Medical examiner

The medical examiner is an appointed official in some American jurisdictions^[1] that investigates deaths that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdictions to initiate inquests. They are necessarily trained in pathology.^[2]^[3]

In the US, there are two death investigation systems: first, the coroner system based on English law; and second, the medical examiner system, which evolved from the coroner system during the latter half of the 19th century. The type of system varies across jurisdictions, with over 2,000 separate jurisdictions for investigating unnatural deaths. In 2002, 22 states had a medical examiner system, 11 states had a coroner system, and 18 states had a mixed system. Since the 1940s, the medical examiner system has gradually replaced the coroner system and serves about 48% of the US population.^[4]^[5] The largest medical examiner's office in the United States is located in Baltimore, Maryland.^[6]

The coroner is not necessarily a medical doctor. They may be a lawyer or a layperson. In the 19th century, the public became dissatisfied with lay coroners and demanded that the coroner be replaced by a physician. In 1918, New York City introduced the office of the Chief Medical Examiner and appointed physicians experienced in the field of pathology. In 1959, the medical subspecialty of forensic pathology was formally certified.^[7]

The types of death reportable to the system are determined by federal, state, or local laws. Commonly, these include violent, suspicious, sudden, and unexpected deaths, death when no physician or practitioner was present or treating the decedent, inmates in public institutions, those in custody of law enforcement, deaths during or immediately following therapeutic or diagnostic procedures or deaths due to neglect.

Duties

A medical examiner's duties vary by location, but typically include:

investigating human organs like the stomach, liver, and brain
determining cause of death
examining the condition of the body^[3]
studying tissue, organs, cells, and bodily fluids^[3]
issuing death certificates
maintaining death records
responding to deaths in mass disasters
working closely with law enforcement^[8]
identifying unknown dead
performing other functions depending on local law.

In some jurisdictions, a coroner performs these and other duties. It is common for a medical examiner to visit crime scenes or to testify in court.^[8] Medical examiners specialize in forensic knowledge and rely on this during their work.^[3] In addition to studying cadavers, they are also trained in toxicology, DNA technology and forensic serology (blood analysis).^[8] Pulling from each area of knowledge, a medical examiner is an expert in determining a cause of death.^[3] This information can help law enforcement solve cases and is crucial to their ability to track criminals in the event of a homicide or other related events.^[3]

Within the United States, there is a mixture of coroner and medical examiner systems, and in some states, dual systems. The requirements to hold office vary widely between jurisdictions.

Qualifications

United Kingdom

In England and Wales, a new statutory Medical Examiner system based in NHS Acute Trusts commenced in 2019 and is expected to be fully operational several years later. A medical examiner is always a medical doctor, whereas a coroner is a judicial officer.^[9]

Pilot studies in Sheffield and seven other areas, which involved medical examiners looking at more than 27,000 deaths since 2008, found 25% of hospital death certificates were inaccurate and 20% of causes of death were wrong. Suzy Lishman, president of the Royal College of Pathologists, said it was crucial there was "independent scrutiny of causes of death".^[10]

United States

Qualifications for medical examiners in the US vary from jurisdiction to jurisdiction. In Wisconsin, for example, some counties do not require individuals to have any special educational or medical training to hold this office.^[11] In most jurisdictions, a medical examiner is required to have a medical degree, although in many there is no requirement for specialized training in pathology. Other jurisdictions have stricter requirements, including additional education in pathology, law, and forensic pathology. Medical examiners are typically appointed officers.^[1]

Education

In the United States, medical examiners require extensive training in order to become experts in their field.^[8] After high school, the additional schooling may take 11–18 years.^[8] They must attend a college or university to earn a bachelor's degree sufficient for admission to medical school.^[3] Biology is usually the most common.^[12] A medical degree (MD or DO) is often required to become a medical examiner.^[13]^[12] To enter medical school, the MCAT (Medical College Admissions Test) is usually required ^[3] after which medical school is another four years with the first two dedicated to academics and the rest of the two used to gain clinical experience.^[12]

To become experts in pathology, specifically, additional training is required after medical school. The first step is to complete pathological forensic training.^[13] This usually consists of anatomic and clinical pathology training which takes anywhere from four to five years to complete.^[3] After this, the physician may complete an anatomic pathology residency or a fellowship.^[12] Before practicing as a medical examiner, the physician must also become board certified through the American Board of Pathology.^[13]^[14]

Career

The general job outlook for medical examiners in the United States is considered to be excellent.^[8] Remuneration varies by location, but it is estimated to average between $105,000 and $500,000.^[8]

Shortage

In the United States, there are fewer than 500 board-certified forensic pathologists, but the National Commission on Forensic Science estimates the country needs 1,100–1,200 to perform the needed number of autopsies. The shortage is attributed to the nature of the work and the higher pay in other medical specialties. It has caused long delays in some states and resulted in fewer investigations and less thorough investigations in some cases.^[15]

References

^ ^a ^b Strengthening Forensic Science in the United States: A Path Forward (PDF). Washington DC: National Academies Press. 2009. pp. 241–253.
^ "Coroner vs. medical examiner". Visible Proofs. Retrieved 12 October 2014.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ "Forensic Medical Examiner Jobs in Forensic Criminal Investigations". www.crimesceneinvestigatoredu.org. 8 October 2013. Retrieved 2018-03-30.
^ Jason Payne-James, ed. (2005), "Death Investigation Systems/United States of America", Encyclopedia of Forensic and Legal Medicine
^ Randy Hanzlick; Debra Combs (1998), "Medical Examiner and Coroner Systems", JAMA, 279 (11): 870–874, doi:10.1001/jama.279.11.870, PMID 9516003
^ Engelhaupt, Erika (2020). Gory details: adventures from the dark side of science. Washington, DC: National Geographic Partners, LLC. ISBN 978-1-4262-2098-2.
^ "Overview of the Medicolegal Death Investigation System in the United States". Medicolegal Death Investigation System: Workshop Summary. Institute of Medicine. 2003.
^ ^a ^b ^c ^d ^e ^f ^g "Forensic Pathologist | explorehealthcareers.org". explorehealthcareers.org. Retrieved 2018-03-30.
^ "National Medical Examiners Report 2022" (PDF).
^ "Medical examiners help expose patient safety risks". Health Service Journal. 12 February 2015. Retrieved 10 March 2015.
^ Coroners and Medical Examiners: A Comparison of Options Offered by Both Systems in Wisconsin Jenifer Keach, Rock (WI) County Coroner, April 6, 2010
^ ^a ^b ^c ^d "How to Become a Medical Examiner in 5 Steps". Retrieved 2018-03-30.
^ ^a ^b ^c "Medical Examiner – Forensic Science Careers". Forensic Science Careers. Retrieved 2018-03-30.
^ "Becoming a Medical Examiner: Salary Info & Job Description". learningpath.org. Retrieved 2018-03-30.
^ "Families suffer due to medical examiner shortage". 7 Dec 2015.