When a group of physicians convened in Washington state for their annual meeting, one of them revealed a shocking revelation: I can tell you when, how, and where to kill someone, and you’ll get away with it. No issue.
Because the skill and availability of coroners, who assess the cause of death in criminal and inexplicable deaths, varies greatly across Washington, as it does in many other regions of the country, this is the case.
Nancy Belcher, chief executive officer of the King County Medical Society, the group that gathered that day, stated, “A coroner is not required to have ever attended a science lesson in their life.”
She stated that her colleague’s stunning remark propelled her on a four-year journey to reform the state’s antiquated death investigation procedure. “These individuals examine a homicide scene or death and determine whether an autopsy is necessary. They make the ultimate decisions “Belcher added.
The majority of states assign the investigation of violent and unexplained fatalities to cities, counties, and regional authorities. A coroner can be chosen at the age of 18 or a highly trained physician might be appointed as a medical examiner. Some death investigators are employed by elected sheriffs who attempt to avoid controversy or who owe political favors. Others own funeral homes and transport deceased individuals to their private companies.
It is a disorganized and chronically underfunded system, with over 2,000 offices determining the cause of death in about 600,000 instances every year.
According to Justin Feldman, a visiting professor at Harvard University’s FXB Center for Health and Human Rights, conflicts of interest involving coroners can be “very serious.”
Last year, state legislators in Washington enacted a new statute in response to Belcher’s efforts to change the state’s coroner system, while reform efforts in California, Georgia, and Illinois have lately failed.
Oftentimes, determining the cause of death is murky and contentious, especially in police-involved homicides such as the killing of George Floyd in 2020. Floyd’s death was deemed a homicide by the Hennepin County medical examiner in Minnesota, but a heart condition and the presence of fentanyl may have played a role. Floyd’s family hired pathologists who concluded that he died of lack of oxygen when a police officer kneeled on his neck and back.
In a recent California case, the Sacramento County coroner’s office determined that Lori McClintock, the wife of congressman Tom McClintock, died in December 2021 from dehydration and gastroenteritis after swallowing white mulberry leaf, a non-toxic plant. The ruling prompted scientists, physicians, and pathologists to challenge the decision to link the plant to her death. When asked to explain how he discovered the connection, Dr. Jason Tovar, the chief forensic pathologist reporting to the coroner, stated that he used WebMD and Verywell Health to research online literature regarding the plant.
The differing credentials of death investigators are not distinguished by their numerous titles. Coroners may be elected or appointed to their positions, and they may or may not have medical training. In contrast, medical examiners are often physicians who have undergone residencies in forensic pathology.
The National Research Council suggested in 2009 that states replace coroners with medical examiners, describing the current system as “in need of major improvement.”
In 1877, Massachusetts was the first state to statewide replace coroners with medical examiners. According to the Centers for Disease Control and Prevention, as of 2019, 22 states and the District of Columbia had solely medical examiners, 14 states had only coroners, and 14 states had a combination.
The drive to convert the rest of the country’s death investigators from coroners to medical examiners is dwindling, a victim of the political power of coroners in their communities and the greater costs required to compensate for the competence of medical examiners.
The current objective is to improve coroner training and grant them greater autonomy from other government organizations.
Dr. Jeffrey Jentzen, a former medical examiner for the city of Milwaukee and the author of “Death Investigation in America: Coroners, Medical Examiners, and the Pursuit of Medical Certainty,” stated, “When you try to remove them, you come into a political wall.”
“You cannot kill them, therefore you must assist in their training,” he added.
According to Dr. Kathryn Pinneri, president of the National Association of Medical Examiners, there wouldn’t be enough medical examiners to meet demand regardless, due in part to the time and money required for training following medical school. She thinks that there are approximately 750 full-time pathologists and 80 job opportunities in the United States. On average, forty forensic pathologists are qualified each year, she said.
Pinneri remarked, “There is a severe deficiency.” “It is not possible to remove the coroner system, despite popular belief. I believe we should train coroners. This is what will make the system better.”
Her organization has advocated for coroners and medical examiners to operate alone, without ties to other government or law enforcement authorities. The organisation discovered in a 2011 study that 82% of the forensic pathologists who replied had been pressured by politicians or the deceased person’s family to change the reported cause or manner of death in a case.
Former California chief forensic pathologist Dr. Bennet Omalu quit five years ago, citing intervention by the San Joaquin County sheriff in protecting law enforcement officers.
In 2018, Omalu testified before the state Senate Governance and Finance Committee, “California is the most regressive death investigation system, is the most regressive in forensic science and forensic medicine.”
Since then, San Joaquin County has separated the coroner from the sheriff’s office.
California is one of three states that permit sheriffs to also serve as coroners, and all but ten of the state’s 58 counties combine the positions. At least two legislative attempts to separate them have failed, most recently this year. AB 1608, which was championed by state Assembly member Mike Gipson (D-Carson), passed the Assembly but failed to pass the Senate.
“We believed we had a reasonable proposal. That it was the initial step, “Robert Collins, whose stepson Angelo Quinto, 30, died after being restrained by Antioch police in December 2020, campaigned for the bill.
The Contra Costa County coroner’s office, which is part of the sheriff’s department, determined that Quinto’s death was caused by “excited delirium,” a contentious diagnosis that is sometimes used to explain deaths in police custody. The American Medical Association and the World Health Organization have disputed the finding.
Collins stated that legislators “did not want their names attached to something that would turn the sheriffs against them.” The very presence of this opposition is enough to intimidate many politicians.
The influential California State Sheriffs’ Association and the California State Coroners Association opposed the bill, citing the “huge costs” associated with establishing independent coroner offices.
Democratic state representative Maurice West presented identical legislation in Illinois last year. In response, a number of Illinois counties stated that they would bear a financial cost. His expansive bill would have substituted medical examiners for coroners.
He stated that rural counties in particular protested about their constrained budgets and killed his idea before it could be heard by a committee.
West stated, “When something like this impacts rural regions and they push back a little bit, we simply stop.”
In small, rural counties of Washington state, the local prosecutor doubles as the coroner. Proponents of reforming the system met similar obstacles.
The King County Medical Society, which authored the legislation to separate the two, asserted that the current structure presented a conflict of interest. However, minor counties feared they lacked the funds to hire a coroner.
Therefore, lawmakers reached an agreement with the counties to let them to pool their resources and hire pooled contract coroners in exchange for the elimination of prosecutors’ dual roles by 2025. The bill, HB 1326, which was approved by Democratic Governor Jay Inslee last year, also compels coroners and medical examiners to undergo more stringent training.
Belcher stated, “We encountered a few aggressive individuals who genuinely believed we were out to get them, despite the fact that we were not.” “We were merely attempting to determine a system that I believe everyone would agree needed to be updated.”
This article was created by KHN (Kaiser Health News), one of the three major running programs of KFF that delivers in-depth coverage of health topics on a national scale (Kaiser Family Foundation). California Healthline, an editorially independent service of the California Health Care Foundation, is published by KHN.
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