A Perspective on Medicolegal Death Investigation in the United States: 2013

The status of medicolegal death investigation in the United States is reviewed based on the literature, reports, surveys, and vital statistics data. The vast majority of chief medicolegal death investigation system officers are coroners, but the majority of the U.S. population is served by medical examiner systems. Conversion of coroner systems to medical examiner systems has come nearly to a halt. More forensic pathologists are needed to enable autopsy performance at a rate of one per thousand population and comply with the National Association of Medical Examiners (NAME) standards regarding autopsy caseload. Efforts are needed to recruit and retain forensic pathology trainees in the specialty of forensic pathology. More medicolegal death investigators are needed and measures need to be taken to train and certify more of them. Regional medicolegal death investigation and autopsy centers are needed in some parts of the country and some areas of the U.S. lack ready access to forensic pathologists. Only a small portion of medical examiner and coroner offices is accredited by NAME or the International Association of Coroners and Medical Examiners (IAC&ME). Medical examiner/coroner death certification and autopsy rates in the states vary considerably, probably due to variations in statutes, funding, staffing, practice preferences, and practice patterns that have evolved through tradition and custom. Although death investigation in the United States seems to be adequate to meet basic needs in the various states, there is room for further improvement in the scope and quality of service and manpower.