Medical examiner

A medical examiner is an official trained in pathology that investigates deaths that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdictions to initiate inquests.[1][2]

In the US, there are two death investigation systems, the coroner system based on English law, and the medical examiner system, which evolved from the coroner system during the latter half of the 19th century. The type of system varies from municipality to municipality and from state to state, with over 2000 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.[3][4]

The coroner is not necessarily a medical doctor, but a lawyer, or even 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.[5]

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 treated recently, inmates in public institutions, in custody of law enforcement, during or immediately following therapeutic or diagnostic procedures, or deaths due to neglect.

MedicalExaminerVan
Medical examiner van

Job roles

A medical examiner's duties may vary depending on location. The medical examiners’ job is usually extensive and has a lot that goes into it. Typically, a medical examiner's duties may include:

  • investigating human organs like the stomach, liver, brain,
  • determining cause of death,
  • examining the condition of the body[2]
  • studying tissue, organs, cells, and bodily fluids[2]
  • issuing death certificates,
  • maintaining death records,
  • responding to deaths in mass disasters,
  • working closely with law enforcement[6]
  • identifying unknown dead, or
  • performing other functions depending on local law.

In some jurisdictions, a coroner performs these and other duties. It’s not uncommon for a medical examiner to visit crime scenes or to testify in court.[6] This takes a certain amount of confidence in which the medical examiner has to rely on their expertise to make a true testimony and accurately testify the facts of their findings.[6] Medical examiners specialize in forensic knowledge and rely on this during their work.[2] In addition to studying cadavers, they are also trained in toxicology, DNA technology and forensic serology (blood analysis).[6] Pulling from each area of knowledge, a medical examiner can accurately determine a cause of death.[2] This information can help law enforcement crack a case and is crucial to their ability to track criminals in the event of a homicide or other related events.[2]

Within the United States, there is a mixture of coroner and medical examiner systems, and in some states, dual systems. The requirements to hold office vary widely between jurisdictions.

Qualifications

United Kingdom

In the UK, formal medical training is required for medical examiners. Many employers also request training in pathology while others do not. In the UK, a medical examiner is always a medically trained professional, whereas a coroner is a judicial officer.

Pilot studies in Sheffield and seven other areas, which involved medical examiners looking at more than 27,000 deaths since 2008, found 25% of hospital death certificates were inaccurate and 20% of causes of death were wrong. Suzy Lishman, president of the Royal College of Pathologists, said it was crucial there was "independent scrutiny of causes of death".[7]

United States

Qualifications for medical examiners in the US vary from jurisdiction to jurisdiction. In Wisconsin, for example, some counties do not require individuals to have any special educational or medical training to hold this office.[8] In most jurisdictions, a medical examiner is required to have a medical degree, although in many this need not be in pathology. Other jurisdictions have stricter requirements, including additional education in pathology, law, and forensic pathology. Medical examiners are typically appointed officers.[9]

Education

In the United States, Medical Examiners require extensive training in order to become experts in their field.[6] After high school, the additional schooling may take 11–18 years.[6] They must attend a college or university to receive a bachelor’s degree in the sciences.[2] Biology is usually the most common.[10] A medical degree (MD) is often required to become a medical examiner.[11][10] To enter medical school, the MCAT (Medical College Admissions Test) may be required [2] after which Medical school is another four years with the first two dedicated to academics and the rest of the two used to gain clinical experience.[10]

Additional training is required after medical school. The first step is to complete pathological forensic training.[11] This usually consists of anatomic and clinical pathology training which takes anywhere from four to five years to complete.[2] After this, an anatomic pathology residency and/or a fellowship in forensic pathology should be completed.[10] Before practicing, they must also become certified through the American Board of Pathology.[11][12]

Career

The general job outlook for medical examiners in the United States is considered to be excellent.[6] Remuneration varies by location, but it is estimated to average between $105,000 and $500,000.[6]

See also

References

  1. ^ "Coroner vs. medical examiner". Visible Proofs. Retrieved 12 October 2014.
  2. ^ a b c d e f g h i "Forensic Medical Examiner Jobs in Forensic Criminal Investigations". www.crimesceneinvestigatoredu.org. Retrieved 2018-03-30.
  3. ^ Jason Payne-James, ed. (2005), "DEATH INVESTIGATION SYSTEMS/United States of America", Encyclopedia of Forensic and Legal Medicine
  4. ^ Randy Hanzlick; Debra Combs (1998), "Medical Examiner and Coroner Systems", JAMA, 279 (11), doi:10.1001/jama.279.11.870
  5. ^ Medicolegal Death Investigation System: Workshop Summary. Institute of Medicine. 2003.
  6. ^ a b c d e f g h "Forensic Pathologist | explorehealthcareers.org". explorehealthcareers.org. Retrieved 2018-03-30.
  7. ^ "Medical examiners help expose patient safety risks". Health Service Journal. 12 February 2015. Retrieved 10 March 2015.
  8. ^ Coroners and Medical Examiners: A Comparison of Options Offered by Both Systems in Wisconsin Jenifer Keach, Rock (WI) County Coroner, April 6, 2010
  9. ^ National Academy of Sciences, Strengthening Forensic Science in the United States: A Path Forward, (2009), pp 241–253.
  10. ^ a b c d "How to Become a Medical Examiner in 5 Steps". Retrieved 2018-03-30.
  11. ^ a b c "Medical Examiner - Forensic Science Careers". Forensic Science Careers. Retrieved 2018-03-30.
  12. ^ "Becoming a Medical Examiner: Salary Info & Job Description". learningpath.org. Retrieved 2018-03-30.

Further reading

1st to Die

1st to Die is a 2001 crime novel by James Patterson that is the first book in the Women's Murder Club series. The series is about four friends who pool their skills together to crack San Francisco's toughest murder cases. The women each have different jobs: Lindsay Boxer, a homicide inspector for the San Francisco Police Department, Claire Washburn, a medical examiner, Jill Bernhardt, an assistant D.A., and Cindy Thomas, a reporter who just started working the crime desk of the San Francisco Chronicle.

Allegheny County District Attorney

The Allegheny County District Attorney is the elected district attorney for Pittsburgh and Allegheny County, Pennsylvania. The office is responsible for the prosecution of violations of Pennsylvania commonwealth laws. (Federal law violations are prosecuted by the U.S. Attorney for the Western District of Pennsylvania). The current District Attorney is Stephen Zappala.

In 1995 the Assistant District Attorneys formed a collective bargaining unit and voted to be represented by the United Steelworkers of America. The bargaining unit also represents Assistant Public Defenders, Scientists in the Coroner's Office (now the Office of Medical Examiner) and computer professionals in the Prothonotary's Office (now the Department of Court Records.)

Allegheny County Medical Examiner

The Office of Allegheny County Medical Examiner investigates cases of persons who die within Allegheny County, Pennsylvania from criminal violence by casualty or by suicide, when unattended by a physician; under correctional custody or any other suspicious or unusual manner. The office's jurisdiction includes the city of Pittsburgh and its immediate suburbs.

Prior to 2005 the "Coroner" was an elected position within the county, however on December 29, 2005 the position was abolished and retitled "Medical Examiner" with all future office holders being appointees of the Allegheny County Executive once approved by county council. Longtime coroner Wecht continued to serve as both the last coroner and first medical examiner.The Medical Examiner's Office also houses the Forensic Laboratory Division for the county. The disciplines within the laboratory are Drug Chemistry, Environmental Health, Firearms/Toolmarks, Forensic Biology, Latent Prints, Mobile Crime Unit, Toxicology, and Trace Evidence.

The office made headlines in the 1930s in its investigations into some of the Mad Butcher Killings. In the 1950s the office (headed by William McClelland) was a leader in attempting to raise the driving age from 16 to 18. The 1970s had the office gaining national prominence as Dr. Wecht led several investigations into the Kennedy Assassination.

Aviation medical examiner

In Europe, the United States, and other countries, an aviation medical examiner or aero-medical examiner (AME) is a physician designated by the local aviation authority and given the authority to perform flight physical examinations and issue aviation medical certificates. AMEs are practitioners of aviation medicine, although most are also qualified in other medical specialties.

The International Civil Aviation Organization have established basic medical rules for determining whether a pilot is fit to act in that capacity, and they are codified in Annex 1 to the Convention on International Civil Aviation. However, most countries' aviation authorities have developed their own specific details and clarifications to be used in addition to – frequently more stringently than – the high-level standards prescribed by ICAO.The military equivalent of the AME is the flight surgeon.

Aviation medicine

Aviation medicine, also called flight medicine or aerospace medicine, is a preventive or occupational medicine in which the patients/subjects are pilots, aircrews, or astronauts. The specialty strives to treat or prevent conditions to which aircrews are particularly susceptible, applies medical knowledge to the human factors in aviation and is thus a critical component of aviation safety. A military practitioner of aviation medicine may be called a flight surgeon and a civilian practitioner is an aviation medical examiner. One of the biggest differences between the military and civilian flight doctors is the military flight surgeon's requirement to log flight hours.

Charles Norris (medical examiner)

Charles Norris (December 4, 1867 - September 11, 1935) was New York's first appointed chief medical examiner (1918–1935) and pioneer of forensic toxicology in America.

Coroner

A coroner is a government official who is empowered to conduct or order an inquest into the manner or cause of death, and to investigate or confirm the identity of an unknown person who has been found dead within the coroner's jurisdiction.

In medieval times, English coroners were Crown officials who held financial powers and conducted some judicial investigations in order to counterbalance the power of sheriffs.

The word coroner derives from the same source as the word crown, and it is believed to denote an officer of the Crown.

Crossing Jordan

Crossing Jordan is an American television crime drama series created by Tim Kring that aired on NBC from September 24, 2001, to May 16, 2007. It stars Jill Hennessy as Dr. Jordan Cavanaugh, a crime-solving forensic pathologist employed in the Massachusetts Office of the Chief Medical Examiner. In addition to Jordan, the show followed an ensemble cast composed of Jordan's co-workers and police detectives assigned to the various cases.

After six seasons and 117 episodes, the series was canceled by NBC on May 14, 2007 and concluded on May 16, 2007.

David McCallum

David Keith McCallum, Jr. (born 19 September 1933) is a British-American actor and musician. He first gained recognition in the 1960s for playing secret agent Illya Kuryakin in the television series The Man from U.N.C.L.E..

In recent years, McCallum has gained renewed international recognition and popularity for his role as NCIS medical examiner Dr. Donald "Ducky" Mallard in the American television series NCIS.

Death of Eric Garner

On July 17, 2014, Eric Garner died in Staten Island, New York City, after Daniel Pantaleo, a New York City Police Department (NYPD) officer, put him in a headlock or chokehold for 15 seconds while arresting him. The filming of the incident brought police brutality into wider public awareness.NYPD officers approached Garner on suspicion of selling single cigarettes from packs without tax stamps. After Garner told the police that he was tired of being harassed and that he was not selling cigarettes, the officers went to arrest Garner. When officer Daniel Pantaleo tried to take Garner's wrist behind his back, Garner pulled his arms away. Pantaleo then put his arm around Garner's neck and took him down onto the ground. After Pantaleo removed his arm from Garner's neck, he pushed the side of Garner's face into the ground while four officers moved to restrain Garner, who repeated "I can't breathe" eleven times while lying facedown on the sidewalk. After Garner lost consciousness, officers turned him onto his side to ease his breathing. Garner remained lying on the sidewalk for seven minutes while the officers waited for an ambulance to arrive. The officers and emergency medical technicians did not perform cardiopulmonary resuscitation (CPR) on Garner at the scene; according to a spokesman for the PBA, this was because they believed that Garner was breathing and that it would be improper to perform CPR on someone who was still breathing. He was pronounced dead at the hospital approximately one hour later.

NYPD policy prohibits the use of chokeholds, and Pantaleo denied choking Garner. According to Pantaleo's lawyer, a subsequent internal report from NYPD Chief Surgeon Eli Kleinman, completed at the request of NYPD Internal Affairs Bureau, found that Pantaleo did not put Garner into a chokehold, and that Garner's pre-existing health conditions contributed to his death. However, New York City Medical Examiner Dr. Floriana Persechino disagreed, stating Garner died of an asthma attack brought on by a chokehold and a lethal series of events. This conclusion was confirmed by an independent autopsy which found hemorrhaging around Garner's neck. The NYPD internal affairs inquiry also determined that Pantaleo used a chokehold and recommended disciplinary charges, although no charges were ever filed by the department.The medical examiner ruled Garner's death a homicide. According to the medical examiner's definition, a homicide is a death caused by the intentional actions of another person or persons, which is not necessarily an intentional death or a criminal death. On December 3, 2014, the Richmond County grand jury decided not to indict Pantaleo. On that day, the United States Department of Justice announced it would conduct an independent investigation. The event stirred public protests and rallies, with charges of police brutality made by protesters. By December 28, 2014, at least 50 demonstrations had been held nationwide specifically for Garner while hundreds of demonstrations against general police brutality counted Garner as a focal point. On July 13, 2015, an out-of-court settlement was announced in which the City of New York would pay the Garner family $5.9 million.

Death of Lisa McPherson

Lisa McPherson (February 10, 1959 – December 5, 1995) was an American member of the Church of Scientology who died of a pulmonary embolism while under the care of the Church of Scientology Flag Service Organization, Inc. Following the report of the state of Florida's medical examiner that indicated that Lisa was a victim of negligent homicide, the Church of Scientology was indicted on two felony charges, "abuse and/or neglect of a disabled adult" and "practicing medicine without a license." The charges against the Church of Scientology were dropped after the state's medical examiner changed the cause of death from "undetermined" to an "accident" on June 13, 2000. A civil suit brought by her family against the Church was settled on May 28, 2004.

Diving medicine

Diving medicine, also called undersea and hyperbaric medicine (UHB), is the diagnosis, treatment and prevention of conditions caused by humans entering the undersea environment. It includes the effects on the body of pressure on gases, the diagnosis and treatment of conditions caused by marine hazards and how relationships of a diver's fitness to dive affect a diver's safety.

Hyperbaric medicine is a corollary field associated with diving, since recompression in a hyperbaric chamber is used as a treatment for two of the most significant diving-related illnesses, decompression sickness and arterial gas embolism.

Diving medicine deals with medical research on issues of diving, the prevention of diving disorders, treatment of diving accidents and diving fitness. The field includes the effect of breathing gases and their contaminants under high pressure on the human body and the relationship between the state of physical and psychological health of the diver and safety.

In diving accidents it is common for multiple disorders to occur together and interact with each other, both causatively and as complications.

Diving medicine is a branch of occupational medicine and sports medicine, and an important part of diver education.

Forensic pathology

Forensic pathology is pathology that focuses on determining the cause of death by examining a corpse. A post mortem is performed by a medical examiner, usually during the investigation of criminal law cases and civil law cases in some jurisdictions. Coroners and medical examiners are also frequently asked to confirm the identity of a corpse. Also see forensic medicine.

Jan Garavaglia

Jan Carla Garavaglia (born September 14, 1956), better known as "Dr. G", served as the Chief Medical Examiner for Orange and Osceola counties in Orlando, Florida from 2004 until her retirement in May 2015. She starred in the hit series Dr. G: Medical Examiner on the Discovery Health Channel which first aired in July 2004 and ran until 2012. Repeats of the show are aired on the Discovery Life Channel and Justice Network. The show is ranked No. 1 for Discovery Health and is also broadcast in Australia, Europe, South America and South Africa. Garavaglia has appeared on The Oprah Winfrey Show, Larry King Live, The Rachael Ray Show, The Doctors and The Dr. Oz Show.

Los Angeles County Department of Medical Examiner-Coroner

The Los Angeles County Department of Medical Examiner-Coroner (formerly the Department of Coroner) was created in its present form in Boyle Heights on December 7, 1990 by an ordinance approved by the Los Angeles County Board of Supervisors, although it has existed in some form since the late 19th century. On September 3, 2013, the Los Angeles County Board of Supervisors approved the name change for the department, from the Department of the Coroner to the Department of Medical Examiner-Coroner.On July 9, 2013, the Board of Supervisors approved the appointment of Mark A. Fajardo, the Chief Forensic Pathologist at Riverside County, as the new Medical Examiner-Coroner, at an annual salary of $275,000. He formally replaced Lakshmanan Sathyavagiswaran, who served 21 years as the Coroner, in August 2013.Dr. Mark Fajardo resigned in March 2016. A news report indicates that "he left because it became common to have up to 50 bodies waiting to be processed and the backlog of bodies was 'nuts'. ... and toxicology tests were taking six months to complete" due to inadequate staffing.Lakshmanan Sathyavagiswaran was re-appointed, but as interim coroner, on April 11, 2016. As of December 30, 2016, the position of Chief Medical Examiner-Coroner had not been permanently filled. A search process had been initiated by the county, with Ralph Andersen & Associates working "to develop a customized recruitment brochure for this position".Dr. Jonathan R. Lucas was appointed as the Chief Medical Examiner-Coroner on July 10, 2017.

Office of Chief Medical Examiner of the City of New York

The Office of Chief Medical Examiner of the City of New York (OCME) is a department within the city government that investigates cases of persons who die within New York City from criminal violence; by casualty or by suicide; suddenly, when in apparent good health; when unattended by a physician; in a correctional facility; or in any suspicious or unusual manner. The OCME also investigates when an application is made pursuant to law for a permit to cremate the body of a deceased person.

Oklahoma Office of the Chief Medical Examiner

The Office of the Chief Medical Examiner (OCME) is the agency of the government of Oklahoma (USA) responsible for investigating sudden, unexpected, violent or suspicious deaths. In this capacity, OCME provides support services to State law enforcement agencies, prosecutors, and public health officials.

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