OVERVIEW OF THE MEDICOLEGAL DEATH INVESTIGATION SYSTEM IN THE UNITED STATES
The medicolegal death investigation system is responsible for conducting death investigations and certifying the cause and manner of unnatural and unexplained deaths. Unnatural and unexplained deaths include homicides, suicides, unintentional injuries, drug-related deaths, and other deaths that are sudden or unexpected. Approximately 20% of the 2.4 million deaths in the US each year are investigated by medical examiners and coroners, accounting for approximately 450,000 medicolegal death investigations annually.
Death investigations carry broad societal importance for criminal justice and public health. Death investigations provide evidence to convict the guilty and protect the innocent, whether they are accused of murder, child maltreatment, neglect, or other crimes. Death investigations aid civil litigation, such as in malpractice, personal injury, or life insurance claims. Death investigations are critical for many aspects of public health practice and research, including surveillance, epidemiology, and prevention programs, most often in injury prevention and control but also in prevention of suicide, violence, or substance abuse. And death investigations are emerging as critically important in evaluating the quality of health care and the nation’s response to bioterrorism.
The term medicolegal death investigation system is something of a misnomer. It is an umbrella term for a patchwork of highly varied state and local systems for investigating deaths. Death investigations are carried out by coroners or medical examiners. Their role is to decide the scope and course of a death investigation.
Qualifications For a Death Investigator – No Consistency
The quality of a death investigation system is difficult to assess, but it can be measured with several indicators. One is accreditation by NAME, the professional organization of physician medical examiners. Only 42 of the nation’s medical examiner offices, serving 23% of the population have been accredited by NAME in recent years. Most of the population (77%) are served by offices lacking accreditation. Another indicator of quality is statutory requirements for training: about 36% of the US population lives where minimal or no special training is required of those responsible for death investigations (Hanzlick, 1996). In Georgia, for example, the typical requirements for serving as a coroner are being a registered voter at least 25 years old, not having any felony convictions, having a high-school diploma or the equivalent, and receiving annual training of 1 week.
Funding levels also vary greatly. County systems range from $0.62 to $5.54 per capita, with a mean of $2.6 per capita. Statewide systems are generally funded at lower levels: $0.32-$3.20 per capita, with a mean of $1.41 per capita. Third-party payers generally do not support the costs of operations, nor are there medical billing systems. Funding is almost exclusively from tax revenues. Because of insufficient funding, salaries of medical examiners are much lower than those of other physicians. Lower salaries lead to difficulty in recruiting and retaining skilled personnel.