Review of State Coroner and Medical Examiner Laws (PRESENTING AUTHOR CHANGE)

BACKGROUND:   Mortality data are a fundamental source of demographic, geographic, and cause-of-death information, and are one of the few sources of health-related data that are comparable for small geographic areas and available for an extended period in the US. However, death investigations are performed by approximately 2,000 different coroner and medical examiner offices across the country, which may lead to significant variations in the collection and reporting of mortality data. Two CDC programs, National Center for Health Statistics and the Public Health Law Program, assessed state coroner and medical examiner laws to provide an overview of the death investigation system in every state, and to document variations between state systems.

METHODS:   PHLP staff used WestlawNext to systematically collect all statutes and regulations pertaining to medicolegal death investigations. Specific characteristics of laws were analyzed, coded, entered into a database, and organized by state. The results describe the following features of the system: the structure of each state’s system; the qualifications and continuing training requirements for lead medicolegal death investigators; and which deaths must be investigated and/or autopsied. Analysis was performed during February-May 2013 on laws current as of January 31, 2013.

RESULTS:   Fourteen states have coroner systems; 22 states and DC use medical examiners; and 14 states have a combination of coroners and medical examiners. Sixteen state systems and DC are centralized, while the remaining 34 are county- or district-based. At least 27 states allow for election of some lead medicolegal officers. Of states with coroners, 57% require initial and/or continuing training. Twenty states and DC require that only pathologists perform autopsies. Researchers also identified characteristics of deaths that might lead to investigation and/or require autopsy in each state.

CONCLUSIONS:

Death investigation systems across the country perform the same primary role, but laws governing these systems’ structure and activities vary widely. This assessment details each state’s death investigation legal landscape, allowing for informed comparisons across systems. While additional analysis is necessary to determine whether specific elements of death investigation systems impact the collection of mortality data, CDC hopes this assessment will support scientific research in the fields of public health and forensic science, and help states considering changing their death investigation systems.