes perfect sense, the coroner was a representative of the crown, and his authority superseded the Sheriff, but he then had to explain to the King why he did what he did.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.
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