4 Surprising Truths About How America Investigates Death

Beyond the Crime Scene

On television, death investigation is a high-tech, seamless process. Teams of brilliant forensic experts in state-of-the-art labs use cutting-edge science to unravel the most complex cases in under an hour. This popular image, reinforced by countless crime dramas, suggests a standardized, scientifically rigorous system that always delivers truth and justice. The reality of America’s Medicolegal Death Investigation (MLDI) system, however, is far more complicated and concerning. Instead of a single, unified system, the United States relies on a fragmented patchwork of over 2,000 independent offices, governed by wildly different standards, budgets, and levels of expertise. It’s a system built on a medieval English model, where the “crown officer” was more concerned with protecting the king’s financial interests than with medical science. This fractured reality has profound implications not only for the criminal justice system but for public health and safety. The quality of a death investigation can vary dramatically from one county to the next, creating an uneven landscape of justice and public health surveillance. Here are four of the most surprising and impactful truths about this critical system.

1. In Many Places, Your Coroner Is an Elected Official—Not a Medical Expert.

The United States operates under two primary systems of who investigate deaths in America: the medical examiner system and the coroner system. Medical examiners are physicians, nearly always with specialized training in forensic pathology. Coroners, however, are a holdover from English law and are often elected officials who may have no medical or scientific background whatsoever. This is not a new problem; reform efforts began as early as 1877, when Massachusetts replaced its coroners with medically qualified professionals, setting a precedent the rest of the country has been slow to follow. The qualifications to be an elected coroner in some states are shockingly minimal. In Alabama, for instance, a candidate must be at least 25 years old, a high school graduate, a resident of the county, a registered voter, and must not have a felony conviction. Medical expertise is not on the list. This stands in stark contrast to the rigorous requirements for a board-certified forensic pathologist, which include a medical degree, a 3- to 4-year residency in pathology, and an additional 1- to 2-year fellowship in forensic pathology. This disparity is deeply impactful: the person officially tasked with determining the cause and manner of death—a decision crucial for identifying crimes, securing convictions, and tracking public health threats—may lack the fundamental scientific expertise to do the job accurately.

2. A Severe Lack of Experts and Resources Creates an “Uneven Landscape.”

Across the country, the MLDI system is strained by a critical shortage of board-certified forensic pathologists. One recent estimate suggests that while the nation has around 800 full-time forensic pathologists, at least twice that number are needed to adequately serve the country. This shortage has severe real-world consequences, forcing the medical examiner’s office in New York City to stop performing autopsies on suspected drug overdoses due to low staffing. The problem is most acute where the system is least equipped. In Nebraska, for instance, the situation is stunning: all death investigations are performed by law enforcement because there are no medicolegal death investigators. In other areas, the problem is chronic underfunding that deprives offices of the most basic resources. Cilina Evans, the Coroner for Shelby County, Alabama, described the dire situation in some counties: “They don’t have cameras; they do not have morgues. Some counties do not have body bags. They don’t have disposables, an office, a phone, a vehicle, or even a computer. They’re running everything on their private phone.” This lack of resources is compounded by startling conflicts of interest. As Evans notes, the system’s flaws can attract the wrong candidates. “In some cases, and in Alabama about 30% [of the time], the coroner’s position is held by a funeral director, which is a conflict of interest to me,” she stated. The stakes of this systemic neglect are high, leading directly to “incomplete death investigations, investigations not being conducted, incomplete evidence collection, incorrect conclusions, [and] mistaken diagnoses.”    

3. The Standards for Death Investigation Are Largely Optional.

Because there is no centralized national system for death investigation, practices and standards can differ dramatically between jurisdictions. Professional organizations like the National Association of Medical Examiners (NAME) offer accreditation to offices that meet quality standards, but this accreditation is entirely voluntary and often too costly for underfunded offices to pursue. The results are telling: a staggering 86% of coroner’s offices and 71% of city or county medical examiner offices operate without accreditation from a leading professional body. The technological gap is also wide; a 2018 survey found that only 43% of these offices even had a computerized information management system. The lack of enforceable standards can have a profound impact on justice, as seen in the trial for the murder of George Floyd. The official autopsy from the Hennepin County Medical Examiner was essential to the prosecution’s case. But the defense called its own expert, former Maryland chief medical examiner David Fowler, who testified that Floyd’s death resulted from other factors, not the officer’s restraint. Fowler’s conclusions “sparked immediate concern among hundreds of his peers,” who suggested his testimony was not based on sound science, leading Maryland’s Attorney General to launch an audit of his previous work. This public battle of experts perfectly illustrates how, in the absence of mandatory standards, the integrity of justice itself can be put on trial.

4. It’s Not Just About Solving Crimes—It’s About Saving Lives.

While often associated with the criminal justice system, the role of medical examiners and coroners is equally vital to public health. The data they collect from death investigations serves as a frontline surveillance system for identifying and tracking threats to community well-being, from infectious disease outbreaks to emerging drug epidemics. During the opioid crisis, forensic pathologists were at the forefront of identifying the lethal rise of fentanyl. In the COVID-19 pandemic, they provided essential data to help public health officials monitor the spread of the virus and identify hotspots. Their investigations also uncover hidden dangers, such as unsafe consumer products or environmental hazards, prompting life-saving changes in policy and public behavior. One of the most powerful historical examples of this function is the discovery of the effectiveness of infant car seats. As an autopsy technician in 1979, Susan Baker had a hunch that infants were dying in car crashes at a disproportionate rate. She later recalled: “Using death certificate data… it took me about 10 minutes to discover that my hunch had been correct. I remember my excitement, and it turned out that my simple analysis had far-reaching results.” Her findings were published and eventually led to laws requiring the use of infant car seats, saving countless lives. This critical public health function is put at risk every day by a system hobbled by fragmentation, underfunding, and a lack of enforceable standards.

Conclusion: A System at a Crossroads

The popular perception of death investigation as a seamless, high-tech machine could not be further from the truth. The U.S. medicolegal death investigation system is a fractured, under-resourced, and unevenly skilled network that falls dangerously short of public need. It is a system struggling with a severe shortage of experts, a lack of basic funding, and a reliance on voluntary standards that few can afford to meet. This reality affects us all, from the integrity of our justice system to the safety of our communities. Given that every death investigation holds clues for protecting the living, how can we justify a system where the quality of that investigation is left entirely to geographic luck?  

Contact A Wrongful Death Lawyer Near You

If you have lost a loved one and feel that their death was not investigated adequately we urge you to reach out to the team here at the Lovely Law Firm. We will do all we can to get you the answers you’re looking for and fight for justice. Contact our office to book a free case consultation with one of our wrongful death attorneys in Myrtle Beach.