Context.— Medical legal investigations in the United States (primarily unnatural
or suspected unnatural deaths) are carried out by medical examiner or coroner
systems. Medical examiners—usually physicians and generally with training
in pathology, medicolegal death investigation, and performance of forensic
autopsies—generally have greater expertise in unnatural death investigations
than do coroners.
Objective.— To document the locations and implementation year for states and counties
that have medical examiner systems that have replaced coroner systems or that
are defined in statute and assist coroners in their investigations.
Design.— Review of published information and national survey in 1997.
Setting.— United States.
Participants.— County medical examiners and state medical examiners or their administrators.
Main Outcome Measures.— The location of states and counties with medical examiner systems, the
implementation year for each system, and the proportion of counties and population
served by medical examiner systems.
Results.— A total of 79 of 91 county medical examiners responded. A total of 36
states have at least 1 medical examiner system at the county, district, or
state level in which there is no coroner involved in the death investigation
process. Only 22 states have medical examiner death investigation systems
in place and have no coroners in the state. Among 13 states in which some
counties have coroner systems and some have medical examiner systems, medical
examiner systems exist in 8% of counties and serve 43% of the population.
Medical examiner systems that operate without coroner involvement serve about
48% of the population nationwide. Few state or county medical examiner systems
have been implemented since 1990.
Conclusions.— In this century, medical examiner systems have gradually replaced coroner
systems, but such change has slowed in recent years, with medical examiner
systems now serving about 48% of the national population.
Hanzlick R, Combs D. Medical Examiner and Coroner SystemsHistory and Trends. JAMA. 1998;279(11):870–874. doi:10.1001/jama.279.11.870
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