U.S. Department of Justice Office of Justice Programs Bureau of Justice Statistics Special Report Medical Examiners and Coroners' Offices, 2004 June 2007, NCJ 216756 ------------------------------------------------------ This file is text only without graphics and many of the tables. A Zip archive of the tables in this report in spreadsheet format (.csv) and the full report including tables and graphics in .pdf format are available from: http://www.ojp.usdoj.gov/bjs/abstract/meco04.htm ------------------------------------------------------ Matthew J. Hickman, Ph.D. Kristen A. Hughes Bureau of Justice Statistics Kevin J. Strom, Ph.D. Jeri D. Ropero-Miller, Ph.D., DABFT RTI International About 2,000 medical examiners and coroners'(ME/C) offices provided death investigation services across the United States in 2004. These offices were responsible for the medicolegal investigation of death. They may conduct death scene investigations, perform autopsies, and determine the cause and manner of death when a person has died as a result of violence, under suspicious circumstances, without a physician in attendance, or for other reasons. As of 2004, 16 States had a centralized statewide medical examiner system (see map). Fourteen States had a county coroner system, 7 had a county medical examiner system, and 13 had a mixed county medical examiner and coroner system. Eight States with decentralized death investigation systems also had a State medical examiner office performing medicolegal duties (Alabama, Arkansas, Georgia, Iowa, Kentucky, Montana, North Dakota, and Tennessee). The District of Columbia reported a city medical examiner office, which functioned similar to a statewide system. ME/C offices employed an estimated 7,320 FTE employees. Estimated annual budgets for these offices totaled $718.5 million, an average of $387,000 per office. The majority of ME/C offices in 2004 were county coroners' offices (1,590 or 80%), most of which served small jurisdictions(less than 25,000 persons). Nearly one million human death cases were referred by medical and law enforcement personnel to the Nation's ME/C offices in 2004, accounting for approximately 40% of all deaths in the United States that year.***Footnote 1: For more information about the total number of deaths in the United States, see the Center for Disease Control's website on "Deaths/Mortality" at .*** Depending on the circumstances of the death, characteristics of the death scene, the decedent's medical history, and other factors, death cases may be cleared without the medical examiner or coroner accepting jurisdiction and conducting an additional investigation to determine the cause and manner of death. Overall, ME/C offices in 2004 accepted about half of all referred cases for further investigation. The 2004 Bureau of Justice Statistics'(BJS)Census of Medical Examiner and Coroners' Offices represented the Bureau's first effort to describe the medicolegal investigation of death in the United States. The census also gathered detailed information on unidentified human decedents handled by ME/C offices because they represent a critical component in the Nation's effort to resolve missing persons cases. In a typical year ME/C offices reported that they handled about 4,400 unidentified human decedents of which about 1,000 remained unidentified after one year. Sixteen States in 2004 had centralized, statewide medical examiner systems Although the specific title and duties of medicolegal officials varied, each State had one of three basic types of death investigation systems: medical examiner, coroner, or mixed systems. States varied in the degree to which death investigation was centralized. Some States had a statewide medical examiner system with no independently functioning county entities, while other States had independent medical examiner or coroner offices in each county or in other political or geographic subdivisions, such as judicial districts. Some ME/C offices were responsible for a specific city, a county, multiple counties, or larger regions within a State. Caution should be exercised when making comparisons by the type of office. States differed in selection and qualification standards for medicolegal officials. The distinction between coroner and medical examiner systems varied by jurisdiction; and the qualifications, skills, and activities of medicolegal personnel cannot necessarily be inferred from the title attached to the office. In general, coroners were elected officials while medical examiners were appointed. Coroners may be lay persons while medical examiners were generally required to be physicians and may have specialized training (such as forensic pathology). Among many exceptions, there were forensic pathologists who had been elected to the position of coroner and served in a coroner's office. In addition, some medicolegal officials held the title of medical examiner or coroner, while the title of the office was the opposite. These factors complicate comparisons by type of office. Two-thirds of the nearly 2,000 ME/C offices in the United States served populations of less than 50,000 persons A total of 1,998 ME/C offices were enumerated in the BJS census, including offices in the District of Columbia and in each State except Louisiana. Due to Hurricane Katrina, data collection was temporarily suspended in affected gulf-coast States and ultimately canceled in Louisiana. Sixty-four offices were operating in Louisiana at the time of the census. In the aftermath of Hurricane Katrina, Louisiana created a centralized State medical examiner office. Most ME/C offices served relatively small jurisdictions. About two-thirds of the offices in the BJS census (1,361 offices, or 68%) served populations of less than 50,000 persons. Nearly 1 in 5 served populations of less than 10,000 persons. Of the 57 offices that served jurisdictions with populations of 1 million or more, 12 were centralized medical examiner offices serving an entire state. County coroners' offices accounted for 80% of all ME/C offices in the United States The majority of ME/C offices in the United States were county coroner offices (1,590 offices, or 80%), most of which serve relatively small jurisdictions. County medical examiner offices were the next most common type of office (316 offices, or 16%), the majority serving medium-sized jurisdictions (25,000 to 249,999 persons). The remainder consisted of State medical examiner offices, district or regional medical examiner and coroner offices, and city medical examiner offices. ME/C offices employed an estimated 7,320 full-time personnel nationwide; over half worked in offices serving 500,000 or more persons. ME/C offices employed an estimated 7,320 full-time equivalent (FTE) personnel in 2004. Most of the personnel were employed in offices serving jurisdictions of 500,000 or more persons. While only 6% of all offices served populations of 500,000 or more persons, these offices employed over half of all FTE personnel. Offices serving 100,000 or more persons, representing 20% of all offices, employed more than two-thirds (69%) of all FTE personnel. County coroner offices employed nearly half (48%) of all FTE personnel in 2004, and county medical examiner offices employed 28%. ME/C offices serving large jurisdictions had an average of over 20 FTE personnel, while those serving medium and small jurisdictions averaged about 1 to 2 FTE positions. Offices serving jurisdictions of 1 million or more persons had an average of about 50 FTE personnel. Among offices serving large jurisdictions (250,000 or more persons), most of the FTE salaried employees (40%) were categorized as ancillary death investigation personnel, such as medical death investigators, autopsy technicians, and photographers. Forensic pathologists (13%) and other medical examiners and coroners(7%)comprised 20% of all FTE employees. Thirteen percent were laboratory support personnel, such as lab technicians, analysts, and toxicologists. Forensic specialists, such as odontologists, entomologists, and anthropologists, comprised less than 1% of all FTE employees. Some ME/C offices did not have FTE salaried personnel and the individuals performing medicolegal duties were compensated on a per case, per diem, fee-for-service, or other "as needed" basis. ME/C offices may also use full- or part-time consultants and contractors, including pathologists, forensic specialists, on-call field investigators, and others. Nearly 1 million human death cases referred in 2004; about 500,000 accepted In general, when a human decedent is discovered by law enforcement, medical personnel, or other persons, the decedent case is referred to the ME/C office that has jurisdiction. An estimated 956,000 cases were referred to the Nation's ME/C offices during calendar year 2004. Referred cases were generally screened to determine if they can be cleared based on death scene characteristics, medical history, and other factors, or if it was necessary to assume jurisdiction and conduct additional investigations, including toxicological screens, autopsies, and specialized procedures. About 487,000 cases, or 51% of all cases referred in 2004, were accepted, meaning that the office conducted additional investigations and completed the death certificate or otherwise determined the cause of death. These cases represented about a fifth of all human deaths in 2004. About three-quarters(74%)of all referred cases in 2004 were handled by ME/C offices serving jurisdictions of 250,000 or more persons. These offices handled about two-thirds(64%)of all accepted cases. The percentage of referred cases accepted for further investigation was higher in smaller jurisdictions. About 85% or more of referred cases were accepted in jurisdictions serving less than 25,000 persons, compared to less than half of referred cases in jurisdictions serving 250,000 or more. These differences may be due to variations in referral and screening practices, workload, and other factors. Overall an average of about 480 cases were referred to ME/C offices in 2004. About 240 of the referred cases were accepted. The average number of cases referred in 2004 ranged from 40 to 70 among county coroner and medical examiner offices serving small jurisdictions to over 3,500 among county medical examiner offices serving large jurisdictions. State medical examiner offices averaged about 4,800 referrals. Accepted cases in 2004 ranged from an average of 30 to 50 in county coroner and medical examiner offices serving small jurisdictions to more than 1,200 in large jurisdictions. State medical examiner offices accepted an average of about 3,000 cases. Completed autopsy in nearly half of accepted cases; autopsy more likely in large jurisdictions Accepted cases may involve a variety of procedures related to the medicolegal investigation of death. Among 1,087 offices reporting details on accepted death case procedures performed in 2004, about 62% of accepted cases included a death scene investigation (not shown in table). Other common procedures included toxicology analysis (51%), complete autopsy (48%), and review of medical records (45%). Less common were radiology (13%), microbiology (7%), crime scene processing (5%), partial autopsy (4%), metabolic screen (3%), and characterization of skeletal remains (1%). ME/C offices serving jurisdictions of less than 250,000 conducted death scene investigations in a greater percentage of accepted cases (72%), compared to jurisdictions serving 250,000 or more (42%). This difference may be due to variation in screening practices; for example, death scene investigations may be part of the screening process prior to accepting a case in jurisdictions of 250,000 or more persons, but after accepting a case in jurisdictions of less than 250,000. ME/C offices serving jurisdictions of 250,000 or more conducted toxicology analyses (57%) in a greater percentage of accepted cases, compared to offices serving smaller jurisdictions (34%). Similarly, offices serving large jurisdictions conducted complete autopsies in a greater percentage of accepted cases (45%), compared to offices serving smaller jurisdictions (23%). ------------------------------------------ Nearly 13,500 unidentified human decedents presently on record; total number affected by variation in record keeping practices ME/C offices reported a total of 13,486 unidentified human decedents currently on record, with the largest jurisdictions (those serving 250,000 or more) accounting for 87% of all cases. Overall, an estimated 23% of ME/C offices reported one or more unidentified decedents on record (not shown in table). Both jurisdiction size and record keeping practices of offices affected the number of unidentified human decedents on record. An estimated half (49%) of ME/C offices in 2004 had a policy for retaining records on unidentified human decedents, such as x-rays, fingerprints, or DNA. ME/C offices serving larger jurisdictions were more likely to have such a policy. More than 90% of those serving 250,000 or more persons had a policy to retain records of unidentified human decedents. In comparison, 29% of ME/C offices serving jurisdictions of less than 2,500 persons reported such a policy. A forthcoming BJS report will compare the information on unidentified human decedents obtained in the BJS census with data available in the Federal Bureau of Investigation's National Crime Information Center. The report will also explore different methods for generating national estimates of the total number of unidentified human decedents. Understanding the number and distribution of unidentified human decedents is critical to improving national databases, particularly regarding missing persons investigations. ------------------------------------------ 4,400 unidentified human decedents reported in an average year; 1,000 remained unidentified after 1 year Medical examiners and coroners are occasionally faced with a human decedent that cannot be identified. ME/C offices estimated that a total of about 4,400 unidentified human decedents were reported in an average year. Ninety percent of these estimated annual unidentified decedents were reported by offices serving jurisdictions of 250,000 or more persons (not shown in figure). After one year an estimated 1,000 (or 23%) remained unidentified and became "cold cases." Seventy percent of these estimated annual cold cases were reported by offices serving jurisdictions of 250,000 or more persons(not shown in figure). ME/C offices reported that a total of about 600 cold cases underwent final disposition (such as burial, cremation, or other means of disposition) in 2004. Seventy-one percent of these cases were reported by offices serving jurisdictions of 250,000 or more persons (not shown in figure). Eighty percent of ME/C offices reported they "rarely or never" used NCIC An estimated 20% of ME/C offices reported they used the FBI's National Crime Information Center(NCIC) "somewhat often" or "very often," while 80% said they used the NCIC "rarely or never". Frequent use of NCIC was more common among offices serving larger jurisdictions, including 59% of those serving 1,000,000 or more persons. Direct access to NCIC by ME/C offices was not permitted at the time of the census. Typically, information on unidentified human remains was entered by law enforcement agencies on behalf of ME/C offices. In May 2006 direct access to NCIC was granted to ME/C offices by the FBI. Greater use of NCIC might be expected as a result, but increased workload and the cost of access remain obstacles. As of February 2005 the NCIC Unidentified Person file contained about 5,800 unidentified human decedent records. Twenty-seven percent of these unidentified persons were determined to be homicide victims. The cause of death for more than half of the victims could not be determined. California was the only State that mandated information about the unidentified be reported to NCIC within a specified period. About 42% of all records in the NCIC unidentified persons file were from California. Estimated annual budgets totaled $718.5 million or about $387,000 per office ME/C offices had estimated overall annual budgets of nearly $718.5 million, an average of $387,000 per office. The median budget was $37,000. County medical examiner budgets averaged $715,000, ranging from an average of $2.5 million among those serving large jurisdictions to $18,000 among those serving small jurisdictions. County coroner budgets averaged $225,000, ranging from an average of about $1.4 million among those serving large jurisdictions to $41,000 among those serving small jurisdictions. Overall, ME/C offices had annual budgets equivalent to about $99,000 per FTE employee. Among county coroner and medical examiner offices, per FTE amounts were higher in medium jurisdictions and lowest in small jurisdictions. County medical examiner offices serving small jurisdictions had the lowest per FTE budget, at $11,400. County coroner offices serving medium jurisdictions had the highest per FTE budget, at $143,400. Methodology Data collection for the 2004 Census of Medical Examiner and Coroner Offices was conducted by RTI International (RTI) on behalf of BJS under cooperative agreement 2005-MU-MU-K011. BJS provided an initial draft questionnaire and respondent list to RTI. RTI reviewed the draft questionnaire for general content and design and coordinated a forensic expert panel review of the instrument to obtain feedback on specific items. The initial list of ME/C offices operating in the United States was provided to BJS by the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. RTI updated the list and conducted telephone verification of contact information for each office. Data were collected by mixed mode. In addition to mail-out packages, RTI created a web site on which respondents could access the questionnaire and provide responses electronically. Follow-up efforts included Computer Assisted Telephone Interviewing (CATI) and e-mail. Seventy-one percent of respondents used mail or facsimile transmission of data, 13% responded via the Internet, and 16% responded by telephone. A total of 1,998 ME/C offices were enumerated in the census. Despite extensive follow-up efforts, 281 ME/C offices did not respond to the request for information, yielding an overall response rate of 85.9%. By population served, the response rate was lowest among ME/C offices serving 10,000 to 49,999 persons (83.9%), and generally higher among those serving 100,000 or more. By type of office, the response rate was lowest among county medical examiner offices serving small jurisdictions (77.3%). Response rates for other types of offices were as follows: State medical examiner offices (100.0%); city medical examiner offices (100.0%); district or regional medical examiner offices (94.3%); county coroner offices (85.9%); county medical examiner offices (84.2%). Five States had overall response rates below 80%, including Kansas (79.4%), Wyoming (78.3%), Tennessee (77.4%), Arizona (64.3%), and Illinois (60.4%). In counties in Texas, justices of the peace are not death investigators or coroners. They may make cause and manner of death determinations but were out of scope for this census. Imputations were made for missing continuous data elements including FTEs, budgets, and workload items (cases referred and accepted, and unidentified decedents handled in an average year). Imputation cells were based on the State in which an ME/C office was located, type of office, and population served. For FTE data the median ratio of FTEs to population served was calculated within imputation cells and multiplied by the population for offices with missing data to produce the imputed values. Imputations for FTE data in sheriff-coroner offices were based on agency employment data from the BJS Law Enforcement Management and Administrative Statistics (LEMAS)program. For budget data the median ratio of budget to FTEs was calculated within imputation cells and multiplied by the total FTEs in offices with missing data to produce the imputed values. For referred cases, accepted cases were divided by the median ratio of cases accepted to those referred. For accepted cases, referred cases were multiplied by the median ratio of cases accepted to those referred. If both elements were missing, the median ratio of cases referred to population served was multiplied by the population for offices with missing data to impute referred cases. The median ratio of cases accepted to those referred was multiplied by the number of referred cases to impute accepted cases. For unidentified decedents reported annually, remaining unidentified after 1 year, and undergoing final disposition, the median value within imputation cells was used as the imputed value. ---------------------------------------------- The Bureau of Justice Statistics is the statistical agency of the U.S. Department of Justice. Jeffrey L. Sedgwick is director. This Special Report was written by Matthew J. Hickman and Kristen A. Hughes of BJS, under the supervision of Steven K. Smith, and Kevin J. Strom and Jeri D. Ropero-Miller of RTI International. Tracey Kyckelhahn provided statistical review. Data collection for the 2004 Census of Medical Examiner and Coroners' Offices was conducted by RTI International on behalf of BJS under cooperative agreement 2005-MU-MU-K011. The National Association of Medical Examiners (NAME) and the International Association of Coroners and Medical Examiners (IACME) provided valuable assistance in development of the data collection instrument and in encouraging participation in the study. (See and for more information.) Carolyn C. Williams edited the report, with assistance from Joanna S. Bradford, and Jayne Robinson prepared the report for final printing, under the supervision of Doris J. James. June 2007, NCJ 216756 ----------------------------------------------- ----------------------------------------------- This report in portable document format and in ASCII and its related statistical data and tables are available at the BJS World Wide Web Internet site: ----------------------------------------------- End of file 06/06/07 ih