Problems and Issues in Death Investigations and with the Medical Examiner System
What You Need To Know
by Karen Russo © 2008

Adequate investigations of death require the combined efforts and cooperation of law enforcement and other public-service agencies, medical professionals, and those within the forensic community. Cooperation between these entities is not automatic.

These front-line individuals, whether medical examiners, physicians, coroners, pathologists, forensic pathologists, funeral homes, or lay-people, are required to make important decisions which have far-reaching consequences. Put into the hands of the untrained and/or unskilled is dead-wrong. And put into the hands of the trained that are compensated by State agencies, should equally be cause for alarm.

There are gross deficiencies in the current death investigation process within each state. Death investigation practices vary greatly among medicolegal jurisdictions.

In order to "tease out" substandard and inadequate death investigation practices across the country, the Institute monitors and categorizes death investigation by type of system, whether it be a state medical examiner/county coroner type system or a medical examiner system; we monitor questionable and substandard medical examiner and death investigation practices across the country.

Within the U.S. those charged with the investigation of suspicious, unusual, and unnatural deaths have historically been under the umbrella of the coroner. However, in some states the word coroner is used interchangeably with the term medical examiner. By definition they do not mean the same thing.

Almost all coroner systems are intertwined in politics; and as a result, poor, biased and ineffectual death investigation is the result providing no recourse by family. Additionally, a wide variation in investigation quality is the norm when comparing one jurisdiction to another.

Limitations also exist in the use of the term medical examiner. Some systems limit the title "medical examiner" (M.E.) to mean board certified or eligible forensic pathologists; others use the term to mean pathologists, and others limit its use to mean physicians or coroners.

In some jurisdictions, other terms are used to delineate which M.E. is a board certified forensic pathologist, pathologist, physician, death investigator or non-physician death investigator. Terms such as "deputy chief M.E.," "deputy M.E.," "district M.E.," "regional M.E.," "county M.E.," "assistant M.E.," & "associate M.E" are all used to distinguish between different specialists, professions, training and educational background.

There is very little consistency from one jurisdiction to another when comparing terminology. In other words, in some states, the term "deputy M.E." is used to describe a board-certified forensic pathologist. In another state, that same title can mean a non-pathologist physician death investigator. And yet still, in a different state the same title can describe a non-physician death investigator.

Bottom line: The numerous titles given to death investigators across the country causes a great deal of confusion, compounded by the fact that almost 50% of systems require no formal training in death investigation. Those that do require training do not enforce the requirement.

In addition to these already existing issues and problems is the refusal of the medical examiner / coroner system to provide information-------not just to the general public but to the families that are directly affected by their investigations and reports. Reports can be denied outright, never provided or incomplete.

Some jurisdictions have tried to fix these problems by implementing changes and regulations within their coroner systems; others have completely done away with the coroner system altogether in favor of the medical examiner system.

In the 1992 publication by the Center for Disease Control "Death Investigation in the United States and Canada, 1992" the CDC separated the U.S. death investigation systems into three categories:

1. Medical Examiner
2. Mixed Medical Examiner and Coroner Systems
3. Coroner Systems

and each type was further divided into subcategories.

The death investigator is the most crucial element in the entire death investigation process. And while the CDC's "Death Investigation in the U.S. & Canada, 1992" gives information about each state's death investigation system, what is missing is complete information regarding death investigator training requirements, educational requirements, continuing education requirements, and enforcement policies.

Regardless of the type of system implemented in your State and jurisdiction, the front line death investigators, whomever they are, are necessary for effective, efficient, high quality death investigations.

The Institute seeks to highlight and zero-in on substandard death investigation practices across the U.S. relating to prison deaths, hospital deaths, nursing home deaths, deaths due to accident, homicide, suicide and those deemed " natural."

If you are having difficulty with the Medical Examiner/Coroner system in your state, if you have a loved one who has died within a prison system, in a hospital setting, in a nursing home, or due to an accident, a personal injury, homicide or suicide, if you do not know what your rights are in so far as stating to a medical examiner what you desire or are not being provided, contact us. By phone, fax or email.

Requesting information and specific protocols of the medical examiner/coroner at the outset is key. The knowledge needed in order to request that information---priceless.

  The following websites will provide you with helpful information with respect to the Medical Examiner and Coroner systems. These links will open in a "new browser frame". When you are finished viewing, close the new browser frame to return to the links page. State boards may require use of the scroll bar to the right.

Copyright © 2008 Karen L. Russo - The Wrongful Death Institute & Forensic Science Associates. All Rights Reserved. These articles or pages may not be copied, transmitted, forwarded, reposted, or republished, in whole or in part, electronically or in any other format, without express written permission. This is not a solicitation for legal business. The Institute is not engaged in the practice of law. Mere contact through this website does not constitute a contract for representation. Wrongful Death Institute pages are designed and maintained by Four Boys Inc.