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Kentucky has historically been considered a national model in its death investigations. It was the first state to implement a dual coroner and medical examiner system, something it’s had in place since 1973. That has given the state an important balance of elected leadership and forensic know-how. Coroners are elected county officials responsible for investigating any death that’s deemed unnatural. Once elected, they go through death investigation training with the Kentucky Department of Criminal Justice and are expected to keep up 18 hours of continuing education. They work with state medical examiners to determine the exact cause of death and decide whether an autopsy or toxicology test is needed, which a medical examiner would have to perform.
But it’s a system that has been strained in recent years. Pollard, who also serves as director of the Kentucky Coroner’s Association, made headlines last year for convincing one state medical examiner to stay on after the doctor had announced his resignation, citing a lack of funding and resources to properly do his job. The National Association of Medical Examiners recommends that professionals not perform more than 250 autopsies a year; Kentucky is averaging about 280, according to Pollard. “We need two more doctors. That would ease our caseload tremendously,” he says. In Henry County, Pollard used to investigate around 26 cases in his county per year in the 1990s. In recent years, that number has risen to around 66.
These issues aren’t singular to Kentucky. Coroners, medical examiners, forensic pathologists -- and people who wear more than one of those hats -- say their profession is more vital than ever before, particularly in the midst of the opioid epidemic. But low pay, long hours and heavy debt loads carried by young physicians make it hard to recruit and retain talented people.
America’s system for investigating deaths is a patchwork quilt of different laws, procedures and job descriptions. From state to state -- and even from one county to the next -- there can be variations in how sudden deaths are handled. “Unlike primary care or obstetrics, it’s the one specialty in medicine that’s practiced differently depending on where you live,” says Gregory Davis, former associate chief medical examiner for Kentucky.
Confusing matters even more, qualifications for each title also vary depending on state statute. Coroners are overwhelmingly an elected or politically appointed position, a tradition that dates back centuries to when they were simply tax collectors for the deceased; America’s first coroner took office in 1636 in Plymouth County, Mass. Some states require a coroner to be a physician; other states only stipulate that you must be 18 and have no felony convictions.
- Wikipedia: Coroner.
- Wikipedia: Coroner.
