Coroner or medical examiner; who should tend the dead?by Cara Hetland, Minnesota Public Radio
When a person dies, the investigation varies from state to state, even from county to county. Many states, like North and South Dakota still have coroners determine the cause of death while other states, like Wisconsin and Minnesota, combine the services of coroners and medical examiners.
Across the country, the process used to investigate a death is changing, and South Dakota may be at just such a point. The state will lose one of its two medical examiners soon, and so far, there's no one to take his place. While the field of forensic pathology may be popular on television, it's not so in real life.
Sioux Falls, S.D. — Television shows like CSI make it seem so high tech and glamorous. Murder cases are solved with microscopic clues, or tests that still seem like science fiction. Brad Randall says it's not quite that exciting.
"It smells bad. The environment is wet and dirty and messy. The hours are often frustrating," he says.
Randall, 57, is medical examiner in Sioux Falls. He'll retire in three years, and that'll leave counties in eastern South Dakota with a problem. Randall is the one who does all the autopsies for the region.
Twenty-eight states still primarily use coroners to determine the cause of death. That's often done without an autopsy by a forensic pathologist.
In South Dakota, there's an elected coroner in each county, except the most populated counties where the law requires a medical examiner.
Most coroners are either funeral home directors or emergency medical technicians. Brad Randall says the system lacks quality and consistency.
Randall wants South Dakota to create a state level office of Medical Examiner, with local death investigators.
"The state medical examiner, in return, would have the responsibility for training that individual to do their job," Randall says. "There would be requirements for so many training hours per year. There would be requirements for a baseline of training to be a death investigator."
Randall says New Mexico has a similar system and so does Hennepin County in Minnesota. Hennepin County Medical Examiner Andy Baker says it's important to have a trained death investigator at every death scene.
"Somebody who understands the combination of the forensic issues, the medical issues, the evidentiary issues," Baker explains. "Somebody who can address things like the rigor mortis of the body, the position of the body, who can then give those clues back to the forensic pathologist in a way that would be meaningful to him or her."
Baker has about a dozen death investigators for Hennepin County.
Randy Hanzlick, a medical examiner in Georgia who teaches forensic pathology, has researched the coroner system.
Hanzlick says death investigation should be a locally controlled issue. But he says there is a need for a more consistently professional approach to the process.
That's a challenge because despite its popularity on television, there aren't many people entering the forensic pathology profession. In the last 50, years only 1,300 people have been licensed as medical examiners.
"A lot of those people who are certified are no longer working or have died, and we're only putting out maybe 30 a year," Hanzlick says. "So there's a short supply of forensic pathologists, really. There's not enough out there. As far as we know there are only about 400 or 500 that are actually practicing full time in the country."
Hanzlick says across the country, there should be 1,000 medical examiners, but only half of that are practicing now. That's why Sioux Falls' medical examiner is so sure there isn't anyone interested in replacing him.
"We are a very obscure part of government, and until there is a perceived need within the public and the politicians respond to it, we will always be an under-funded part of government services," Randall says.
Brad Randall says it's up to South Dakota lawmakers to determine whether the state should change how it investigates deaths. If lawmakers do nothing, Randall says deaths needing an investigation will likely be sent out of state for an autopsy.
- Morning Edition, 01/17/2008, 6:55 a.m.