Who probes suspicious deaths? It may not be who you think

(Photo by Mathew Schwartz, Unsplash)

A chronically underfunded system riddled with egregious conflicts of interest. That's one way to describe the state-by-state system that governs U.S. coroners, reports Samantha Young of Kaiser Health News. The meshwork is so sticky, one physician shared this observation with Young: "If you ever want to know when, how — and where — to kill someone, I can tell you, and you’ll get away with it. No problem."

Nancy Belcher, chief executive officer of the King County Medical Society in Seattle, told Young that in Washington, "A coroner doesn’t have to ever have taken a science class in their life. These are the people that go in, look at a homicide scene or death, and say whether there needs to be an autopsy. They’re the ultimate decision-maker."

How suspicious death is investigated varies from state to state, and even within states. "The job can be held by an elected coroner as young as 18 or a highly trained physician appointed as medical examiner," Young reports. "Some death investigators work for elected sheriffs who try to avoid controversy or owe political favors. Others own funeral homes and direct bodies to their private businesses. . . . It’s a disjointed and chronically underfunded system — with more than 2,000 offices across the country that determine the cause of death in about 600,000 cases a year."

The cost to hire medical examiners or properly train coroners is disproportionately difficult for rural areas, Young reports: "Many Illinois counties also said they would shoulder a financial burden under legislation introduced last year by state Rep. Maurice West, a Democrat. His more sweeping bill would have replaced coroners with medical examiners. Rural counties, in particular, complained about their tight budgets and killed his bill before it got a committee hearing. West told Young, “When something like this affects rural areas, if they push back a little bit, we just stop."

Dr. Jeffrey Jentzen, a former medical examiner for Milwaukee, told Young, “When you try to remove them, you run into a political wall. You can't kill them, so you have to help train them." Young notes that a 2011 study by the National Association for Medical Examiners "found that 82% of the forensic pathologists who responded had faced pressure from politicians or the deceased person’s relatives to change the reported cause or manner of death in a case."

Lawmakers have made some progress by allowing counties to "pool their resources and hire shared contract coroners in exchange for ending the dual role for prosecutors by 2025," Young writes. Belcher told Young, “We were just trying to figure out a system that I think anybody would agree needed to be overhauled."