Coroner, Medical Examiner, or Something Else?

I frequently see questions similar to “Does the Medical Examiner pick up the body from the crime scene and then do the autopsy?” or “Does the coroner always do an autopsy?” I’m going to try to give you some general information here. If you’re writing about a real location, contact your ME or Coroner to get specific answers.

What’s the difference between a coroner and a medical examiner?
In general, a medical examiner is a person with a medical degree. They may or may not be a pathologist. This person is hired.
A coroner is typically elected and usually doesn’t need a medical degree. In fact, they may not have any medical background at all. In some California counties, the coroner is also the sheriff.
In Utah, the state Office of Medical Examiner performs all autopsies. They report to the Utah Department of Health. In New York, each county has an office of coroner or medical examiner that reports to the county health department.

What is a Chief Medical Examiner?
This person is a manager. They almost never go out to a crime scene and may not do many autopsies. Their job is to make sure they are properly staffed and all applicable laws and guidelines are followed.

When is an autopsy performed?
An autopsy is performed when the death is suspicious or not natural. That means the ninety-three year old great-grandma who has a heart condition and dies in bed during her sleep is unlikely to be autopsied. But if there is evidence that she was smothered, then an autopsy is likely.

What is the purpose of an autopsy?
An autopsy is done to determine two things: manner of death and cause of death. Manner of death can be one of five things: suicide, accident, homicide, natural causes, or undetermined. Cause of death could be anything from cancer, to gunshot wound, to stabbing, to fell off a ladder.

Is time of death important?
Crime shows on TV will lead you to believe time of death is exact. It’s not. At best, you’ll get a window of a few hours. The ME would say, “Time of death was between 11:00 AM and 3:00PM.”
But many factors can affect that. A body stored in a freezer or in a warm swamp could make it difficult if not impossible to get a time or even a date of death. On occasion, you may lucky. “It was 5:00 because we were just getting off work when John fell down the elevator shaft.” If TOD can be determined, it is important, especially in a homicide.

So, who picks up the body?
If you watch NCIS, you might think that every investigation team has their own ME and forensics expert who knows everything. It doesn’t work like that. Ever.
In many places, there is a person called a Death Scene Investigator. Their job is to go to the place the death occurred, take pictures, gather evidence, and take the body to the morgue. That evidence gathering is important and in most states they do NOT need a warrant. This is because they are not investigating a crime. They are investigating a death. Remember this person is not law enforcement. They can…and should…collect all the medicines and anything related to the death. That could be clothes, sheets, etc.
The police could be there but the body should NOT be touched or moved until this person is done. (But it may have been. Perhaps the person was alive and Paramedics tried to save them but failed or they were transported to a hospital and died enroute.) A detective may request the ME (I’m using this term loosely) make they check under the fingernails or request injection points be identified, etc.
If the coroner/ME does not use a DSI, someone with the title of Assistant or Deputy ME or Assistant or Deputy Coroner will likely collect the body. Or, it could be someone used to working with dead bodies. In Florida, for example, this could be people from a local funeral home who do this as a sideline (thanks Paul Rose, Jr for this info.)
In the case of a mass casualty incident, it generally all hands on deck, so even the Chief ME will be there. Also, the Chief ME may arrive if the dead person is high profile.

But what about the actual autopsy?
Again, mass casualty or high profile, it may be the Chief ME and others. But it can be an assistant, deputy, or a pathologist. In some places, it must be someone with a pathology degree. What they won’t do is send blood to forensics (think Ducky on NCIS sending blood to Abby) to test. It will either be done in house or sent to a contracted lab.

What if it’s a buried body?
A buried body or one that’s been in a freezer has their own unique problems. How long the body has been there, what type of soil, humidity, rainfall, wrapped in plastic, or lack of any of that, all make a difference on how fast a body will decay. If buried in the woods, animals may sniff it out and drag off the entire body or just parts of it.
If it’s a skeleton, the ME may call in a Forensic Pathologist (think Temperance Brennan in the TV show Bones) to date the age of the bones. And yes, just from bones, they may be able to determine gender and approximate age of the person when they died, and how long they had been there.
One thing to keep in mind, if the bones are old enough, even if there are definite signs of homicide (think bullet hole in the skull, etc) there may not be a police investigation. Say the bones are fifty years old. How likely is it that the killer is still alive? What if they’re a hundred years old?

Conclusion
Determining if you have a medical examiner or coroner for a real place is as easy as a web search. Figuring out who collects the body may take a call to the proper office. If you make up a place, you may be able to write it any way you want. Just keep in mind…once you settle on coroner or medical examiner, don’t mix up the terms.

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