Coroners vs. Medical Examiners: What's in a Name?
In the recent edition of N.A.M.E News (Vol. 11, No. 2 -Page 5), my respected colleague, Dr. Dimitri Contostavios, wrote a piece for "In My Humble Opinion". While I was pleased to note that the Allegheny County Coroner's Office was specifically excluded from the reference to "anachronistic coroner systems", I must nevertheless comment on what I consider to be an extremely important point that well- intentioned, genuinely dedicated individuals, who call for the replacement of all elected coroners by appointed medical examiners, either fail to note or unfortunately do not appreciate.
Simply put, there is an oxymoron between points 1 and 2 set forth by Dr. Contostavios, namely, the juxtaposition of the words "appointed" and "autonomous". If you are appointed by someone, then you cannot truly be considered as autonomous. Every medical examiner is chosen and put into office by some elected political official, local or state government agency, or an intermediary commission selected by such political entities, In contrast, a coroner is elected by the voters in his/her community and therefore is not answerable to any government official.
If any of my younger forensic pathologist colleagues believe that this is an unrealistic or exaggerated concern, I suggest they contact two of the most respected and competent forensic pathologists in the United States, Dr. Thomas Noguchi and Dr, Michael Baden. Ask them about autonomy. Somehow, such a professional status failed to protect and immunize them from being forced out of their positions as Chief Medical Examiner of Los Angeles and New York City, respectively, when local politicians became displeased with some of their scientific findings and publicly expressed opinion regarding certain high profile death cases.
As an elected coroner, I conduct open inquests into any matter that I believe may adversely affect the health, welfare, or safety of the residents of our community. This includes every kind of police-related death, from pursuit to incarceration. If we believe that any particular death investigation - hospital, personal care/nursing homes, industrial, motor vehicular, environmental, etc. - requires further public scrutiny, we do not hesitate to subpoena records, conduct a news conference, convene an open inquest, and ultimately arrive at a formal opinion. We often make recommendations to the District Attorney for criminal charges to be filed after previously unknown facts are elicited during testimony given under oath.
I believe that the ultimate responsibilities, purpose and objectives of a modern day medical-legal investigative office cannot be fully achieved unless appropriate and necessary follow-up measures are pursued by that office. Performance autopsies by trained, competent forensic pathologists with the scientifically accurate determination of cause and mechanism of death is not always sufficient. Sometimes, it is only the beginning of a proper and essential inquiry. If the community is to truly benefit from the services of skilled forensic pathologists and other related forensic scientists in the investigation of unnatural, suspicious, and controversial deaths, it is essential that medical-legal investigative offices aggressively attempt to correlate pathologic findings in certain cases to various external factors and situation. If an elected coroner has the knowledge to recognize these kinds of critical cases and the courage to pursue them - no matter whose ox may be gored - then these important goals can be achieved. That is the literal meaning and practical significance of true autonomy. How many medical examiners in the United States have the inherent procedural power to pursue such matters in this fashion? And in highly sensitive and politically controversial matters, how many have the courage to speak out publicly, especially if they are aware that such freely expressed criticism will not be appreciated and calmly received by the political official or governmental agency that appointed him? What is in a name is not the controlling factor in the longstanding and ongoing debate. How the medical-legal investigative office is structured, and how the forensic pathologist executes this duties and ultimate responsibilities for the community he serves, are what count.
Think about it.
Cyril H. Wecht, M.D., J.D.
Coroner, Allegheny County, PA