The examples and perspective in this article may not represent a worldwide view of the subject.(December 2024) |
The medical examiner is an appointed official in some American jurisdictions [1] that investigates deaths that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdictions to initiate inquests. They are necessarily trained in pathology. [2] [3]
In the US, there are two death investigation systems: first, the coroner system based on English law; and second, the medical examiner system, which evolved from the coroner system during the latter half of the 19th century. The type of system varies across jurisdictions, with over 2,000 separate jurisdictions for investigating unnatural deaths. In 2002, 22 states had a medical examiner system, 11 states had a coroner system, and 18 states had a mixed system. Since the 1940s, the medical examiner system has gradually replaced the coroner system and serves about 48% of the US population. [4] [5] The largest medical examiner's office in the United States is located in Baltimore, Maryland. [6]
The coroner is not necessarily a medical doctor. They may be a lawyer or a layperson. In the 19th century, the public became dissatisfied with lay coroners and demanded that the coroner be replaced by a physician. In 1918, New York City introduced the office of the Chief Medical Examiner and appointed physicians experienced in the field of pathology. In 1959, the medical subspecialty of forensic pathology was formally certified. [7]
The types of death reportable to the system are determined by federal, state, or local laws. Commonly, these include violent, suspicious, sudden, and unexpected deaths, death when no physician or practitioner was present or treating the decedent, inmates in public institutions, those in custody of law enforcement, deaths during or immediately following therapeutic or diagnostic procedures or deaths due to neglect.
A medical examiner's duties vary by location, but typically include:
In some jurisdictions, a coroner performs these and other duties. It is common for a medical examiner to visit crime scenes or to testify in court. [8] Medical examiners specialize in forensic knowledge and rely on this during their work. [3] In addition to studying cadavers, they are also trained in toxicology, DNA technology and forensic serology (blood analysis). [8] Pulling from each area of knowledge, a medical examiner is an expert in determining a cause of death. [3] This information can help law enforcement solve cases and is crucial to their ability to track criminals in the event of a homicide or other related events. [3]
Within the United States, there is a mixture of coroner and medical examiner systems, and in some states, dual systems. The requirements to hold office vary widely between jurisdictions.
In England and Wales, a new statutory Medical Examiner system based in NHS Acute Trusts commenced in 2019 and is expected to be fully operational several years later. A medical examiner is always a medical doctor, whereas a coroner is a judicial officer. [9]
Pilot studies in Sheffield and seven other areas, which involved medical examiners looking at more than 27,000 deaths since 2008, found 25% of hospital death certificates were inaccurate and 20% of causes of death were wrong. Suzy Lishman, president of the Royal College of Pathologists, said it was crucial there was "independent scrutiny of causes of death". [10]
Qualifications for medical examiners in the US vary from jurisdiction to jurisdiction. In Wisconsin, for example, some counties do not require individuals to have any special educational or medical training to hold this office. [11] In most jurisdictions, a medical examiner is required to have a medical degree, although in many there is no requirement for specialized training in pathology. Other jurisdictions have stricter requirements, including additional education in pathology, law, and forensic pathology. Medical examiners are typically appointed officers. [1]
In the United States, medical examiners require extensive training in order to become experts in their field. [8] After high school, the additional schooling may take 11–18 years. [8] They must attend a college or university to earn a bachelor's degree sufficient for admission to medical school. [3] Biology is usually the most common. [12] A medical degree (MD or DO) is often required to become a medical examiner. [13] [12] To enter medical school, the MCAT (Medical College Admissions Test) is usually required [3] after which medical school is another four years with the first two dedicated to academics and the rest of the two used to gain clinical experience. [12]
To become experts in pathology, specifically, additional training is required after medical school. The first step is to complete pathological forensic training. [13] This usually consists of anatomic and clinical pathology training which takes anywhere from four to five years to complete. [3] After this, the physician may complete an anatomic pathology residency or a fellowship. [12] Before practicing as a medical examiner, the physician must also become board certified through the American Board of Pathology. [13] [14]
The general job outlook for medical examiners in the United States is considered to be excellent. [8] Remuneration varies by location, but it is estimated to average between $105,000 and $500,000. [8]
In the United States, there are fewer than 500 board-certified forensic pathologists, but the National Commission on Forensic Science estimates the country needs 1,100–1,200 to perform the needed number of autopsies. The shortage is attributed to the nature of the work and the higher pay in other medical specialties. It has caused long delays in some states and resulted in fewer investigations and less thorough investigations in some cases. [15]
Pathology is the study of disease. The word pathology also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in the context of modern medical treatment, the term is often used in a narrower fashion to refer to processes and tests that fall within the contemporary medical field of "general pathology", an area that includes a number of distinct but inter-related medical specialties that diagnose disease, mostly through analysis of tissue and human cell samples. Idiomatically, "a pathology" may also refer to the predicted or actual progression of particular diseases. The suffix pathy is sometimes used to indicate a state of disease in cases of both physical ailment and psychological conditions. A physician practicing pathology is called a pathologist.
Anatomical pathology (Commonwealth) or anatomic pathology (U.S.) is a medical specialty that is concerned with the diagnosis of disease based on the macroscopic, microscopic, biochemical, immunologic and molecular examination of organs and tissues. Over the 20th century, surgical pathology has evolved tremendously: from historical examination of whole bodies (autopsy) to a more modernized practice, centered on the diagnosis and prognosis of cancer to guide treatment decision-making in oncology. Its modern founder was the Italian scientist Giovanni Battista Morgagni from Forlì.
Forensic pathology is pathology that focuses on determining the cause of death by examining a corpse. A post mortem examination is performed by a medical examiner or forensic pathologist, usually during the investigation of criminal law cases and civil law cases in some jurisdictions. Coroners and medical examiners are also frequently asked to confirm the identity of remains.
A coroner is a government or judicial official who is empowered to conduct or order an inquest into the manner or cause of death. The official may also investigate or confirm the identity of an unknown person who has been found dead within the coroner's jurisdiction.
An autopsy is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death; or the exam may be performed to evaluate any disease or injury that may be present for research or educational purposes. The term necropsy is generally used for non-human animals.
Michael M. Baden is an American physician and board-certified forensic pathologist known for his work investigating high-profile deaths and as the host of HBO's Autopsy. Baden was the chief medical examiner of the City of New York from 1978 to 1979. He was also chairman of the House Select Committee on Assassinations' Forensic Pathology Panel that investigated the assassination of John F. Kennedy.
Neuropathology is the study of disease of nervous system tissue, usually in the form of either small surgical biopsies or whole-body autopsies. Neuropathologists usually work in a department of anatomic pathology, but work closely with the clinical disciplines of neurology, and neurosurgery, which often depend on neuropathology for a diagnosis. Neuropathology also relates to forensic pathology because brain disease or brain injury can be related to cause of death. Neuropathology should not be confused with neuropathy, which refers to disorders of the nerves themselves rather than the tissues. In neuropathology, the branches of the specializations of nervous system as well as the tissues come together into one field of study.
Cyril Harrison Wecht was an American forensic pathologist. He was president of both the American Academy of Forensic Sciences and the American College of Legal Medicine, and headed the board of trustees of the American Board of Legal Medicine. Wecht served as County Commissioner and Allegheny County Coroner and Medical Examiner, serving the Pittsburgh metropolitan area. He was perhaps best known for his criticism of the Warren Commission's findings concerning the assassination of John F. Kennedy.
Medical jurisprudence or legal medicine is the branch of science and medicine involving the study and application of scientific and medical knowledge to legal problems, such as inquests, and in the field of law. As modern medicine is a legal creation, regulated by the state, and medicolegal cases involving death, rape, paternity, etc. require a medical practitioner to produce evidence and appear as an expert witness, these two fields have traditionally been interdependent.
Charles Randal Smith is a former Canadian pathologist known for performing flawed child autopsies that resulted in wrongful convictions.
Cedric Keith Simpson was an English forensic pathologist. He was Professor of Forensic Medicine in the University of London at Guy's Hospital, Lecturer in Forensic Medicine at the University of Oxford and a founding member and President of the Association of Forensic Medicine. Simpson became renowned for his post-mortems on high-profile murder cases, including the 1949 Acid Bath Murders committed by John George Haigh and the murder of gangster George Cornell, who was shot dead by Ronnie Kray in 1966.
An inquest is a judicial inquiry in common law jurisdictions, particularly one held to determine the cause of a person's death. Conducted by a judge, jury, or government official, an inquest may or may not require an autopsy carried out by a coroner or medical examiner. Generally, inquests are conducted only when deaths are sudden or unexplained. An inquest may be called at the behest of a coroner, judge, prosecutor, or, in some jurisdictions, upon a formal request from the public. A coroner's jury may be convened to assist in this type of proceeding. Inquest can also mean such a jury and the result of such an investigation. In general usage, inquest is also used to mean any investigation or inquiry.
The American Board of Medicolegal Death Investigators (ABMDI) is an independent not-for-profit certification board based in Baltimore, MD that works to encourage and enhance professional standards among medicolegal death investigators (individuals involved in establishing the cause of death and the identification of the deceased).
A pathologists' assistant (PA) is a physician extender whose expertise lies in gross examination of surgical specimens as well as performing forensic, medicolegal, and hospital autopsies.
In many legal jurisdictions, the manner of death is a determination, typically made by the coroner, medical examiner, police, or similar officials, and recorded as a vital statistic. Within the United States and the United Kingdom, a distinction is made between the cause of death, which is a specific disease or injury, versus manner of death, which is primarily a legal determination, versus the mechanism of death, which does not explain why the person died or the underlying cause of death and can include cardiac arrest or exsanguination.
The Delaware County Office of the Medical Examiner is the office responsible for the investigation of all unnatural deaths in Delaware County, Pennsylvania and natural deaths where there is no treating doctor or which occur suddenly outside a medical institution.
A coroner in the U.S. state of Washington is a quasi-judicial, public official principally charged with the certification of human death. It is completely identical in authority to the parallel office of medical examiner, which also exists in the state. Washington uses a "mixed system" of death investigation with some counties employing coroners, and some employing medical examiners.
The International Association of Coroners and Medical Examiners (IAC&ME) is a United States-based professional society composed primarily of coroners, with a smaller number of members who are medical examiners.
The American Board of Pathology (ABPath) is one of 24 member boards of the American Board of Medical Specialties. This organization was assembled in May 1936, under the approval of the Advisory Board for Medical Specialties (ABMS) and the American Medical Association (AMA) Council on Medical Education and Hospitals. It is the duty of the ABPath to grant certification in Anatomic Pathology, Clinical Pathology and/or Anatomic/Neuropathology to qualified Doctors of Medicine and Doctors of Osteopathic Medicine (M.D./D.O.).
Janis Carol Amatuzio is an American forensic pathology specialist. She has authored books and has practiced forensic science for 20 years. Amatuzio is known as the "compassionate coroner".