When a group of doctors gathered in Washington state for an annual meeting, one made a surprising revelation: If you want to know when, how – and where – to kill someone, I can tell you, and you’ll get away with that. . No problem.
That’s because the expertise and availability of coroners, who determine causes of death in criminal and unexplained cases, vary widely across Washington, as well as in many other regions. of the country.
“The coroner doesn’t necessarily take a science class in life,” said Nancy Belcher, executive director of the King County Medical Association, the group that met that day.
She said her colleague’s startling comment set her on a four-year journey to improve the state’s archaic death investigation system. “These are people who come in, see a murder or death scene, and say if an autopsy is needed. They are the final decision makers,” added Belcher.
Each state has its own laws governing the investigation of violent and unexplained deaths, and most assign tasks to cities, counties, and regional counties. The work may be undertaken by an elected coroner aged 18 or by a highly trained physician appointed as a medical examiner. Some death investigators work for elected police chiefs who try to avoid controversy or owe political favors. Others own funeral homes and transfer the bodies to their private businesses.
Overall, it’s a fragmented and often underfunded system — with more than 2,000 offices Nationwide identify the cause of death of about 600,000 cases each year.
“There are some really serious conflicts of interest that can arise with investigators,” said Justin Feldman, a visiting professor at Harvard University’s FXB Center for Health and Human Rights.
Belcher’s campaign succeeded in changing several aspects of Washington’s coroner system when state legislators approved it. a new law last year, but recent attempts to reform death investigations in California, Georgia and Illinois have failed.
Judgments about cause of death are often unclear and can be controversial, especially in police-related deaths like the 2020 murder. George Floyd. In that case, the medical examiner for Minnesota’s Hennepin County ruled Floyd’s death a homicide but suggested heart disease and the presence of fentanyl in his system may have been factors. . Pathologists hired by Floyd’s family say he died of lack of oxygen when a police officer pressed his neck and back.
In a recent case in California, the Sacramento County coroner’s office ruled that Lori McClintock, wife of congressman Tom McClintock, died of dehydration and gastroenteritis in December 2021 after ingesting the leaves of the white mulberry, a plant not considered toxic to humans. decision trigger question by scientists, doctors and pathologists about the decision to link the plant to her cause of death. When asked to explain how he made the connection, Dr Jason Tovar, the lead forensic pathologist who reports to the coroner, said he had reviewed the material online. about this plant using WebMD and Verywell Health.
The different titles used by death investigators do not distinguish the difference in their credentials. Some communities rely on coroners, who may be elected or appointed to their office, and may — or may not — have medical training. Medical examiners, on the other hand, are usually physicians who have completed a residency in forensic pathology.
In 2009, the National Research Council recommends that states replace coroners with medical examiners, describing a system that “needs to be significantly improved”.
Massachusetts is first state to replace the coroner with a medical examiner statewide in 1877. As of 2019, 22 states and the District of Columbia had only medical examiners, 14 states only had medical examiners. survey and 14 states have the combination, according to Centers for Disease Control and Prevention.
The movement to convert the rest of the country’s death investigators from coroner to medical examiner is waning, as a result the coroner’s political power in their communities and spending. additional fees required to pay for the expertise of the medical examiner.
The effort now is to better train investigative officers and make them more independent from other government agencies.
Jeffrey Jentzen, a former Milwaukee medical examiner and author of the book “Death Investigations in America: Coroners, Medical Examiners, and Death Pursuits,” said Dr. If you try to get rid of them, you will hit a political wall. Medical certainty.”
“You can’t kill them, so you have to help train them,” he added.
Dr Kathryn Pinneri, president of the National Association of Medical Examiners, said there won’t be enough medical examiners anyway to meet demand, in part due to the time and expense required to be trained. created after graduating from medical school. She estimates there are about 750 full-time pathologists nationwide and about 80 job openings. On average, she says, there are about 40 certified forensic pathologists each year.
“There is a huge shortage,” Pinneri said. “People talk about abolishing the investigative system, but it’s really not feasible. I think we need to train investigators. That is what will improve the system.”
Her association has called for coroners and medical examiners to operate independently, not tied to government or other law enforcement agencies. One 2011 survey by the team found that 82% of the forensic pathologists who responded had faced pressure from politicians or relatives of the deceased to change the cause or manner of death reported. reported in one case.
Dr. Bennet Omalu, former head of forensic pathology in California, resigned five years ago than what he described as noise by the San Joaquin County sheriff to protect law enforcement officers.
“California has the most backward system in death investigation, and the most backward in forensic and forensic science.” Omalu testifies before the state Senate Finance and Administration Committee in 2018.
San Joaquin County since then broke up Its investigative duties from the sheriff’s office.
The golden state is one of three states allows the sheriff to also act as a coroner, and all but 10 of California’s 58 counties combine offices. Legislative efforts to separate them have failed at least twice, most recently this year.
AB1608led by member of the State Assembly Mike Gipson (D-Carson), passed that chamber but did not receive enough votes in the Senate.
“We thought we had a modest proposal. That’s the first step,” said Robert Collins, who supports the bill and has a 30-year-old stepchild. Angelo Quintodied after being restrained by Antioch police in December 2020.
The Contra Costa County Coroner’s Office, a division of the sheriff’s department, blamed Quinto’s death on “delirious excitement,” a controversial finding sometimes used to explain deaths in police custody. Detection was rejected by American Medical Association and the World Health Organization.
The lawmakers “don’t want their name behind something that will turn the sheriff against them,” Collins said. “Just having that outcry is enough to scare off many politicians.”
Influential California State Police Chiefs Association and California State Coroners Association oppose the billdescribes the “huge cost” of setting up independent investigative offices.
Many Illinois counties also said they would be financially burdened similar legislation was introduced last year by Congressman Maurice West, a Democrat. His more sweeping bill would replace coroners with medical examiners.
In particular, rural counties complained about their tight budgets and killed his bill before it made it to a committee hearing, he said.
“When things like this affect rural areas, if they step back a little bit, we’ll stop,” West said.
Proponents of a system overhaul in Washington state – where in small, rural counties, local prosecutors act as coroners – face similar roadblocks.
The King County Medical Association, which drafted the two-person divorce law, said the system created a conflict of interest. But small counties worry that they don’t have the money to hire coroners.
So the legislators made a deal with counties to allow them to pool their resources and hire coroners in exchange for ending the dual role of prosecutors. 2025. Bill, HB1326signed last year by Democratic Governor Jay Inslee, also requires more rigorous training for coroners and medical examiners.
“We have some hostile people that we talk to who really feel that we are attacking them, and we are not at all,” Belcher said. “We’re just trying to figure out a system that I think anyone would agree needs an overhaul.”
This story is produced by KHNpublish California Health Linean editorially independent service of California Health Care Foundation.
