The public authorities charged with investigating causes of death and assisting with identification of deceased persons are either medical examiners or coroners. Medical examiners are appointed officials, while coroners are usually elected public servants. Medical examiners are always physicians; often they are forensic pathologists, meaning they have received specialized training in determining cause and manner of death. Coroners, on the other hand, are not required in most jurisdictions to be medical doctors. When a death did not obviously result from natural causes, a coroner conducts an inquest or investigation before a jury to determine cause of death. If the coroner is not a physician, the coroner's office appoints a licensed physician to perform the forensic medical procedures required or a coroner's office may employ a team of doctors, pathologists, and forensic pathologists. In this chapter, we use the term medical examiner to refer to all these entities.
Offices of medical examiners range in size from a single individual, who serves part-time, to departments at the city or county level that employ full-time physicians, paraprofessionals, laboratory technicians and deputies who visit crime scenes, interact with law enforcement, collect bodies while preserving evidence, and testify in court. Other specialists who may offer their services include dentists, radiologists, radiology technicians, toxicologists, genetics experts, and anthropologists. In short, many of the same competencies applicable to the care of living patients are also applicable to inquiries into causes of death.
The training of the medical examiner's staff varies by job description. A coroner need not be a physician, but will often have a medical background.A coroner may have a law enforcement background; in California, for example, coroners are also sworn peace officers who have attended a law enforcement academy (Riverside County, 2005). Universities now offer master's degree programs aimed at coroners (Philadelphia College of Osteopathic Medicine, 2005, Kezdi, 2005). They develop a mastery of skills such as interviewing, obtaining medical histories, evidence collection, and report writing.
Forensic pathologists are physicians who have completed medical school and residency training; academic centers have created fellowships in forensic pathology, designed to train pathologists to serve as medical examiners (Office of Chief Medical Examiner State of North Carolina, 2005). Forensic dentists and odontologists understand the structure and diseases of the teeth and gums and can help establish a diagnosis that is either the cause of death, contributory, or coincidental.
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