A 2009 report from the National Academy of Sciences revealed the U.S. has fewer than half the forensic pathologists it needs, so even "physicians who flunk their board exams find jobs in the field," the reporters write. Officials in Florida, Michigan, Pennsylvania and Arkansas acknowledge that uncertified doctors who had failed board exams were employed in their states. In counties that operate on a coroner system, "the person tasked with making the official ruling on how people die isn't a doctor at all," the reporters write, noting elected or appointed coroners "may have no qualifications beyond a high-school degree have the final say on whether fatalities are homicides, suicides, accidents or the result of natural or undetermined causes."
In it's 2009 report, the academy "called for the creation of uniform federal standards for death investigation and recommended making certification mandatory for doctors working in the field of forensic pathology," the reporters write. So far those proposals have gained little traction in Washington, D.C. The proposals would also take money, though one estimate places the price of a good medical examiner's office at about $2.50 per person per year. "It's difficult for people to spend money on medical examiner systems," Dr. Victor Weedn, the Maryland assistant medical examiner, said. "They see it often as wasting money on the dead, without realizing that everything that is done in a medical examiner office, or a coroner office, is truly done for the living." (Read more)
The state-by-state breakdown of medical center offices is on ProPublica's Web site here. The report uses data from the 17 statewide medical-examiner systems, two hybrid state and county coroner systems, and the systems in the 50 most populous counties that had county-based systems as of July 1, 2009. While the data may be a little urban focused, we imagine this has to be an issue in rural areas as well. UPDATE, Feb. 24: Officials in rural Solano County, California, "xare reviewing more than two dozen homicide cases in which Dr. Thomas Gill, a forensic pathologist with a 20-year history of errors and misdiagnosed causes of death, performed autopsies," Ryan Gabrielson reports for ProPublica.