CONFLICTS OF INTEREST IN U.S. CORONER SYSTEMS

Zug G. Standing Bear, Ph.D., M.S.F.S.
Forensic Health Science Programs, Beth-El College of Nursing and Health Sciences
University of Colorado, Colorado Springs, CO

U. S. State Summary

States with medical examiner systems only: 22 plus DC (AZ, CT, DE, FL, IA, ME, MD, MA, MI, MS, NH, NJ, NM, NC, OK, OR, RI, TN, UT, VT, VA, WV)

States with coroners: 28

States with statutes prohibiting practicing morticians from being coroner: 1 (WA)

States prohibiting coroner from conducting mortuary business with deaths investigated: 1 (WI)

States with Attorney General Opinions barring morticians from serving as coroner
unless that mortician has the only funeral home in the jurisdiction: 2 (CA, ID)

States with coroner-chief of police: 1 (HI)

States requiring coroners to be physicians: 4 (MN, KS, LA, OH)

States having county attorney/coroner or magistrate/coroner: 2 (NE, AK)

States having sheriff-coroners(in addition to CA): 1 (NV)

States requiring physician as coroner in counties over 8K population: 1 (ND)
(Note: 34 Counties have populations under 8K, 18 coroners in these small counties are MDs)

Other states with little practicing mortician presence: 1 (CO-7 morticians)

Total = 14 states with few or no mortician-coroners

States with unknown numbers of morticians as coroners: 2 (NY-county may set rules;
TX-little data to date on the 857 justices of the peace)

Total = 2 unknown states

States with limited mortician coroners: 1 (MT-where 45% on the 56 counties have sheriff-coroners)

Total = one state with nearly half sheriff-coroners

States permitting mortician coroners with large numbers of morticians serving: 11 (AL, AK, GA, IL, IN, KY, MO, PA, SC*, SD, WY)

* SCs Attorney General has ruled that it is unethical for a practicing mortician to hold office as a coroner.

State/Federal/Territory/Provincial Data

Alabama. Nominal qualifications for coroner, no restrictions on practicing morticians. Most Alabama coroners are practicing morticians. Medical examiner appointed by State Director of Forensic Sciences and now must be board certified forensic pathologist (toxicologists have been medical examiners in the past), ME may appoint qualified deputies.

Alaska. Some qualifications for magistrate-coroners (related college degree), the four magistrate coroners in populated areas are full time, thereby negating a role of a practicing mortician. In rural areas, part time coroners are appointed by judges. Although a part-time coroner may be a mortician, it is considered a conflict of interest to be a practicing mortician and a coroner at the same time. Medical examiner must be an Alaska licensed forensic pathologist or employed by the state or US gov't if licensed in another state.

Alberta. The Chief Medical Examiner is appointed by the Cabinet and must be a board certified pathologist. Medical examiners must be physicians and serve in rural areas, are appointed by the Minister of Justice.

American Samoa. Deaths must be reported by the village chief (pulenuu) to the territorial Attorney General or the Department of Medical Services local representative. there is no specific death investigation official.

Arizona. County medical examiners appointed by county Board of Supervisors. ME must be licensed physician certified in pathology.

Arkansas. Nominal qualifications, no restrictions on practicing morticians. Many, if not most, coroners are morticians. Medical examiner must be licensed physician certified in pathology and board eligible in forensic pathology and is appointed by the state Medical Examiner Board.

Armed Forces of the United states. The Armed Forces Medical Examiner must be a board certified forensic pathologist and nominated by the Director, Armed Forces Institute of Pathology and appointed by the AFIP Board of Governors.

British Columbia. The Chief Coroner is appointed by Order-in-Council by the Premier of the Province, there are no statutory qualifications. Regional coroners are appointed by the Attorney General. Local coroners are appointed by the Order-in-Council.

California. Qualifications vary widely for coroner. Attorney General's opinion prohibits a practicing mortician from being a coroner if there is more than one mortuary service company in the county. Although this remedies the "competition" factor, it does not address the "accidental suicide" (colloquial term commonly used when referring to "arrangements" made between mortician-coroners and relatives of decedents) issue. Any county Board of Supervisors may abolish the office of coroner and appoint a medical examiner, which must be a licensed physician and licensed in forensic pathology.

Colorado. Nominal qualifications, no restrictions on practicing morticians. Few of Colorado's coroners are practicing morticians (seven). Many are MDs, PhDs, dentists, nurses, pharmacists, laboratory technicians, physicians assistants, two mayors, a police chief, a sheriff, and a veterinarian. Colorado is unusual in that many forensic pathologists live there as a matter of choice.

Connecticut. Commission on Medicolegal Investigations appoints state Chief Medical Examiner, which must be a physician with 4 years experience in pathology. CME appoints assistants and deputies subject to Commission approval.

Delaware. Chief Medical Examiner appointed by the secretary of the dept. of Health and social Services w/approval of the governor and must be a Delaware licensed physician certified in pathology. CME may appoint deputies which must be physicians.

District of Columbia. Chief Medical Examiner appointed by the mayor must be physician and board eligible in pathology.

Florida. The 24 district medical examiners are appointed by the governor upon recommendation of the state Medical Examiners Commission (except in "home rule" counties). MEs must be practicing physicians in pathology.

Georgia. Nominal qualifications, no restrictions on practicing morticians except in the six urban counties that use the medical examiner system. Most Georgia coroners are practicing morticians. Of 159 counties (only Texas has more counties in the USA), six employ county medical examiner systems (urban) and 153 employ coroners, of which 69 are practicing morticians and two are retired morticians. The primary occupations of Georgia coroners are:

Practicing mortician 69 Retired (various occupations) 4

EMT 31 Police Officer 3

Nurse (RN and LPN) 5 Retired Mortician 2

Coroner (sole occupation) 5 Hardware Store Owner 2

Medical doctor 4 Other 21

The medical examiner "system" is the most complex in north America, with State, Regional, County, and "Local" medical examiners, which may or may not be physicians.

Guam. The Chief Medical Examiner, who must be a board certified forensic pathologist, is appointed by the Commission on Post-Mortem Examinations. a deputy may be appointed by the CME and must be a physician board eligible in pathology.

Hawaii. Coroners are county chiefs of police, except in Honolulu where the Medical Examiner is ex-officio coroner (appointed by the mayor and must be a board certified pathologist)

Idaho. Nominal qualifications, a coroner may not be a practicing mortician if there is a competing mortuary in the same county. About 1/4th of the state's 44 counties have practicing morticians as coroners (where they are the only funeral home in the county).

Illinois. Nominal qualifications, no restrictions on practicing morticians. The states 102 counties have coroners from a wide variety of backgrounds. Medical examiners, appointed by the County Board, must be forensic pathologists.

Indiana. Minimal qualifications, practicing morticians may hold office and most coroners are morticians.

Iowa. State medical examiner, appointed the Commission on Public Safety, must be a physician. County medical examiners, who also must be physicians, are appointed by the County Board of Supervisors.

Kansas. Coroner must be a physician, effectively eliminating practicing morticians. Coroner is a district office appointed by the county commissioners of the largest county in the district (there are 31 districts and 105 counties).

Kentucky. Nominal qualifications, no restrictions on practicing morticians. Many coroners are practicing morticians. Medical examiners are employed by the State Justice Cabinet and must be board certified forensic pathologists.

Louisiana. Coroner must be a physician "unless none will accept the office." Of the 64 parishes, only five have non-physician coroners, of which two are practicing morticians.

Manitoba. The Chief Medical Examiner, who must be an MD, is appointed by the Order-in-Council.

Minnesota. Extensive qualifications in the successful passing of academic courses generally related to physician education. All newly appointed coroners are MDs or DOs and of the 87 counties, only three are non-MDs (one practicing mortician, one DO, and one paramedic).

Maine. Chief Medical Examiner is appointed by the governor and deputies appointed by the CME. All must be physicians and the CME must be a board certified forensic pathologist.

Maryland. Postmortem Examiners Commission appoints one Chief Medical Examiner and deputies, all of which must be licensed physicians.

Massachusetts. Governor appoints State Chief Medical Examiner, who must be a board certified forensic pathologist. CME appoints district/county medical examiners who shall be "duly qualified persons learned in the science of medicine."

Michigan. County medical examiners appointed by the County Board of Supervisors. ME and deputies must be physicians.

Minnesota. The county elected coroner must have completed "academic courses in pharmacology, surgery, pathology, toxicology, and physiology." Medical examiners are appointed by the county commissions in Hennepin and Ramsey counties and must be MDs.

Mississippi. State medical examiner, who must be a board certified forensic pathologist, is appointed by the Commissioner of Public Safety. County Medical Examiner-Coroners are elected and must by physicians.

Missouri. Nominal qualifications, practicing morticians may be elected coroner. Cities over 700,000 may, with referendum vote, change system (all are ME systems). ME must be a physician.

Montana. Nominal qualifications, practicing morticians may be elected coroner. Of the 56 counties, 45% are sheriff-coroners (and therefore not morticians) and 55% are civilian coroners and may be morticians. State Medical Examiner, who must be physician, is appointed by State Attorney General. Associate Medical Examiners, appointed by State ME, also must be physicians.

Nebraska. County attorney is ex-officio coroner, effectively excluding morticians, and may delegate those duties to a peace officer (i.e., sheriff or deputy sheriff). Coroner's physicians are appointed by the coroner.

Nevada. County sheriff is ex-officio coroner, but county may create office of county coroner. All counties have coroner-sheriff except Clark (Las Vegas) which has a Chief Medical Examiner and Washoe, which has a coroner (a full time administrator who is not a mortician).

New Brunswick. The Chief Coroner, who must be a lawyer, is appointed under the Coroner's Act. All sheriffs and deputy sheriffs are ex-officio coroners, although not all are designated by the Chief coroner to perform coroner duties.

Newfoundland. The Chief Forensic Pathologist and all deputies must be forensic pathologists and are appointed by the Lieutenant Governor in Council. Deaths are investigated by the RCMP and the Newfoundland Constabulary.

New Hampshire. State Chief Medical examiner is appointed by the governor and Council, County Medical Examiners are appointed by county commissioners. State CME must be board certified forensic pathologist, county MEs must be physicians.

New Jersey. State Medical Examiner is appointed by the governor, county MEs appointed by the board of chosen freeholders. . State CME must be board certified forensic pathologist, county MEs must be physicians.

New Mexico. State Medical Investigator appointed by the Board of Medical Investigators (consisting of the Dean of the UNM Medical School, Secretary of Health and Environment, Chairman of the Board of Thanatopractice, and the Chief of the State Police). State MI appoints district MIs. All must be licensed physicians.

New York. Mixed medical examiner and coroner system. Each county can set qualifications and decide whether to use ME or coroner system. One county (Putnam) prohibits practicing morticians from holding office as coroner. Cayuga County's only coroner is a board certified forensic pathologist (elected to the office), where Cattaraugus County's four coroners are all practicing morticians. Twelve counties (Suffolk, Richmond, Queens, Kings, New York, Bronx, Rockland, West Chester, Onondaga, Monroe, Nassau, and Erie) have medical examiner systems headed by forensic pathologists, where eight counties (Tompkins, Chemung, Chenango, Delaware, Schenectady, Rensselaer, Ulster, and Duchess) have medical examiner systems headed by medical doctors who are not forensic pathologists. Three counties (Lewis, Oswego, and Madison) engage the district attorney as coroner, and one county (Broome) has an appointed coroner. The remaining 38 counties have elected coroners where the county may establish qualifications.

North Carolina. State Chief Medical Examiner, who must be a board certified forensic pathologist, is appointed by the Secretary of Environment, Health, and Natural Resources. County MEs, who must be physicians, are appointed by the CME. Acting medical examiners, with no specific qualifications, may be appointed in the absence of an available physician.

North Dakota. Counties over 8,000 population requires physician, under 8,000, nominal qualifications. Out of 53 counties, 34 have populations under 8,000. Of these 34, 18 coroners are MDs, 15 have no specific designation, and one (Eddy County) has two coroners, a sheriff-coroner and a coroner-undertaker.

Northern Mariana Islands. Information unknown.

Northwest Territories. The Chief Coroner is appointed by the Territorial Minister and "must take training courses as they are offered."

Nova Scotia. The Chief Medical Examiner, who must be a "duly qualified medical practitioner," is appointed by the Government in Council. Medical practitioners may be appointed by the CME as deputies.

Ohio. Coroner must be a physician (and is elected), except non-physicians may serve if was serving as a coroner on October 12, 1945. Accordingly, all coroners in Ohio's 88 counties are either MDs or DOs.

Oklahoma. State Chief Medical Examiner, who must be a physician and a board certified forensic pathologist, is appointed by the Board of Medicolegal Investigations. The state CME appoints county MEs, who must by physicians.

Ontario. The Chief Coroner and Deputy Chief Coroner must be physicians and are appointed by the Lieutenant Governor in Council. Over 400 local coroners (also physicians) are distributed throughout the province. The unique inquest policy practiced by Ontario, where over a thousand inquests are conducted each year yielding hundreds of recommendations to government, commerce, and industry concerning the public health and welfare make this medicolegal death investigation system the finest on the world.

Oregon: State Medical Examiner is appointed by the Superintendent of the State Police upon advice of the state medical Examiner Advisory Board. The State ME must be a pathologist. State ME appoints district MEs with approval of the County Board of Commissioners. District MEs must be physicians.

Pennsylvania. In Pennsylvania's 67 counties, two are ME systems and one is an elected forensic pathologist/coroner. Nominal qualifications otherwise in the remaining 64 counties, and practicing morticians may be elected. About 50% are practicing morticians and 10% EMTs or paramedics.

Prince Edward Island. The Chief coroner, who must be a physician, is appointed by the governing body of Prince Edward Island.

Puerto Rico. The Director/Medical Examiner is appointed by the Board of Directors of the Institute of Forensic Sciences, and must be "a qualified forensic scientist."

Quebec. The Coroner en Chef, which is appointed by the Conseil des Ministres, must be either a physician, lawyer, or notary. the present Coroner en Chef is an attorney. Deputy coroners, appointed for 5-year terms, must have the same qualifications as the Coroner en Chef.

Rhode Island. Chief Medical Examiner, appointed by the governor with the advice and consent of the State Medical Commission, must be a pathologist. CME may appoint assistants, who must be physicians.

Saskatchewan. The Chief Coroner is appointed by Minister's Order. There are no specific statutory qualifications for office of the Chief Coroner or deputies. The current Chief Coroner is an MD.

South Carolina. Nominal qualifications for coroner. Medical examiners practice in populated areas. At least half of the coroners are practicing morticians. SC Attorney General has issued a ruling that it is unethical for a practicing mortician to serve as coroner. This ruling has not, however, been enforced.

South Dakota. Nominal qualifications for coroner. In the state's 66 counties, 32 coroners are practicing morticians. The next largest group are EMTs.

Tennessee. State Chief Medical Examiner is appointed by the Commissioner of Health with approval of the governor. County medical examiners are elected by the county legislative body from a slate of no more than two nominations advanced by the physicians in the county. Metropolitan governments appoint MEs through the Chief Executive Officer, subject to confirmation by a majority of the whole membership of the Metropolitan Council. CME and county MEs must be physicians.

Texas. Texas is a complicated state to research in a study of this sort because of its large number of counties (254) and the fact that the officiator of death in all but the 12 largest counties (where there are medical examiner systems) is an elected judicial official known as the Justice of the Peace. Half of Texas' ca. 18,000,000 population lives in the twelve largest counties, the other half in the other 242 counties. Officially, the Justice of the Peace (JP) is a full time occupation because s/he is "on call" 24 hours a day, but in some counties a JP serves for $1.00 per year and others serve for very small salaries (hardly a living wage). This means that these JPs are either "retired" or work at some other occupation. Being a licensed mortician is not a restriction to serving as a JP, and is it known that about six that are practicing morticians do serve as JPs in certain places, but this figure has not been specifically compiled in this very large state which employs some 857 JPs, including three in a county of less than 500 in population.

Utah. State Medical Examiner is appointed by the Executive Director of the Department of Health. SME must be board certified in forensic pathology. SME may appoint "regional pathologists and local representatives" as deputy medical examiners.

Vermont. The State Board of Health may contract with anyone for the position of Chief Medical Examiner, an office for which there are no statutory qualifications. The CME may appoint regional MEs, which must be physicians.

Virgin Islands (U.S.). The Medical Examiner is appointed by the governor and must be a physician.

Virginia. The State Chief Medical Examiner, who must be a forensic pathologist, is appointed by the Commissioner of Health with the approval of the Board of Health. County or city medical examiners (the state has 95 counties and 41 independent cities) are appointed by the State CME, must be physicians. The State CME may also appoint (with approval of the Commissioner), forensic pathologists to serve as Assistant Chief MEs in the central (Richmond) or district (Arlington, Roanoke, Tidewater) district offices.

Washington. In small counties, the coroner is also the prosecuting attorney, effectively eliminating practicing morticians. In larger counties, the coroner is elected and may not be a practicing attorney or the owner or employee of any funeral home or mortuary. In counties with "home rule" charter, the county may choose to have a medical examiner who must be a physician, appointed by the county executive (four of the five such counties have medical examiners, and three of those are forensic pathologists).

West Virginia. Chief Medical Examiner is appointed by the Director of the Division of Health, must be a physician board-eligible in pathology. CME appoints county MEs, who must be physicians.

Wisconsin. Nominal qualification for election as coroner or appointment by the county commission as medical examiner. Medical examiners tend to be the designation in more heavily populated areas, but not all medical examiners are MDs, several are RNs. Wisconsin has the largest number of RNs as coroners in the USA. For Wisconsin's 72 counties, coroners/medical examiners tend to be nurses, EMTs, MDs, and LPNs. There are no morticians, although the law does not prohibit a mortician from running for coroner. However, a state law prohibits a coroner investigating a death from engaging in business with the decedent's family or estate as a result of the death, which essentially precludes a coroner from seeking office in the state. Accordingly, there are no practicing morticians serving as coroners in Wisconsin.

Wyoming. Nominal qualifications for election as coroner. No apparent restrictions on practicing morticians as coroner. Presently, 16 of the 23 Wyoming counties have licensed morticians as coroners. A recent Federal lawsuit in one of the Wyoming counties (NOT a county with a licensed mortician as a coroner, but rather as a deputy coroner) addresses conflict of interest.

Yukon Territory. The Chief Coroner and investigative coroners are appointed by the Commissioner in Executive Council. There are no statutory qualifications for office. The present Chief Coroner is a registered nurse.