Decoding Local Government: End-of-Life Duties

By Jo-Ann Johnston

We live in an age when we rely on medical expertise routinely. 

That is partly why many public servants want to reconsider an elected position still existing in 1,200 counties in the United States: the elected coroner. 

The coroner, in the communities where they still work, are the people designated to handle death investigations, both for the good of the family of the deceased and for the interests of justice and possible public health concerns. 

As some counties with this system employ more than one staff coroner, there are likely more than 1,200 elected county coroners. Depending on the area, the coroners may not have to be medical doctors. In fact, many are not MDs. 

Their responsibilities can routinely include visiting the scene. Determining the manner and cause of the death is another duty that can be made more difficult in instances where the body was found by itself or temporarily unattended. Conducting various medical or scientific tests is expected. Also, many situations will require the coroner to find a professionally, legally qualified individual to perform an autopsy. Ultimately, death certificates will have to be issued.

Such duties, including the autopsies, are now handled in other American counties by appointed medical examiners -- typically medical doctors with training in pathology and forensic science. Appointed medical examiners are seen by many in health and legal communities as the ideal choice for the important responsibilities involved.

Medical examiners typically point out their extensive knowledge can be critical in finding clear answers where conditions or outcomes are initially uncertain. For instance, in some cases it is unclear whether a person died by accident or foul play, or whether a communicable disease was involved, or whether a drug overdose can be detected. Cases where a person died in the custody of law enforcement or while incarcerated may benefit from a medical examiner’s involvement.

For all these reasons and more, medical examiners have become more common in bigger, more populous counties, especially ones with tax bases that can afford well-equipped and professionally staffed operations.

Still, you might wonder how we came to maintain these two differing approaches, even now.

Coroners date back to earlier times in American – and British -- history.  They may have been trusted, sensitive individuals in their towns and counties in another era, perhaps even funeral directors – a credential still held by some people in the occupation. Others come from occupations in law enforcement or health. 

But qualifications to run for office vary by state and county and can be thin, such as being 18, a U.S. citizen and proven county resident, and having no criminal record.

In recent years, major news outlets such as the PBS program Frontline and NPR have done stories on these differing standards for death investigators in America.

Advocates for coroners who want to remain in this line of work have pointed out that their elected status gives them a level of accountability and familiarity to the public that is appreciated – sometimes particularly among surviving family members. 

Gradually, things are changing in some counties.

Some areas have chosen to create a sort of combination office, at least for now, that are staffed by individuals from both backgrounds with medical examiners ranking higher than the lay people acting as coroners. And a number of counties have responded by at least raising training requirements for coroners in recent years, especially once they are elected. Another strategy for improvement while containing costs has been for neighboring counties to pool expertise and equipment. 

Taken together, these trends seem to suggest that older systems can remain in operation past their prime, unless voters actively push for modern levels of services.

The origins of the term coroner, and the job, by the way, are said to date back to medieval England. The king appointed a servant to investigate deaths within the kingdom to ensure the sovereign received any “death duties” (taxes or profits) owed to him, which were referred to as “the crown’s pleas.” In other words, it was an accounting and tax-collection assignment, rather than having anything to do with health or public safety.

-End of blog series- 

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