Medical Examiner

In the United States alone there are over 3,100 counties that have more than 2,300 separate death investigation systems. The term medical examiner may refer to: a member of the state medical licensing body (the Board of Medical Examiners), a life insurance medical physical inspector (who may or may not be a physician), a physician in general, a coroner or similar death investigator (usually not a physician), or a forensic pathologist. For the purposes of this discussion, the term medical examiner is used to refer to the governmental physician employee specifically charged with the medicolegal investigation of deaths occurring in the jurisdiction.

The Evolution of a System of Medical Investigation

The societal interest in death investigation is longstanding. In fact, the function of medicolegal death investigator is the oldest judicial office in existence in Anglo-American law. More specifically the office of coroner (a corruption of the original “crowner”) or custos placitorum coronas, the keeper of the pleas of the crown, is first documented in 1194 in the Articles of Eyre. However, the office dates even further to pre-Norman England circa 900. In Ancient China (ca. 475–221 B.C.E.), the government had an office charged with the function of medicolegal death investigation.

Although the original motivations for the creation of a death investigatory body are unknown, the reasons for this interest are many and have evolved with the passage of time. Originally, the function was primarily financial in attempting to maximize death-related revenues to the crown. Over time, the government's monetary interest faded as the information took on greater significance. The office of coroner immigrated to the colonies and continued much as it had in the United Kingdom. Gradually the medical aspect became more important and physicians became involved in the process, eventually giving rise to the medical specialty of forensic pathology and the office of the medical examiner.

Initiatives undertaken within the Northeastern United States were responsible for this gradual advance of the science of death investigation. Maryland was at the early forefront of professionalizing death investigation with the coroner permitted to require physician attendance at inquests as early as 1860. This was followed by an elected physician coroner position created in 1868 and physician medical examiners performing autopsies for the coroner in 1890. Massachusetts replaced coroners with physician medical examiners in 1877. The first medical examiner system, in the purest sense, began in New York City in 1918.

Over time, the need for increased professionalism became more apparent and the modern concept of medical examiner spread. Roughly every 15 to 20 years since 1928, the need for improved medicolegal death investigation is recognized at a national level. One of the most significant such analyses resulted in the creation of a Model Postmortem Examinations Act in 1954 by the Uniform Law Commission. The result was establishment of a plan for improved death investigation by a local implementation in interested communities of a functional plan. There ensued a flurry of activity and creation of many new medical examiner systems across the country up to about 1990, [Page 700]at which time the movement toward improvement stalled at both the state and local levels.

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