Medical examiner

The medical examiner is an appointed official in some American jurisdictions^[1] that investigates deaths that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdictions to initiate inquests. They are necessarily trained in pathology.^[2][3]

In the US, there are two death investigation systems: first, the coroner system based on English law; and second, the medical examiner system, which evolved from the coroner system during the latter half of the 19th century. The type of system varies across jurisdictions, with over 2,000 separate jurisdictions for investigating unnatural deaths. In 2002, 22 states had a medical examiner system, 11 states had a coroner system, and 18 states had a mixed system. Since the 1940s, the medical examiner system has gradually replaced the coroner system and serves about 48% of the US population.^[4][5]

The coroner is not necessarily a medical doctor. They may be a lawyer or a layperson. In the 19th century, the public became dissatisfied with lay coroners and demanded that the coroner be replaced by a physician. In 1918, New York City introduced the office of the Chief Medical Examiner and appointed physicians experienced in the field of pathology. In 1959, the medical subspecialty of forensic pathology was formally certified.^[6]

The types of death reportable to the system are determined by federal, state, or local laws. Commonly, these include violent, suspicious, sudden, and unexpected deaths, death when no physician or practitioner was present or treating the decedent, inmates in public institutions, those in custody of law enforcement, deaths during or immediately following therapeutic or diagnostic procedures or deaths due to neglect.