Coroners and Medical Examiners Keep You Alive: Five Things You Should Know About Death Investigation in the U.S.

"So You Wanna Be A Coroner? Almost Anybody Can!"

That's the title of a humorous -- and informative -- YouTube video by commentator and comedian Eunice Elliot, who is part of the team at WTVM in Birmingham, Alabama.  Her video was inspired by a brief article I wish I could put into the hands of everyone in the U.S. who can read: Leada Gore's "Does it matter if the coroner is a Republican or a Democrat?" at al.com

I have been talking about problems with death investigation for years, mostly over at the Crime Lab Project website -- http://www.crimelabproject.com, and I'm not the first (for example, a 1928 National Academy of Sciences report said we should get rid of the coroner system). I'm far from the only one who is concerned.

Here are five things I wish people knew about this subject:

1) In most states, coroners do not need medical training, legal training, or forensic science training. A large number of jurisdictions require no training of any kind.
See http://www.npr.org/2011/02/02/133403760/coroners-dont-need-degrees-to-determine-death
http://www.npr.org/2011/02/03/131242432/graphics-how-is-death-investigated-in-your-state

There is no consistency whatsoever.  In many places, it's a political plum handed out by appointment, in others, an elected position with no other requirements than "18 years of age, resident of the state, registered to vote."
In Indiana, if a veterinarian takes the job of coroner, the Office of the Attorney General has ruled that "A licensed veterinarian is a 'physician' within the meaning of the statute and is entitled to one and one-half times the base salary for a county coroner." http://www.in.gov/ctb/files/section101.pdf

2) Not all medical examiners are doctors, and many medical examiners who are doctors are not trained forensic pathologists.
In Wisconsin, a medical examiner is appointed, a coroner elected. That's the only difference between the two, although some counties have greater restrictions: http://www.waukeshacounty.gov/defaultwc.aspx?id=37208
In many states, there is no requirement of forensic pathology training. Gynecologists, dentists, general practitioners, and others have served as medical examiners. 

3) The autopsy rate in the U.S. is abysmally low. We really don't know why people are dying.
Autopsies rates in the U.S.A. http://projects.propublica.org/forensics/
Declining autopsy rates affect medicine and public health http://www.amednews.com/article/20120220/health/302209940/4/

More Deaths Go Unchecked as Autopsy Rate Falls to “Miserably Low” Levels

http://www.pbs.org/wgbh/pages/frontline/criminal-justice/post-mortem/more-deaths-go-unchecked-as-autopsy-rate-falls-to-miserably-low-levels/

4) The work of coroners and medical examiners keeps you alive. 
Saying coroners and medical examiners work for the dead is a statement of ignorance. (And doubly so for those who add, "The dead don't vote.") The dead don't need anything. The living seek justice on their behalf if they are murdered, but that's also because if someone is running around killing people, the living want to know that. Death certificates help decide how medical research will be funded. They allow families to collect insurance and deal with the estate of the deceased.
Here are just a few additional examples of how their work benefits the living:
Public health -- recognition of health problems and disease outbreaks
Mass disasters -- mass disasters bring about mass fatalities
Safety -- recognizing potentially fatal dangers in the workplace, cribs, toys, amusement parks, in automobiles and elsewhere helps the living
Missing persons -- putting a name to the unidentified dead not only helps the families of the missing, but allows investigators to solve cold cases

Silent Mass Disaster http://www.nij.gov/journals/256/pages/missing-persons.aspx

5) Death investigation should not be given over to morticians with little or no forensic or medical training, especially if no firm ethics requirements are in place.
Problems arise when there is a conflict of interest and money to be made from the families of the dead. But that's just the beginning. Death investigation cannot be handed off to someone on the basis of having the equipment to do body removal and the stomach handle remains. This is a serious and important matter than affects the justice, safety, and health of living individuals. Certification and accreditation are important, and voters should demand them.

http://www.funeralethics.org/coroners.htm

http://www.funeralethics.org/summary.htm
http://www.nij.gov/topics/law-enforcement/investigations/death-investigation/symposium/Pages/education.aspx

Many homicide, accident, and public health investigations begin when a body is discovered. Someone with training should be on the job.

Further reading:
ProPublica Post-Mortem Series http://www.propublica.org/series/post-mortem

The Death Quiz http://crimelabproject.wordpress.com/the-death-quiz/

National Academies of Science (2009) Strengthening Forensic Science in the United States: A Path Forward  "Chapter 9: Medical Examiner and Coroner Systems: Current and Future Needs" Can be read for free here: http://www.nap.edu/openbook.php?record_id=12589&page=241

Bureau of Justice Statistics (2007) Special Report: http://www.bjs.gov/content/pub/pdf/meco04.pdf

NPR: Chronic Dysfunction Found in Death Investigations http://www.npr.org/2011/02/08/133595702/chronic-dysfunction-found-in-death-investigations

National Institute of Justice Forensic Death Investigation Symposium http://www.nij.gov/topics/law-enforcement/investigations/death-investigation/symposium/Pages/welcome.aspx