Current Trends Death Investigation -- United States, 1987

In the United States, medical examiners and coroners (ME/Cs) are responsible for investigating violent, suspicious, or unexpected deaths and deaths that are unattended by a physician. State laws specify the types of death that are investigated, the official(s) responsible for investigations, and the qualifications of the official. Depending on the jurisdiction, approximately 20% of all deaths fall under the purview of ME/Cs.

In 1981, the Office of Maternal and Child Health compiled information on the death investigation systems in the United States (1). To update this information, during fall 1987, CDC surveyed either the state ME's office, the state vital registrar's office, or the state ME/C's association. Current information was obtained for all states except Alaska, Arizona, Colorado, Iowa, Nevada, and Ohio. For these six states, information is from the 1981 report.

There are three basic types of death investigation systems (Table 1, Figure 1):

1. Medical Examiner. Nineteen states and the District of Columbia have a state chief ME who is responsible for investigating deaths for the entire state. The chief ME is usually appointed and must be a licensed physician with training in pathology. Deputy or county MEs, who are supervised by the chief ME, are appointed by either the chief ME or a county board of supervisors or commissioners. In Mississippi, county MEs are elected. Three states have county or district MEs but no state chief ME. Florida has 24 district MEs appointed by the governor. Arizona and Michigan have county MEs appointed by each county's board of supervisors. 2.Coroner. Twelve states have county or district coroners who are responsible for investigating deaths within each county. The coroner is elected, and there are usually no specific statutory requirements for training. 3.Mixed Medical Examiner and Coroner. Thirteen states have county or district death investigation systems, some of which are directed by MEs and some by coroners. In these states, no one person has supervisory responsibility for the state. However, three states--Arkansas, Kentucky, and Montana--have an appointed state chief ME and elected county coroners.

The variations in these systems are illustrated by two states, Alabama and Connecticut. In Alabama, all deaths in the county where the deceased died without being attended by a legally qualified physician must be investigated by the county health officer or coroner (2). The county coroner is elected and is not required by statute to be trained in pathology or forensic science. In contrast, Connecticut has a state chief ME who ust be "a doctor of medicine licensed to practice medicine in Connecticut and (who) shall have had a minimum of four years postgraduate training in pathology and such additional subsequent experience in forensic pathology as the commission (on medicolegal investigations) may determine" (3). The ME is responsible for investigating all deaths in the state that are as follows: Violent, whether apparently homicidal, suicidal, or accidental, including but not limited to deaths due to thermal, chemical, electrical, or radiational injury. Sudden or unexpected, not caused by readily recognizable disease. Under suspicious circumstances. Where the body is to be cremated, buried at sea, or otherwise disposed of so as to be thereafter unavailable for examination. Related to occupational disease or accident. Related to disease that might threaten public health (4). Reported by: Surveillance and Programs Br, Div of Environmental Hazards and Health Effects, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Information collected by ME/Cs can be applied to many public health areas (5-11). For some problems, such as violent and sudden death, for which surveillance and evaluation information is difficult to obtain, ME/C data may be especially useful. For these reasons, CDC is working with ME/Cs and with organizations representing them to encourage collaboration and the exchange of information between ME/Cs and public health officials.

Because many states still have county-based systems, approximately 2000 separate death investigation jurisdictions exist in the United States. The results of this survey demonstrate the variability in the way deaths are investigated in different state and local jurisdictions. As an example, one component of the death investigation, the autopsy, varies by type of system (ME, C, or mixed) (12).

Information gathered in this survey has identified states that have centralized supervision of death investigations and, therefore, greater uniformity in investigation procedures and data. This information should allow each state to compare its system with that of other states and to facilitate the exchange of ideas on improving death investigation systems.

A detailed description of each state's death investigation system (including the method of selection and qualifications of its ME/Cs and the types of deaths that can be investigated under state law) and a directory of county ME/Cs is available as Medical Examiner and Coroner Jurisdictions in the United States from the American Academy of Forensic Sciences, P.O. Box 669, Colorado Springs, CO 80901-0669; telephone (719) 636-1100. The cost is $30. References

1. Health Services Administration. Death investigation: synopsis and analysis of laws (including sudden infant death syndrome (SIDS) legislation) in 56 US jurisdictions (1980). Washington, DC: US Department of Health and Human Services, Public Health Service, 1981. Final report, contract no. HSA-240-80-0027. 2.Alabama Code 22-9-71(1987). 3.Connecticut General Statute 19a-404 (1987). 4.Connecticut General Statute 19a-406 (1987). 5.National Center for Health Statistics. Vital statistics of the United States, 1986. Vol II. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, 1988; DHHS publication no. (PHS)88-1114. 6.Goodman RA, Mercy JA, Rosenberg ML. Drug use and interpersonal violence: barbiturates detected in homicide victims. Am J Epidemiol 1986;124:851-5. 7.Kellermann AL, Reay DT. Protection or peril? An analysis of firearm-related deaths in the home. N Engl J Med 1986;314:1557-60. 8.Emerick SJ, Foster LR, Campbell DT. Risk factors for traumatic infant death in Oregon, 1973 to 1982. Pediatrics 1986;77:518-22. 9.MayoSmith MF, Hirsch PJ, Wodzinski SF, Schiffman FJ. Acute epiglottitis in adults: an eight-year experience in the state of Rhode Island. N Engl J Med 1986;314:1133-9. 10.Smith SM, Middaugh JP. Injuries associated with three-wheeled all-terrain vehicles, Alaska, 1983 and 1984. JAMA 1986;255:2454-8. 11.Kirschner RH, Eckner FAO, Baron RC. The cardiac pathology of sudden, unexplained nocturnal death in Southeast Asian refugees. JAMA 1986;256:2700-5. 12.CDC. Autopsy frequency--United States, 1980-1985. MMWR 1988;37:191-4.

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