Death Investigation in the United States, 1990: A Survey of Statutes, Systems, and Educational Requirements

We conducted a survey to summarize the status of medicolegal death investigation in the United States in terms of system type, language in state statutes, and terms of service and educational requirements for coroners and medical examiners (death investigators). Certain types of deaths are often mentioned in statutes while others are inconsistently investigated in the various states. The majority of the U.S. population is served by death investigation that is organized on a local or district level, but often administered by a nonmedical branch of government. Many more jurisdictions have elected coroners than appointed medical examiners, but the majority of the population is served by a medical examiner. One-fourth of the population is served by death investigators who are not required to have a medical background or training or experience in death investigation. We recommend that all States adopt policies and minimum educational and training requirements for their death investigators that emphasize medical investigation of death, ongoing continuity and experience, and medically oriented administration. We also recommend that each state address in their statutes certain types of deaths that are inconsistently investigated, including fetal deaths, anesthetic and intra-operative deaths, peri-therapeutic or peri-diagnostic deaths, requested cremations, deaths of institutionalized individuals, suspected cases of sudden infant death syndrome, and deaths occurring shortly after arrival or admission to hospitals.