Forensic Investigation's Head Honcho: The Medical Examiner - dummies

Forensic Investigation’s Head Honcho: The Medical Examiner

By Douglas P. Lyle

Coroners and medical examiners are charged with determining the cause and manner of death, overseeing the analysis of evidence, and presenting their findings in court. They often work with the police to help guide ongoing investigations by supplying them with the results of any forensic tests that have been performed. The responsibilities of these two offices cover every aspect of investigating a death.

The terms coroner and medical examiner (ME) are often used interchangeably, but they are, at least theoretically, quite different (see the following section for details). Regardless of which system is employed, in death investigations many of the duties of the coroner or the ME are similar. Some jurisdictions employ coroners for handling the legalities of death.

Looking at two forensic systems

In the United States, two types of forensic investigative systems exist: the coroner system and the medical examiner system. Fortunately, the trend is toward the latter system, though it is far from perfect.

The coroner is an appointed or elected position that, unfortunately, requires no special medical or forensic skills. The sole criterion seems to be the ability of the person seeking the office to be elected or appointed. The coroner could be the sheriff, a newspaper publisher, a neighborhood café owner, or the local funeral director. They too often possess little or no medical training or experience.

During the past several decades, the politics of the office have evolved so that today many jurisdictions require the coroner to be a licensed physician. He may be an internist, an obstetrician, or a dermatologist but doesn’t necessarily have to be a pathologist and certainly not a forensic pathologist. Thus, the coroner may not actually be qualified to perform many of the duties of the office. This deficiency led to the creation of the medical examiner system.

In theory, a medical examiner (ME) is a physician licensed to practice medicine, and many are trained in pathology and forensic pathology, meaning that ideally they are medical doctors with special training in pathology and experience and training in forensic pathology.

A forensic pathologist is a clinical pathologist who has taken extra forensic training. He usually heads up the crime lab and oversees all aspects of death and criminal injury. The heart of the forensic pathologist’s job is performing forensic autopsies, which are designed to help determine the cause and manner of death.

In an ideal world, every jurisdiction would have a medical examiner who also is a board-certified forensic pathologist, qualified to fulfill all the duties of his office. The world, as you know, is not ideal, and even today in many jurisdictions nonmedically trained coroners and MEs continue serving as local public officials charged with investigating death. This solution is a practical, money-saving one because these areas simply don’t have the population base to justify the presence of a forensic pathologist. Under these circumstances, the coroner/ME has several alternatives for acquiring the needed specialized pathological services.

If the coroner/ME is not a pathologist and not licensed to practice medicine, he must contract with larger regional or state medical examiner’s offices for pathological examinations and laboratory testing or hire a forensic pathologist to serve as an assistant coroner or medical examiner. Under the legal umbrella of the coroner’s or ME’s office, the assistant coroner then performs autopsies, testifies in court, and oversees the crime lab.

Checking out the duties of a coroner or medical examiner

The duties of the coroner and ME are diverse, but many of them relate to the forensic investigation of death, including

  • Determining the cause and manner of death

  • Establishing the identity of any unnamed corpses

  • Estimating the time of death

  • Supervising the collection of evidence from the body

  • Searching for any contributory factors such as disease

  • Correlating wounds with the weapons that may have been used to inflict them

  • Certifying or signing the death certificate

In fulfilling these duties, the coroner or ME uses any and all available information. Reviewing witness statements, visiting crime scenes, reviewing collected evidence and the results of crime lab testing, and, if a pathologist, performing autopsies are part of this endeavor.

In addition, the coroner or ME performs other duties not directly related to death investigations. These include

  • Examining injuries of the living and determining their cause and timing

  • Providing expert testimony in court

  • Overseeing the crime lab (in some areas)

Following the medical examiner in action

When faced with an unexplained death, the ME takes a systematic approach to evaluating the case. This approach is similar to the one taken by physicians who treat the ill. Good physicians take a complete patient history, perform a thorough physical exam, order appropriate laboratory tests, and make an informed diagnosis. Only after this process can treatment begin.

The ME, on the other hand, obviously cannot obtain a direct history from the deceased but nevertheless can obtain information from police reports, medical records, witness statements, and interviews with family members, law enforcement, and other medical personnel. To help gather the needed information, the ME may possess (in some jurisdictions) or receive subpoena power from the court and can therefore legally require someone to provide information or evidence such as a blood sample, fingerprint, or shoe impression.

If no evidence of any potentially lethal trauma is seen, the ME then looks for natural causes of death by reviewing medical records, perhaps discussing the death with the person’s physician or performing an autopsy when necessary. These investigations may lead the ME to conclude that the person died as a result of a natural cause, such as a heart attack, an infection, diabetes, or any number of other diseases.

When no natural cause is present or evident, however, the ME explores other manners of death, looking for less-obvious forms of trauma, poisons or drugs, or other signs of accidental, suicidal, or homicidal death.

After the analysis is complete, the ME files a report in which the essentials of the case are laid out and a conclusion is reached regarding the cause, mechanism, and manner of death.

The manner of death is an opinion expressed by the ME based upon all the circumstances leading to and surrounding the death. The ME’s opinion may or may not be accepted by the courts, law enforcement, attorneys, or the victim’s family. Even if the ME concludes that a death was a homicide, prosecutors may disagree and file no criminal charges. Likewise, surviving family members may sue the coroner’s office for any number of reasons to change the manner of death, particularly in situations in which the manner of death has been ruled a suicide.

The ME’s opinion is not written in stone and can change if new evidence comes to light that suggests a previously ruled natural death may not have been so natural after all.