Medical examiners

SIGNIFICANCE: Medical examiners are responsible for leading the investigations of all deaths that are sudden, unexpected, or violent, and they make determinations about the times, manners, and causes of the deaths.

The first government medical examiner was appointed in Boston in the late 1870s. Prior to that time, elected coroners handled death investigations. The coroner system has its roots in England, and dates back a millennium. However, because coroners were traditionally not required to have any medical training, dissatisfaction with the system arose, and medical examiner positions were created to provide an alternative. By the early twenty-first century, about one-half of the residents of the United States were living in jurisdictions with medical examiners. The jurisdictions still employing the coroner system were generally smaller and were predominantly rural areas in which sudden, unexpected, and violent deaths were uncommon. When deaths in those communities require autopsy services, medical examiners from nearby jurisdictions are often utilized.

Functions of Medical Examiners

Upon notification of a person’s death, the medical examiner begins gathering facts relating to the deceased that help in making a determination as to time, manner, and cause of death. The initial call tells the medical examiner where and when the body was found and if there is any evidence of foul play. The body should not be moved until it has either been examined by a medical examiner, or a medical examiner has given permission to move the body.

Because the actual facts surrounding deaths may differ significantly from what they seem to be at first glance, medical examiners gather as much information as they can from different sources before making their determinations. The decedents’ medical records are considered, and their bodies are examined externally.

Time of death is usually not in question. However, when a body is found of a person whose death has not been witnessed, determining the time of death becomes important, regardless of the cause of death. Time of death is established first by looking at the interval between the time when a person was last seen alive and the time when the person’s dead body was found. The larger this interval, the more difficult it is to pinpoint the time of death.

Medical examiners take into account many factors when determining time of death, including the air temperature surrounding a dead body, where a body is found (indoors, outdoors, in water), and if a body has already stiffened in rigor mortis, or if that stage has already passed. If a body is discovered more than a day after death, decomposition may already be apparent, or insects may have begun colonizing it. By analyzing such evidence, the medical examiner can use the physical condition of the body to estimate when death has occurred.

Manner of death is the way in which a person dies: through natural causes, such as disease; through accidents; by suicide; or by homicide. Everyone dies eventually, and many people—especially older people—die of natural causes every day. However, medical examiners should not assume that merely because an individual dies while under a doctor’s care or while in a hospital that the death results from natural causes. Similarly, medical examiners should not assume that merely because a death appears to be from an accident that the cause of death is accidental. Indeed, many apparent automobile accidents that involve only one vehicle are, in fact, suicides. Homicides also often appear to be accidents or suicides.

Medical examiners determine both the immediate and proximal causes of death. The immediate cause is the last event prior to a death, such as an acute myocardial infarction (heart attack), which may happen hours or days before death. The proximal cause is the first event leading up to a death, for example coronary vascular disease, which may have been evident in the decedent several years prior to death.

In homicide investigations, the victims’ bodies are usually the single most important pieces of evidence that are processed. Moreover, the areas immediately surrounding the dead bodies generally contain most of the forensic evidence that is found in homicide cases.

Medical examiners also determine whether decedents have died at the scenes where they are found, or if their deaths have occurred elsewhere and their bodies have been moved. Livor mortis , the settling of blood in bodies after death and the accompanying purplish coloring (which resembles bruising), often indicates whether bodies have been moved.

Medical examiners may conduct autopsies, which include thorough interior physical examinations of the bodies and specialized laboratory tests, or forensic pathologists may do so. Medical examiners may also be called upon to testify in civil and criminal courtrooms regarding the findings from their completed investigation.

Bibliography

Baden, Michael M. Unnatural Death: Confessions of a Medical Examiner. New York: Random, 1989. Print.

Baden, Michael, M., and Marion Roach. Dead Reckoning: The New Science of Catching Killers. New York: Simon, 2001. Print.

Bell, Suzanne. Encyclopedia of Forensic Science. New York: Facts on File, 2004. Print.

Melinek, Judy, and T. J. Mitchell. Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner. New York: Scribner, 2014. Web. 25 May 2016.

Moscufo, Michela. "Medical Examiners Impacted by Relationships with Police, Study Finds." ABC News, 24 Apr. 2024, abcnews.go.com/US/medical-examiners-impacted-relationships-police-study-finds/story?id=85532600. Accessed 8 July 2024.

"The Daunting Task of Strengthening Medical Examiner and Coroner Investigations Across Hundreds of Jurisdictions." National Institute of Justice, 24 Apr. 2024, nij.ojp.gov/topics/articles/daunting-task-strengthening-medical-examiner-and-coroner-investigations-across. Accessed 8 July 2024.

Sachs, Jessica Snyder. Corpse: Nature, Forensics, and the Struggle to Pinpoint Time of Death. New York: Perseus, 2002. Print.