Coroners and Medical Examiners in America

I wrote about coroners in a much earlier post, but many people, including voters, reporters, and crime writers, still confuse coroners with medical examiners. Wherever you live in America, if you die a violent or unexpected death, one of these two will investigate.

At least one-third of Americans live in counties where they choose (elect) their own coroner. Everyone else either lives in a medical examiner system (local, regional, or state) or has an appointed coroner.

In this post, I compare and contrast Coroners with their counterparts, Chief Medical Examiners.

Let’s dive in…

Differences between Coroners and Medical Examiners in America

Coroners*

• Diverse backgrounds, usually not physicians
• Usually elected
• Jurisdiction is within one county
• Low salaries (usually much less than $100,000)

Chief Medical Examiners

• Always physicians, usually board-certified forensic pathologists
• Usually appointed
• Jurisdiction may be a county, a city, a region, or a state
• High salaries (usually greater than $200,000)

Similarities between Coroners and Medical Examiners in America

• Both hold the leadership position in a medicolegal death investigation office
• Both are responsible for determining cause and manner of death for sudden, unexpected, or violent deaths as determined by state law
• Both employ or contract forensic pathologists to perform autopsies
• Both have administrative as well as medical and legal duties
• Both can be called as witnesses in criminal trials

True or False?

Myth #1. Coroners are More Political than Chief Medical Examiners

False, at least in 2024. With the political landscape in flux, I reserve the right to change my mind in a year or two!

Because they’re elected, there’s a perception that American coroners are more political than chief medical examiners. However, almost all chief medical examiners are appointed by political figures. Therefore they are no less and sometimes more vulnerable to political pressures.

Elected coroners may, in fact, have more autonomy than chief medical examiners. As elected officials, they can’t be fired and generally have independent control over their office.

Myth #2. Coroners have less expertise and credibility than Chief Medical Examiners

I rate this as mostly true.

Some, as in this CNN report, advocate for abolishing the coroner system. That’s because the bar to run for coroner is inconsistent and often very low.

Let’s take a look at some examples:

Washington State: In counties with fewer than 40,000 residents, the prosecuting attorney is also the coroner. A 2021 law intended to separate the two functions has met with resistance.

Idaho: Coroners, whether elected or appointed, have to be at least twenty-one years old and attend a “coroner’s school” within a year after taking office. A recent state report exposed serious problems with Idaho’s death investigation system.

Ohio: Elected coroners must be physicians except in Cuyahoga County.

Pennsylvania: Coroners have to be at least eighteen years old and attend one week of training before they are sworn in to office. A 2022 state report identified major issues with Pennsylvania’s death investigation system.

Myth #3. Coroners do Autopsies

False, unless they happen to be pathologists.

Worth noting: in some states (like Pennsylvania) it’s not illegal for a coroner to perform an autopsy.

The fact is that both coroners AND chief medical examiners hire forensic pathologists to do autopsies. Chief medical examiners are highly qualified to perform autopsies and most do, but in large offices (think New York City, Chicago), assistant medical examiners, forensic pathologists by training, carry most of the caseload.

Many forensic pathologists, both chief medical examiners and assistant medical examiners, moonlight doing autopsies for coroners.

Conclusions

A National Academy of Sciences report concluded in 2003 that “a coroner system can approximate the high quality of a medical examiner system, but greater impediments stand in the way.”

Those impediments are significant. They include politics, money, a shortage of forensic pathologists, and voter ignorance and apathy.

The coroner system isn’t going away anytime soon, so states would do well to strengthen eligibility requirements, including medical expertise.

*This post is about coroners in the United States of America. Coroners in other countries often have very different backgrounds and responsibilities.