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EDUCATION AND TRAINING
221
associate degree. Almirall and Furton posit that future trends favor a mini-
mum of a graduate degree in almost all areas of forensic science.9
An issue that has received much attention is the degree requirements
for positions in crime laboratories. A requirement for an entry-level posi-
tion in most crime laboratories is at least a bachelor’s degree in a natural
science or forensic science, and many laboratories require a year or two of
experience, with a master’s degree. Over the years, most crime laboratory
hires have been and continue to be graduates with degrees in chemistry
or biology.
Several studies have focused on the needs of crime laboratories. In 1988
Siegel conducted a survey of undergraduate students at Michigan State
University, forensic science practitioners employed by the Michigan State
Police, and 240 members of the American Society of Crime Laboratory
Directors (ASCLD).10 Survey respondents expressed a strong preference for
a master’s degree in forensic science and a lack of preference for the B.S. in
criminalistics/forensic science. One explanation noted by the respondents
was “that too many programs passing themselves off as forensic science
programs were actually little more than criminal justice programs with a
forensic science internship and a smattering of ‘hard’ science.”11 Another
finding was the importance of chemistry in the backgrounds of prospective
forensic science examiners.
Also in 1988, Higgins and Selavka surveyed laboratory managers.12
Similar to the findings of Seigel, “chemical knowledge was the most impor-
tant ability they considered when evaluating potential employees
”13 In
1996, Furton et al. surveyed members of the ASCLD, primarily drug chem-
ists and trace evidence analysts.14 This survey found that “the majority of
crime lab directors responding require applicants to have B.S. degrees with
a preference for chemistry/biochemistry, followed by biology and forensic
science with a requirement for a substantial number of chemistry and other
natural science courses.”15
9 Ibid.
10 J.A. Siegel. 1988. The appropriate educational background for entry level forensic scien-
tists: A survey of practitioners. Journal of Forensic Sciences 33(4):1065-1068.
11 Ibid., pp. 1067-1068.
12 K.M. Higgins and C.M. Selavka. 1988. Do forensic science graduate programs fulfill the
needs of the forensic science community? Journal of Forensic Sciences 33(4):1015-1021.
13 Ibid., p. 1017.
14 K.G. Furton, Y.L. Hsu, and M.D. Cole. 1999. What educational background is required
by crime laboratory directors? Journal of Forensic Sciences 44:128-132.
15 Ibid., p. 130.
222
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
Proliferation of Forensic Science Programs
In recent years, increasing attention has been paid to the forensic sci-
ence disciplines by the media in the form of many new books, movies, high-
profile court cases, and, especially, television shows such as Crime Scene
Investigation (or CSI).16 This media attention has resulted in explosive
demand by college (as well as primary and secondary school) students for
academic courses and degree programs that will prepare them for careers
in forensic science that are like those portrayed in the media. Evidence of
this is the dramatic rise in enrollments in forensic science courses on col-
lege campuses.17
One issue facing academic forensic science programs is combating
Hollywood’s version of the career of a forensic practitioner. “Students who
enter forensic science programs often expect to work in conditions similar
to the television crime shows they watch. Many find they are unprepared
for the reality of a career in the field. ‘A lot of new students come to our
programs looking for an exciting career. Unfortunately, they come with
unrealistic expectations,’ says Charles Tindall, director of forensic science
at the Metropolitan State College of Denver.”18
Until recently, there were few academic programs in the forensic science
disciplines. The earliest forensic science degree programs and the oldest
continually functioning educational degree programs in forensic science
in the United States were established at Michigan State University in 1946
and the University of California at Berkeley in 1950.19 A survey conducted
in the mid-1970s located 22 colleges and universities in the United States
offering degrees (in one case a certificate) in criminalistics/forensic science,
although some of these institutions offered multiple degrees.20
16 See, e.g., S. Smallwood. 2002. As seen on TV. Chronicle of Higher Education 48(45):
A8-A10.
17 There have been similar increases in demand at the K-12 level. Forensic science has
become a popular component of science teaching. An informal survey conducted in 2004 by
the National Science Teachers Association found that, “Of the 450 middle and high school
science educators who responded to an informal survey, 77 percent indicated that their school
or school district is using forensic investigations to teach science. When asked if the popular-
ity of forensic-based TV shows had ignited students’ interest in science, the response was a
resounding ‘yes’ (78 percent).” NSTA Survey Reveals Forensic Science Is Hottest New Trend
in Science Teaching. Available at http://science.nsta.org/nstaexpress/nstaexpress_2004_10_
25_forensic.htm.
18 National Institute of Justice. 2007. Addressing Shortfalls in Forensic Science Education.
InShort, NCJ 216886. Washington, DC: U.S. Department of Justice, National Institute of
Justice.
19 A. Vollmer, Chief of Police, Berkeley, California, established the School of Criminology
at the University of California at Berkeley.
20 J.L. Peterson, D. Crim, and P.R. De Forest. 1977. The status of forensic science degree
programs in the United States. Journal of Forensic Sciences 22(1):17-33.
EDUCATION AND TRAINING
223
In the 1980s, a contraction of programs occurred—particularly at the
graduate level. Stoney argues that this was because of a lack of financial and
administrative support.21 Higgins and Selavka suggest that the end of fund-
ing provided by the Law Enforcement Assistance Administration in 1978
took important federal support away from many institutions.22 Addition-
ally, they suggest that the then-declining enrollment in graduate programs
might have reflected the generally low-paying opportunities available to
newly minted graduates.
In recent years, this trend has reversed itself. Many colleges and uni-
versities, seeing the potential revenue from increasing numbers of new
students, have responded by creating all manner of new academic pro-
grams. The American Academy of Forensic Sciences (AAFS) now lists
138 undergraduate, 59 graduate, and 6 doctoral forensic science degree
programs in the United States.23 Not all are science based—many are crimi-
nal justice programs. The curricula of these degrees range from rigorous
scientific coursework amounting to a degree in chemistry or biology with
forensic science content, to little more than criminal justice degrees with
an internship.
Doctoral Programs in Forensic Science
There is no doctoral program specifically in forensic science; the pro-
grams noted by AAFS offer Ph.D.s (mostly in chemistry) with a concen-
tration in that area. Some scholars consider this to be a shortcoming in
forensic science education. More than 20 years ago, Kobilinksy and Shee-
han conducted a survey of crime laboratories throughout the United States
and found that almost 73 percent of those responding believed there was a
need for a Ph.D. program.24 The advantages of a Ph.D. program lie in its
positive effect on basic research in the field. Doctoral programs offer more
research depth and capacity, have ties to other fields, have high expectations
for quality, supply graduate student personnel to question and check past
work and challenge conventional wisdom, and inspire more mentoring,
which has two-way benefits.
21 D.A. Stoney. 1988. A medical model for criminalistics education. Journal of Forensic
Sciences 33(4):1086-1094.
22 Higgins and Selavka, op. cit.
23 See www.aafs.org.
24 L. Kobilinksy and F.X. Sheehan. 1984. The desirability of a Ph.D. program in forensic
science. Journal of Forensic Sciences 29(3):706-710.
224
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
CHALLENGES AND OPPORTUNITIES TO IMPROVE
FORENSIC SCIENCE EDUCATION
The overarching challenges facing forensic science education, since its
inception, have been inconsistent quality and insufficient funding. Commen-
tators have noted repeatedly the deficiencies of forensic science education
programs.25 Because, until recently, no nationally recognized, mandated
standards existed for forensic science degree programs at any level, consis-
tent quality cannot be achieved. Peterson et al. note that while “the primary
objective of all degree programs is similar, the capabilities of graduates
from the respective institutions are not uniform. Laboratories are forced to
evaluate each graduate student individually to determine his suitability for
a given position.”26
Unevenness in the quality of these programs has caused problems for
students and future employers. The Council of Forensic Science Educators
stated that, “Students completing these lesser programs expect to find em-
ployment in crime labs but are surprised to learn that lab management is
not impressed by the curriculum.”27
Additionally, the lack of applicants with a science or forensic back-
ground means that crime laboratories have to spend precious time and re-
sources in the training of new scientists.28 If forensic science education pro-
grams had sufficient rigor in science, law, and forensics, crime laboratories
would have to spend less time and money for training,29 thereby shortening
as well the apprenticeship time needed. Forensic science methods should
be taught in the framework of common scientific practice (see Chapters
4 through 6). Even if a student graduates with a science degree, he or she
often lacks education in issues that are critical to the functioning of crime
laboratories, including quality assurance and control, ethics, and expert
testimony. Peterson et al. found that, “The faculty surveyed believes their
students to be well prepared for entry into the field. This is not totally con-
sistent with the feedback from some laboratories which have been less than
satisfied with newly graduated recruits.”30 They continue to recommend
that, “Measures should be taken to improve feedback from the laborato-
ries to the schools to insure that the curriculum is not only comprehensive
25 See, e.g., Peterson et al., op. cit; L.W. Bradford. 1980. Barriers to quality achievement
in crime laboratory operations. Journal of Forensic Sciences 25(4):902-907; Stoney, op. cit.;
NIJ, op. cit.
26 Peterson et al., op. cit., p. 31.
28 Stoney, op. cit.
29 NIJ, 2007, op. cit.
30 Peterson et al., op cit., p. 32.
EDUCATION AND TRAINING
225
from an academic standpoint but also meets the practical requirements of
operating laboratories.”31
Over the past few years, major strides have been taken in bringing a
measure of standardization to forensic science education programs and
boosting their quality. The NIJ report, Forensic Science: Review of Status
and Needs, called in part for an accreditation system for such programs.
Following this report, in 2001, NIJ established a Technical Working Group
for Education and Training in Forensic Science (TWGED)—consisting of
47 experts, including educators, judges, attorneys, crime laboratory direc-
tors, and subject matter scientists—that developed recommended curricu-
lar guidelines for undergraduate and graduate forensic science programs.
These were provided in a 2004 report.32 In 2002, the American Academy
of Forensic Sciences created an ad hoc committee, the Forensic Education
Program Accreditation Committee, to look into issues regarding an ac-
creditation system. The committee was made a standing committee in 2004,
at which time the name was changed to the Forensic Science Education
Program Accreditation Commission (FEPAC). FEPAC is made up of five
forensic science educators, five crime laboratory directors, and one public
member. FEPAC created a process for accrediting undergraduate and gradu-
ate forensic science programs using the TWGED standards.33
FEPAC standards are divided into three parts (see Table 8-2). There
are general standards that all programs must meet and then additional
standards for undergraduate and graduate programs.
An important note regarding the accreditation process is that the pro-
gram must award at least a bachelor’s degree in either forensic science
or a natural science with a concentration in forensic science at both the
bachelor’s and master’s levels. Programs that award certificates or associate
degrees are ineligible for accreditation in this system. Additionally, at this
time only U.S. programs are eligible for accreditation.
To summarize the general standards, such programs shall:
• have an explicit process for evaluating and monitoring its overall
efforts to fulfill its mission, goals, and objectives; for assessing its
effectiveness in serving its various constituencies; for modifying
31 Programs accredited by FEPAC are required to complete periodic self-assessments, which
include job placement statistics and employer satisfaction surveys.
32 Technical Working Group for Education and Training in Forensic Science. 2004. Educa-
tion and Training in Forensic Science: A Guide for Forensic Science Laboratories, Educational
Institutions and Students, Special Report. Washington, DC: U.S. Department of Justice, Na-
tional Institute of Justice. NCJ 203099.
33 See FEPAC Accreditation Standards. Available at www.aafs.org/pdf/FEPAC%20
Accreditation%20Standards%20_082307_.pdf.
226
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
Table 8-2 Major Areas of FEPAC Standards
General Standards for All Programs
-
Eligibility
-
Planning and Evaluation
-
Institutional Support
-
Student Support Services
-
Recruiting and Admissions Practices, Academic Calendars, Catalogs, Publications,
Grading, and Advertising
-
Record of Student Complaints
-
Distance Learning and Other Alternative Delivery Mechanisms
Undergraduate Program Standards
-
Mission, Goals, and Objectives
-
Undergraduate Admissions Requirements
-
Curriculum
-
Program Director
-
Faculty
-
Success with Respect to Student Achievement
-
Professional Involvement
Graduate Program Standards
-
Mission, Goals, and Objectives
-
Graduate Admissions Requirements
-
Curriculum
-
Program Director
-
Faculty
-
Success with Respect to Student Achievement
-
Professional Involvement
SOURCE: www.aafs.org.
the curriculum as necessary, based on the results of its evaluation
activities; and for planning to achieve its mission in the future;
• have adequate institutional support in the form of financial re-
sources, facilities, instructional, and support services;
• provide adequate student support services, such as mentoring, ad-
vising, and career placement;
• have policies and procedures for student recruitment and ad-
missions, with advisers to students regarding requirements for
employment;
• have procedures for handling student complaints; and
• consider the use of distance learning as an instructional technique,
demonstrating that all required laboratory experiences are hands-
on for all students.
EDUCATION AND TRAINING
227
Concerning the undergraduate curriculum, it should, at a minimum,
ensure that each student (1) obtain a thorough grounding in the natural sci-
ences; (2) build upon this background by taking a series of more advanced
science classes; and (3) develop an appreciation of issues specific to forensic
science through course work and laboratory-based instruction.
Forensic science undergraduates in the chemistry track should take, at a
minimum, chemistry courses required for chemistry majors—general chem-
istry, organic chemistry, physical chemistry, analytical chemistry, instru-
mental analysis, and biochemistry. Forensic science students in the biology
track should take those chemistry courses required for biology majors and
biology courses for biology majors, including general biology, biochemistry,
instrumental analysis, genetics, molecular biology, and population genet-
ics. All forensic science students should, at the earliest point possible, take
a hands-on crime scene investigation course that teaches the principles of
evidence, including its collection, preservation, and value. Additionally, the
forensic science courses in drug analysis, criminalistics, and forensic biology
(including DNA analysis) should be at the highest level. All forensic science
majors should take a capstone course.
For graduate programs, the curriculum should, at a minimum, ensure
that each student (1) understand essential issues in the forensic science
disciplines, including the reduction of error rates; (2) develop an under-
standing of the areas of knowledge that are essential to forensic science;
(3) acquire skills and experience in the application of basic forensic science
concepts and of specialty knowledge to problem solving; (4) be oriented in
professional values, concepts and ethics; and (5) demonstrate integration
of knowledge and skills through a capstone experience, such as a formal,
objective tool (e.g., the American Board of Criminalistics Forensic Science
Aptitude Test) or another comprehensive examination or a thesis and/or
research project.
Depending on the specialty track of interest, graduate students should
take advanced courses in specialty areas of interest—drug analysis, toxicol-
ogy, criminalistics, forensic biology, and forensic DNA analysis (including
mtDNA sequencing, low copy number techniques, and SNPs). The crimi-
nalistics and forensic biology courses should be advanced beyond those
seen at the undergraduate level. If the student has not had those lower-level
courses, they should be taken first. Graduate students also should take a
hands-on crime scene investigation class that covers investigation tech-
niques and evidence association, including its examination, collection, and
preservation. In addition, in-service work with a collaborating institution
can provide significant practical training.
Finally, the standards lay out a suggested curriculum for forensic sci-
ence education programs. At the undergraduate level, coursework includes
several classes in the natural sciences (with a focus on chemistry); special-
228
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
ized science courses (e.g., microbiology, genetics, biochemistry); forensic
science courses—which cover courtroom testimony; introduction to law;
quality assurance; ethics; professional practice; evidence identification, col-
lection and processing; a survey of the forensic science disciplines; and
additional courses in the student’s area of specialization. Laboratory work
must be complemented with hands-on training that closely mimics the
experiences of the crime laboratory. At the graduate level, students should
take core forensic science topics, such as physical evidence concepts and
ethics and professional responsibilities; courses in specialized areas; and a
graduate seminar—all aimed at developing skills for conducting indepen-
dent research.
FEPAC began a pilot accreditation program in the fall of 2003, ac-
crediting five programs,34 and the number of accredited programs has
continued to grow (see Table 8-3). As of January 2008, 16 programs have
met FEPAC’s rigorous standards and accordingly have been accredited by
FEPAC.
Accredited forensic science programs are listed on the AAFS Web site.
Accreditation is seen as providing a “seal of quality to an institution;”
helping faculty to improve their curricula; creating a standard for measur-
ing the quality of forensic science programs; and benefiting laboratories by
reducing the need for in-house training.35 Accreditation should become the
norm. The committee believes that, to encourage accreditation, a mecha-
nism could be developed whereby only accredited programs would be eli-
gible to receive certain federal grants and/or scholarships for its students.
If the forensic science disciplines are to grow in stature and be recognized
for their scientific rigor and high standards of quality, their research base
must be broadened and strengthened. This will occur only if significant
federal research funds are made available to universities by scientific grant-
ing agencies such as the National Institutes of Health and the National
Science Foundation. Crime laboratories would be the beneficiaries of a
wave of well-educated workers who would elevate the scientific standards
of the field. The forensic science degree programs that are not sufficiently
rigorous eventually would disappear, because their graduates would not be
competitive in the employment arena. Consequently, employers would be
more confident in the capabilities of graduates of forensic science programs
and hence would be more inclined to hire them.
34 Cedar Crest College (Allentown, Pennsylvania), Eastern Kentucky University (Richmond,
Kentucky), Florida International University (Miami, Florida), Metropolitan State College of
Denver (Denver, Colorado), and Michigan State University (East Lansing, Michigan).
35 NIJ, 2000, op. cit.
EDUCATION AND TRAINING
229
Table 8-3 FEPAC Accredited Programs, 2008
Programs
Degree Program
Albany State University
Bachelor of Science Degree in Forensic
Science
Arcadia University
Master of Science Degree Program in
Forensic Science
Cedar Crest College
Bachelor of Science Degree Program in
Chemistry, Biochemistry, Biology, and
Genetic Engineering, with a concentration in
Forensic Science
Eastern Kentucky University
Bachelor of Science Degree Program in
Forensic Science
Florida International University
Certificate Programs in Conjunction
with the Bachelor of Science in a Natural
Science such as Chemistry or Biology
Florida International University
Master of Science Degree Program in
Forensic Science
Marshall University
Master of Science Degree Program in
Forensic Science
Metropolitan State College of Denver
Bachelor of Science Degree Program
in Chemistry with a concentration in
Criminalistics
Michigan State University
Master of Science Degree Program (biology
and chemistry tracks)
University of Mississippi
Bachelor of Science Degree in Forensic
Chemistry
Ohio University
Bachelor of Science Degree in Forensic
Chemistry
SUNY at Albany
Master of Science Degree in Forensic
Molecular Biology
Virginia Commonwealth University
Bachelor of Science Degree in Forensic
Science
Virginia Commonwealth University
Master of Science Degree in Forensic Science
West Chester University
Bachelor of Science Degree Program In
Forensic and Toxicological Chemistry
West Virginia University
Bachelor of Science Degree—Forensic and
Investigative Science Program
SOURCE: www.aafs.org.
230
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
RESEARCH AS A COMPONENT OF FORENSIC SCIENCE
EDUCATION PROGRAMS
Student research and exposure to research is a critical component of an
appropriate forensic science education.36 Research funding supports both
faculty and graduate student research. Funding also supports the acquisi-
tion and maintenance of equipment and major research instrumentation
and laboratory renovation.37 As noted in Chapter 2, the level of funding
for forensic science research programs is seen by many observers as in-
adequate. Fisher notes that “labs are looking for more forensic scientists
at the master’s and doctorate level. For universities to run graduate-level
programs in the science, research dollars must be made available. However,
the amounts of such R&D funds available to support forensic science at
the National Institute of Justice are small and are all but non-existence
[sic] from the National Science Foundation, and other funding sources.”38
Likewise, NIJ reported in 2004 that, “Currently, no sustainable source of
State or Federal funding exists to support graduate education or research
in forensic science. Nor should state and local governments fund research,
as their funds have to support the service mission of the laboratories. The
National Institute of Justice has traditionally provided virtually all federal
research funding for forensic science, but additional funding from alterna-
tive sources is essential.”39
Many forensic degree programs are found at small colleges or universi-
ties with few graduate programs in science and where research resources
are limited. The lack of research funding has discouraged universities in the
United States from developing research-based forensic degree programs,
which leads to limited opportunities to attract graduate students into such
programs. Only a few universities offer Ph.D.-level education and research
opportunities in forensic science, and these are chemistry or biology pro-
grams with a forensic science focus. Most graduate programs in forensic
science are master’s programs, where financial support for graduate study
is limited.
In addition, the lack of research funds means that universities are
unlikely to develop research programs in forensic science. This lack of
funding discourages top scientists from exploring the many scientific issues
in the forensic science disciplines. This has become a vicious cycle during
36 To receive accreditation by FEPAC, a graduate program must include a component in
which each student completes an independent research project leading to a thesis or written
report, presented orally in a public forum for evaluation.
37 NIJ, 2004, op. cit., p. 23.
38 B.A.J. Fisher. 2003. Field needs adequate funding, national forensic science commission.
Forensic Focus. See http://forensicfocusmag.com/articles/3b1persp1.html.
39 NIJ, 2004, op. cit., p. 22.
EDUCATION AND TRAINING
231
which the lack of funding keeps top scientists away and their unavailability
discourages funding agencies from investing in forensic science research.
Traditional funding agencies have never had a mission to support forensic
science research.
STATUS OF TRAINING
Continuing education and in-service training in forensic science have
been significant issues for many years. Funding programs initially were
offered in the early 1970s through the Law Enforcement Assistance Ad-
ministration. As forensic science grew, the needs for ongoing training and
continuing education also grew. Several studies funded by NIJ have been
undertaken since 1999—Forensic Sciences: Review of Status and Needs
(1999); 40 Education and Training in Forensic Science: A Guide for Foren-
sic Science Laboratories, Educational Institutions, and Students (2004),41
developed by TWGED; and a report prepared by ASCLD for NIJ, published
in May 2004, which has become known as the 180-day Study Report: Sta-
tus and Needs of United States Crime Laboratories.42
The issues addressed in all of these reports are the same ones confront-
ing this committee today, namely the need for continuing education and the
ongoing training of working examiners in the various disciplines:
Prior to conducting analysis on evidence, forensic scientists require both
basic scientific education and discipline-specific training. To be in compli-
ance with widely-accepted accreditation standards, scientists in each of the
disciplines must have, at a minimum, a baccalaureate degree in a natural
science, forensic science, or a closely-related field. Each examiner must
also have successfully completed a competency test (usually after a training
period) prior to assuming independent casework.43
After the initial training period, continuing training is necessary to main-
tain and update knowledge and skills in new technology, equipment, and
methods.
Accreditation and certification programs require some type of continu-
ing education, and the various Scientific Working Groups (SWGs) recom-
40 National Institute of Justice. 1999. Forensic Sciences: Review of Status and Needs. Wash-
ington, DC: National Institute of Justice.
41 National Institute of Justice. 2004. Education and Training in Forensic Science: A Guide
for Forensic Science Laboratories, Educational Institutions, and Students. Washington, DC:
National Institute of Justice.
42 American Society of Crime Laboratory Directors. 2004. 180-day Study Report: Status
and Needs of United States Crime Laboratories. Largo, FL: ASCLD.
43 Ibid., p. 12.
232
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
mend such programs (see Chapter 7). Continuing professional development
also is a means of expanding expertise and career advancement.
Training Needs
As described by ASCLD:
When a new analyst or examiner is hired, usually a recent university
graduate, that individual requires initial training to build competency.
The length of the initial training provided to an analyst depends upon the
laboratory specialty area the trainee will enter.
For example, controlled substance analysts may require only six to twelve
months of training. Those training in experience-based disciplines such
as latent prints examinations, firearms and toolmarks analyses, and ques-
tioned documents examinations may require up to three years of training
before being permitted to perform independent casework. During their
training period, individuals in experience-based disciplines serve much like
an apprentice to a senior examiner.44
NIJ describes a variety of training needs for forensic scientists in crime
laboratories by position.45 For operational scientists, training is needed to
stay up to date in theoretical and practical issues (such as applying methods
and performing analyses). Everyone in a laboratory needs orientation in
such topics as the criminal justice system, the legal system, ethics, profes-
sional organizations, the basic philosophy of forensic science, overview
of disciplines of forensic science, quality control (e.g., good laboratory
practice), effective expert testimony, and safety. First-line supervisors need
training in quality assurance, case file review, and basic supervision skills;
and managers need training in fiscal management, quality systems manage-
ment, leadership, project management, human resource management, and
customer service. Training can be done in-service or through short courses.
The 1999 NIJ report identifies a number of examples of such courses.
On-the-job training involves specific challenges; it is labor intensive and
can be expensive.46 The costs of training include the salary of the trainee as
well as the opportunity cost of the lost productivity of the trainer. More-
over, there are no uniform recommendations on the content of training in
the forensic science disciplines. ASCLD has suggested some examples of ef-
forts to make training more efficient, including conducting some training in
conjunction with universities (essentially conducting training while forensic
44 ASCLD, op. cit., p. 15.
45 NIJ, 1999, op. cit.
46 Ibid.
EDUCATION AND TRAINING
233
scientists are students and before they are full-time employees), and some
laboratories have tried collaborating to train employees.
Continuing Education
Continuing education is critical for all personnel working in crime
laboratories as well as for those in other forensic science disciplines, such as
forensic pathologists or anthropologists. Some commonly used approaches
to continuing education are instructor led, professional conferences/semi-
nars, distributed learning, apprenticeship, residency, internship, teaching
and presentations by trainee/employee, and independent learning.47
The greatest issue for continuing education is quality. TWGED has
provided guidelines for training courses. First, there should be specific
eligibility requirements. Specified minimum and experiential requirements
should be consistent with recognized, peer-defined standards (e.g., SWGs,
ASCLD/Laboratory Accreditation Board). Factors such as drug use, credit
and criminal history, and personal references may affect career opportuni-
ties. Second, the structure of the training programs should include: learn-
ing objectives; instructor qualifications; student requirements; a detailed
syllabus; performance goals; periodic assessments; and competency test-
ing. Third, program content can include a mix of discipline-specific and
core elements. Core elements are essential topics that lay the foundation
for entry into professional practice, regardless of the specialty area. They
include the following:
• Standards of conduct—includes professional ethics training.
• Safety—includes biological, chemical, and physical hazards.
• Policy—includes such administrative and laboratory policies as
standard operating procedures, quality assurance, accreditation,
and security.
• Legal—includes expert testimony, depositions, rules of evi-
dence, criminal and civil law and procedures, and evidence
authentication.
• Evidence handling—includes interdisciplinary issues; recognition,
collection, and preservation of evidence; and chain of custody.
• Communication—includes written, verbal, and nonverbal com-
munication skills; report writing; exhibit and pretrial preparation;
and trial presentation.
Discipline-specific elements include such topics as the history of the
discipline, relevant literature, methodologies and validation studies, instru-
47 NIJ, 2004, op. cit.
234
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
mentation, statistics, knowledge of related fields, and testimony. Finally,
individuals should be assessed through mechanisms such as oral examina-
tions, written examinations, laboratory practicals and laboratory exercises,
mock trials, and the assessment of technical performance by appropriate
senior staff.
EDUCATION IN THE LEGAL SYSTEM
The forensic science community needs to educate those who use their
services and therefore needs to understand the services and their termi-
nology. Users of forensic science analyses include law enforcement of-
ficers, forensic pathologists, the bar, the judiciary, the general public, and
policymakers. This section focuses on education for the legal community
of judges, lawyers, and juries.
In recent years, some judges have struggled to understand increasingly
complex scientific evidence. Sophisticated epidemiology and toxicology
studies often are introduced in mass tort litigation. Complex econometric
models are common in antitrust cases. Disputes over sophisticated engineer-
ing principles often are at the core of patent litigation. Failure to consider
such evidence in a thoughtful and thorough manner threatens the integ-
rity and independence of the judiciary. Following the Daubert decision,
the Federal Judicial Center published the Reference Manual on Scientific
Evidence, and a second edition was issued in 2000 to “facilitate the pro-
cess of identifying and narrowing issues concerning scientific evidence by
outlining for judges the pivotal issues in the areas of science that are often
subject to dispute.”48 In addition, the courts have responded to the grow-
ing complexity of evidence by developing science-based judicial education
programs that explain scientific issues as they may arise in the context of
litigation. However, these courses are not mandatory, there is no fixed rou-
tine of continuing education in legal practice with regard to science, and
there are no good ways to measure the proficiency of judges who attend
these programs.
Pfefferli suggests that it is important to tailor education programs to
the needs of judges:
Forensic educational programs directed towards proficiency in evidence
matter must meet the needs of judicial magistrates, which goes beyond
a better understanding of the scientific principles and technical methods
applied to criminal investigations to demonstrate the existence of a crime.
These programs have to look at a variety of different kinds of forensic
evidence and their interacting processes, giving special attention to in-
dividualization/identification process; evidential value and evaluation of
48 Federal Judicial Center. 2000. Reference Manual on Scientific Evidence. 2nd ed., p. vi.
EDUCATION AND TRAINING
235
evidence; critical issues and quality assurance, and deterministic versus
probabilistic opinions of experts.”49
Pfefferli further notes that different members of the judicial commu-
nity should benefit from customized training. For example, prosecutors
and defense attorneys might benefit from a focus on the interpretation of
and requirements for evidence; and judges may benefit from information
on evaluating the scientific rigor of expert testimony and the reliability of
forensic evidence.
At the end of the 1990s, NIJ noted that training for the judiciary was
sporadic at the federal, state, and local levels and rare in general.50 Virginia
is one state that provides annual seminars for the judiciary, and ASCLD
formerly provided training to judges.
Reliance on DNA technology for identification purposes in forensic
science spurred the development of judicial education programs. As part
of the President’s DNA Initiative, the Department of Justice developed a
series of publications and online training programs designed for officers of
the courts, including judges. The course, “Principles of Forensic DNA for
Officers of the Court,” released in 2006, is designed “to educate criminal
justice professionals and other practitioners about the science of DNA
analysis and the legal issues regarding the use of DNA in the courtroom.”51
The 15 training modules in the course include:
• information on the biology of DNA;
• the history of forensic DNA analysis;
• how to understand a forensic DNA laboratory report;
• factors in postconviction DNA testing requests;
• information about forensic DNA databases;
• issues involved in presenting DNA evidence in the courtroom;
• information on the admissibility issues regarding the use of DNA
evidence; and
• an extensive glossary with basic definitions relating to forensic
DNA analysis.
But other than this initiative, judicial education programs have not focused
on the forensic science disciplines.
49 P.W. Pfefferli. 2003. Forensic Education & Training of Judges and Law Enforcement
Magistrates. Presentation at the International Society for the Reform of Criminal Law, 17th
International Conference, The Hague. Available at www.isrcl.org/Papers/Pfefferli.pdf, p. 2.
50 NIJ, 1999, op. cit.
51 Office of Justice Programs, U.S. Department of Justice. 2006. Department of Justice Re-
leases Interactive Training Tool on Principles of Forensic DNA. Available at www.ojp.usdoj.
gov/newsroom/pressreleases/2006/NIJ06036.htm.
236
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
Another avenue for education would be courses taught by forensic sci-
ence education programs, but geared to continuing education participants
rather than full-time students. The University of Florida, for example, offers
a distance learning, continuing education course for Florida lawyers that is
certified by the Florida Bar Association and that covers a variety of forensic
science topics. Professional organizations also have offered courses. For
example, the National District Attorneys Association founded the American
Prosecutors Research Institute (APRI) as a nonprofit research, technical as-
sistance, and program development resource for prosecutors at all levels of
government. In the past, APRI has offered training opportunities in forensic
science, although its programs have decreased in recent years. The National
College of District Attorneys and the National Association of Criminal De-
fense Attorneys also periodically offer courses in forensic science. A third
option is for law schools to offer more courses in the forensic disciplines,
statistics, or basic science methodology, or to provide credit for students
wishing to take courses in those fields.
Unfortunately, it might be too late to effectively train most lawyers
and judges once they enter their professional fields. Training programs are
beneficial in the short term, because they offer responsible jurists a way to
learn what they need to know. For the long term, however, the best way to
get lawyers and judges up to speed is for law schools to offer better courses
in forensic science in their curricula.
Juries and Scientific Evidence
Despite common stereotypes about jury incompetence and runaway
juries, research has demonstrated a consistency between jury and bench
trial verdicts, regardless of the level of scientific complexity involved.52 Even
in cases in which jurors express incomplete and flawed understandings of
scientific and technical evidence, researchers have described jury results as
generally justified.53 Moreover, it has been suggested that jurors’ errors in
interpreting evidentiary information are often traceable in part to mislead-
ing presentations and instructions by attorneys and judges.54
However, juries have been described as least comfortable and compe-
52 V.P. Hans, D.H. Kaye, M.B. Dann, E.J. Farley, and S. Albertson. 2007. Science in the Jury
Box: Jurors’ Views and Understanding of Mitochondrial DNA Evidence. Cornell Law School
Legal Studies Research Paper No. 07-02. Available at http://ssrn.com/abstract=1025582;
T. Eisenberg, P.L. Hannaford-Agor, V.P. Hans, N.L. Mott, G.T. Munsterman, S.J. Schwab, and
M.T. Wells. 2005. Judge-jury agreement in criminal cases: A partial replication of Kalven &
Zeisel’s The American Jury. Journal of Empirical Legal Studies 2:171-206.
53 Hans, op. cit.
54 Ibid.
EDUCATION AND TRAINING
237
tent with regard to statistical evidence.55 Interestingly, juries are often hesi-
tant to give as much credence as experts suggest to the statistics associated
with DNA evidence.56 Juries frequently raise concerns about laboratory
error and sample contamination, even when opposing counsel does not
introduce such issues.57
Jurors’ use and comprehension of forensic evidence is not well stud-
ied. Better understanding is needed in this area, and recommendations
are needed for programs or methods that will better prepare juries in ap-
propriate, unbiased ways for trials in which scientific evidence is expected
to play a large or pivotal role. However, several studies indicate that trial
judges agree with jury verdicts in an overwhelming proportion of criminal
cases.58
CONCLUSIONS AND RECOMMENDATION
Despite major strides made in recent years in bringing a measure of
standardization to forensic science education programs and boosting their
quality, more information is required on the number of programs that are
available and the depth and breadth of the course offerings. It appears that
there are no formal and systematically applied standards or standardization
requirements for forensic science education programs, making the quality
and relevance of existing programs uncertain. Moreover, there are no re-
quirements or incentives in place to ensure that forensic science education
programs must be accredited in order to receive federal funds.
Current funding is insufficient for developing graduate training pro-
grams that cut across organizational, programmatic, and disciplinary
boundaries and that can attract students in the life and physical sciences
to pursue graduate studies in multidisciplinary fields critical to forensic
science. Similarly, too few funding sources exist for research conducted in
association with forensic science graduate programs.
In addition, forensic researchers, legal scholars, and forensic practitio-
ners and members of the bench and bar do not have sufficient opportuni-
55 Ibid. See also W.C. Thompson and E.L. Schumann. 1987. Interpretation of statistical
evidence in criminal trials: The prosecutor’s fallacy and the defense attorney’s fallacy. Law
and Human Behavior 11:167-187; W.C. Thompson. 1989. Are juries competent to evaluate
statistical evidence? Law and Contemporary Problems 52:9-41.
56 J.J. Koehler. 2001. When are people persuaded by DNA match statistics? Law and Hu-
man Behavior 25:493-513; D.A. Nance and S.B. Morris. 2002. An empirical assessment of
presentation formats for trace evidence with a relatively large and quantifiable random match
probability. Jurimetrics Journal 42:403-448; J. Schklar and S.S. Diamond. 1999. Juror Under-
standing of DNA evidence: An empirical assessment of presentation formats for trace evidence
with a relatively small random-match probability. Journal of Legal Studies 34:395-444.
57 Schklar and Diamond, op. cit.
58 Hannaford-Agor, Hans, and Munsterman, op. cit.
238
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
ties and venues for interaction and sharing information. This impedes the
translation of advances in forensic science to legal scholars and litigators
(including civil litigators, prosecutors, and criminal defense counsel), fed-
eral, state, and local legislators, members of the judiciary, and law enforce-
ment officials. The result is needless delay in improvements in criminal and
civil laws and procedures, law enforcement practices, litigation strategies,
and judicial decisionmaking.
Lawyers and judges often have insufficient training and background in
scientific methods, and they often fail to fully comprehend the approaches
employed by different forensic science disciplines and the strengths and
vulnerabilities of forensic science evidence offered during trials.
Forensic science examiners need additional training in the principles,
practices, and contexts of scientific methodology, as well as in the distinc-
tive features of their specialty. Training should move well beyond intern-like
transmittal of practices to teaching that is based on scientifically valid prin-
ciples. In addition to the practical experience and learning acquired during
an internship, a trainee should acquire rigorous interdisciplinary education
and training in the scientific areas that constitute the basis for the particular
forensic discipline and should also receive instruction on how to document
and report the analysis. A trainee in addition should have working knowl-
edge of basic probability and statistics as they relate to the tasks he or she
may need to address in the applicable discipline.
To correct some of the existing deficiencies, it is crucially important
to improve undergraduate and graduate forensic science programs. The
legitimization of practices in the forensic science disciplines must be based
on established scientific knowledge, principles, and practices, which are best
learned through formal education. Apprenticeship has a secondary role;
under no circumstances can it supplant the need for the scientific basis of
education and of the practice of forensic science. In addition, lawyers and
judges often have insufficient training and background in scientific method-
ology, and they often fail to fully comprehend the approaches employed by
different forensic science disciplines and the degree of reliability of forensic
science evidence that is offered in trial. Such training is essential, because
any checklist for the admissibility of scientific or technical testimony (such
as the Daubert standards) is imperfect. Conformance with items on a
checklist can suggest that testimony is reliable, but it does not guarantee
it. Better connections must be established and promoted among experts
in forensic science and legal scholars and practitioners. The fruits of any
advances in the forensic science disciplines should be transferred directly
to legal scholars and practitioners (including civil litigators, prosecutors,
and criminal defense counsel), federal, state, and local legislators, members
of the judiciary, and law enforcement officials, so that appropriate adjust-
ments can be made in criminal and civil laws and procedures, model jury
EDUCATION AND TRAINING
239
instructions, law enforcement practices, litigation strategies, and judicial
decisionmaking. Law schools should enhance this connection by offering
courses in forensic science, by offering credit for forensic science courses
students take in other colleges, and by developing joint degree programs.
Recommendation 10:
To attract students in the physical and life sciences to pursue gradu-
ate studies in multidisciplinary fields critical to forensic science
practice, Congress should authorize and appropriate funds to the
National Institute of Forensic Science (NIFS) to work with appro-
priate organizations and educational institutions to improve and
develop graduate education programs designed to cut across orga-
nizational, programmatic, and disciplinary boundaries. To make
these programs appealing to potential students, they must include
attractive scholarship and fellowship offerings. Emphasis should
be placed on developing and improving research methods and
methodologies applicable to forensic science practice and on fund-
ing research programs to attract research universities and students
in fields relevant to forensic science. NIFS should also support
law school administrators and judicial education organizations in
establishing continuing legal education programs for law students,
practitioners, and judges.
9
Medical Examiner and Coroner
Systems: Current and Future Needs
The role of coroner emerged in England in the ninth or tenth century. In
the twelfth century, under King Richard I, the role of coroner was formal-
ized in the Articles of Eyre.1 Coroners or “crowners” were “guardians of
the crown’s pleas.” The office originally was created to provide a local offi-
cial whose primary duty was to protect the financial interest of the crown in
criminal proceedings. On behalf of the crown, the crowner was responsible
for inquests to confirm the identity of the deceased, determine the cause and
manner of death, confiscate property, collect death duties, and investigate
treasure troves. Through the implementation of British Common Law, set-
tlers in North America brought coroner laws to the early colonies.2 More-
over, early state constitutions explicitly mentioned the position of coroner,
often without defining the role.3 Georgia’s state constitution was the first.
Article XL stated that, “[i]n the absence of the chief justice, the senior
justice on the bench shall act as chief justice with the clerk of the county,
attorney for the State, sheriff, coroner, constable, and the jurors.”4
The first formal acknowledgment of the need for medical training for
coroners occurred in 1860, when Maryland passed legislation allowing
coroners to require that a physician be present at an inquest. In 1877,
Massachusetts became the first state to replace its coroners with medical
1 Institute of Medicine (IOM). 2003. Medicolegal Death Investigation System: Workshop
Summary. Washington, DC: The National Academies Press, p. 8.
2 Ibid.
3 Ibid.
4 GA. CONST. of 1777, art. XL.
241
242
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
examiners, who were required to be physicians. Physician medical examin-
ers began performing autopsies for coroners in Baltimore in 1890. In 1918,
New York City instituted a medical examiner system.5
The National Academy of Sciences first addressed the state of death
investigation in 1928. The National Research Council’s (NRC’s) Committee
on Medical Legal Problems, whose members included Roscoe Pound, Dean
of Harvard Law School, and John Henry Wigmore, Dean of Northwestern
Law School, released a harshly critical report entitled The Coroner and the
Medical Examiner.6 In its first four recommendations, the 1928 committee
suggested the following: (1) that the office of coroner be abolished. It is an
anachronistic institution which has conclusively demonstrated its incapac-
ity to perform the functions customarily required of it; (2) that the medical
duties of the coroner’s office be vested in the office of medical examiner;
(3) that the office of medical examiner be headed by a scientifically trained
and competent pathologist, selected and retained under civil service, and
compensated by a salary which will attract men of genuine scientific train-
ing and ability; and (4) that the office of medical examiner be provided
with the services of a staff competent in toxicology, bacteriology and other
sciences necessary in the scientific investigation of causes of death, and with
7
adequate scientific equipment
Additionally, the 1928 committee recommended the development of
medicolegal institutes, which would affiliate medical examiners with hos-
pitals and universities.8 In 1932, another NRC committee produced a
review of existing medicolegal collaborations, which were mostly located
in Europe.9 This committee again advised a larger role for medical doctors
within forensic science and criminal proceedings.10
In 1954, the National Conference of Commissioners on Uniform State
Laws issued the Model Post-Mortem Examinations Act (the Model Act).11
In its prefatory note, the Model Act stated the following:
The purpose of the Post-Mortem Examinations Act is to provide a means
whereby greater competence can be assured in determining causes of death
where criminal liability may be involved. Experience has shown that many
5 IOM, 2003, op. cit.
6 Bulletin of the National Research Council, No. 64. 1928. The Coroner and the Medical
Examiner. Washington, DC: National Research Council.
7 Ibid., p. 89.
8 Ibid., p. 90.
9 Bulletin of the National Research Council, No. 87. 1932. Possibilities and Need for
Development of Legal Medicine in the United States. Washington, DC: National Research
Council.
10 Ibid., pp. 111-112.
11The model act has been posted by the National Association of Medical Examiners (NAME)
MEDICAL EXAMINER AND CORONER SYSTEMS
243
elected coroners are not well trained in the field of pathology, and the Act
should set up in each state an Office headed by a trained pathologist, this
Office to have jurisdiction over post-mortem examinations for criminal
purposes. The Office would supersede the authority of Coroner’s Offices
in this field.12
Following the release of the Model Act, a number of states imple-
mented the proposed guidelines. Between 1960 and 1979, 12 states con-
verted from coroners to medical examiners.13 However, in the subsequent
decades, updates to death investigation organizations slowed considerably.
Between 1980 and 1999, only three states converted from coroner to medi-
cal examiner systems.14 Since then, 11 states with coroners have remained
unchanged, and only a handful of individual counties have independently
implemented recommendations from the Model Act.15 Several of the re-
maining coroner states have provisions in their state constitutions requir-
ing that coroners be elected.16 Although these provisions may be amended
or removed, to do so will require political momentum. However, these
provisions do not prohibit the addition of appointed medical examiners.
For example, Kentucky has maintained county coroners, as dictated by its
constitution, while also implementing medical examiners to serve at the
state and district levels.17
MEDICAL EXAMINERS AND CORONERS (ME/C)
About 2,342 medical examiner and coroner offices provided death
investigation services across the United States in 2004.18 Individual state
statutes determine whether a medical examiner or coroner delivers death
investigation services, which include death scene investigations, medical
investigations, reviews of medical records, medicolegal autopsies, determi-
nation of the cause and manner of death, and completion of the certificate
of death.
12 Ibid.
13 Hanzlick, 2003, op. cit.
14 Ibid.
15 Ibid.
16 ARK. CONST. art. VII, § 46; COLO. CONST. art. XIV, § 8; IDAHO CONST. art. XVIII,
§ 6; IND. CONST. art. VI, § 2; MISS. CONST. ANN. art. V, § 135.
17 KY. CONST. § 99; KY. REV. STAT. ANN § 72.210 (2007).
18 Hanzlick, 2007, op. cit. The Bureau of Justice Statistics omits Louisiana and classifies
Texas as a medical examiner state, and accordingly reports the total as 1,998. According to
Hanzlick, many of Texas’s 254 counties maintain justice of the peace/coroner’s offices.
244
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
ME/C JURISDICTION
ME/C jurisdiction is determined by each state code and generally ex-
tends to deaths that are sudden and unexpected, deaths that have no at-
tending physician, and all suspicious and violent deaths. The actual classes
of death over which the ME/C assumes jurisdiction vary from state to
state. Classes may include deaths resulting from injury, such as by violence
or poisoning; by circumstance, such as related to fire or under anesthesia;
by decedent status, such as prisoners or mental health patients; or by time-
frame, such as deaths that occur within 24 hours of admission to a hospital.
About 1 percent of the U.S. population (about 2.6 million people) dies each
year. In 2004, ME/C offices received nearly 1 million reports of deaths, con-
stituting between 30 to 40 percent of all U.S. deaths, and accepted about
one half of those (500,000, or 1 in 6 deaths) for further investigation and
certification.19 Depending on the jurisdiction, about 40 to 50 percent of
deaths referred to the ME/C will, after investigation and examination, be
attributed to natural causes, 27 to 40 percent to accident, 12 to 15 percent
to suicide, 7 to 10 percent to homicide, and 1 percent as undetermined.20
ME/C MISSIONS
ME/Cs serve dual purposes. First, they serve the criminal justice system
as medical detectives by identifying and documenting pathologic findings
in suspicious or violent deaths and testifying in courts as expert medical
witnesses. Second, as public health officers, they surveil for index cases of
infection or toxicity that may herald biological or chemical terrorism, iden-
tify diseases with epidemic potential, and document injury trends.
Additional ME/C responsibilities include the response to and investiga-
tion of all deaths resulting from all hazards, including terrorism and mass
fatality events, and the identification of the unidentified dead. In addition,
some 13,000 unidentified individuals are currently entered into databases
for the unidentified dead, and many thousands more are entered as missing
persons, as thousands of families search for them. Accessing these data-
bases and matching them to the many thousands of individuals entered as
missing persons is a major challenge for all organizations. Eighty percent
of surveyed ME/C systems “rarely or never” utilize the National Crime
Information Center Unidentified and Missing Persons (NCIC UP/MP) files
to match their dead bodies to those reported as missing by law enforcement
19 J.M. Hickman, K.A. Hughes, K.J. Strom, and J.D. Ropero-Miller. 2004. Medical Exam-
iners and Coroners’ Offices, 2004. U.S. Department of Justice, Bureau of Justice Statistics
Special Report NCJ216756.
state.va.us/medExam/Reports.htm.
MEDICAL EXAMINER AND CORONER SYSTEMS
245
agencies, even though NCIC recently granted access to the files by ME/Cs.
Access, however, is not uniform, and the information that may be available
could be limited.21
The newly established National Institute of Justice (NIJ) Office of Jus-
tice Programs, National Missing and Unidentified Persons System, NamUs,
remains underutilized. Identification efforts for either of the national gov-
ernment databases require multiple investigative as well as data entry skills,
and they are labor intensive. ME/Cs need a functional death investigation
system; staff to develop identification features; and the necessary education,
training, and equipment to utilize the multiple databases that are necessary
to identify the unidentified dead and to meet the increasing societal expecta-
tions that ME/C systems should be able to identify the unidentified.22 Criti-
cally needed is a federal requirement that ME/C systems enter information
on the unidentified into federal databases. A later section in this report
discusses the medical examiner/coroner role in homeland security.
VARIATIONS IN ME/C SYSTEMS
As of 2004, administratively, 16 states had a centralized statewide
medical examiner system, 14 had a county coroner system, 7 had a county
medical examiner system, and 13 had a mixed county ME/C system.23 Eight
states had hybrid arrangements, with coroners and a state medical examiner
office that performed medicolegal duties. The District of Columbia relies
on a medical examiner system (see Figure 9-1). In large cities and counties,
forensic pathologists serve both as medical examiners and pathologists. A
few large systems, such as those of Los Angeles, California, and Cuyahoga
County, Ohio, bear the historical name of a coroner system, but function
essentially under a medical examiner structure. Eighty percent of ME/C
offices are run by county coroners.
In total, there are approximately 2,342 separate death investigation
jurisdictions.24 Of 1,590 coroner offices in the United States, 82 serve juris-
dictions with more than 250,000 people; 660 medium-sized offices serve be-
tween 25,000 and 249,999 people; and 848 offices serve small jurisdictions
21 J.C.U. Downs, Board Member and Chair, Governmental Affairs Committee, National
Association of Medical Examiners; Vice Chair, Consortium of Forensic Science Organiza-
tions; Coastal Regional Medical Examiner, Georgia Bureau of Investigation. Presentation to
the committee. June 5, 2007.
22 National Missing and Unidentified Persons System, NamUS. See www.namus.gov.
23 Downs, op. cit.
24 R. Hanzlick. “An Overview of Medical Examiner/Coroner Systems in the United States-
Development, Current Status, Issues, and Needs.” Presentation to the committee. June 5,
2007.
246
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
Figure 9-1 Death investigation systems in the United States, 2004.
SOURCE: J.M. Hickman, K.A. Hughes, K.J. Strom, and J.D. Ropero-Miller.
2004. Medical Examiners and Coroners’ Offices, 2004. U.S. Department of
Justice, Bureau of Justice Statistics Special Report NCJ216756.
(In
2007,
Kentucky became legally a mixed county ME/C system.a)
a Constitution of the State of Kentucky, § 99.
of fewer than 25,000 people.25 The hodgepodge and multiplicity of systems
and controlling statutes makes standardization of performance difficult, if
not impossible. Some observers believe that a revisiting of the model code is
required, as has been proposed by numerous study groups over the years, in
order to work toward the development of a modern model code for death
investigation systems that utilizes new and available technologies that are
responsive to the needs of the citizens.26
25 Ibid.
26 Ibid.
MEDICAL EXAMINER AND CORONER SYSTEMS
247
QUALIFICATIONS OF CORONERS AND MEDICAL EXAMINERS
Jurisdictions vary in terms of the required qualifications, skills, and
activities for death investigators. Coroners are constitutional officers, with
82 percent being elected and 18 percent appointed.27 Coroners as elected
officials fulfill requirements for residency, minimum age, and any other
qualifications required by statute. They may or may not be physicians, may
or may not have medical training, and may or may not perform autopsies
(see Box 9-1). Some serve as administrators of death investigation systems,
while others are responsible solely for decisions regarding the cause and
manner of death. Typical qualifications for election as a coroner include
being a registered voter, attaining a minimum age requirement ranging from
18 to 25 years, being free of felony convictions, and completing a training
program, which can be of varying length. The selection pool is local and
small (because work is inconvenient and pay is relatively low), and medi-
cal training is not always a requirement. Coroners are independent of law
enforcement and other agencies, but as elected officials they must be re-
sponsive to the public, and this may lead to difficulty in making unpopular
determinations of the cause and manner of death.
Recently a 17-year-old high school senior successfully completed the
coroner’s examination and was appointed a deputy coroner in an Indi-
ana jurisdiction.28 In one state, justices of the peace are charged with
determining cause and manner of death, but they are not medical death
investigators. Whether coroners refer cases to pathologists for autopsy is
largely budget driven (an autopsy costs about $2,000), although access to
pathologists may be an issue if regional interjurisdictional arrangements do
not exist. Even so, 84 percent of coroner offices see a need for professional
standards,29 and they identify resources for infrastructure, staff, and train-
ing as continuing needs.
Options for improving death investigation by coroners include (1) re-
placing coroner systems with medical examiner systems; (2) increasing the
statutory requirements for performance of coroners; or (3) infusing funding
to improve the capabilities of coroners.30
Some coroners have suggested establishing a “Coroner College.”31
Coroners want grants for equipment, accreditation incentives, and access
to forensic laboratories, NCIC, and automated fingerprint identification
27 P.M. Murphy, Coroner, Clark County Coroner’s Office, Las Vegas, Nevada. “The Coroner
System.” Presentation to the committee. June 5, 2007.
28 “Teen Becomes Indiana’s Youngest Coroner.” See http://happynews.com/news/5122007/
teen-becomes-indiana-youngest-coroner.htm.
29 Murphy, op. cit.
30 Ibid.
31 Ibid.
248
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
Box 9-1
What Is an Autopsy?
An autopsy is the systematic external and internal examination of a body
to establish the presence or absence of disease by gross and microscopic exami-
nation of body tissues. The pathologist makes a surgical incision from shoulder
to shoulder and from the midpoint of the shoulder to shoulder incision to the
pubic bone. The skin is reflected, and each organ in the chest, including the neck
structures, abdomen, and pelvis is removed and carefully examined. An incision
is also made from the mastoid bone on the right to the mastoid bone on the left,
and the scalp is pulled forward and the bony cap removed to reveal the brain. The
brain is removed and examined. The pathologist takes a small sample or biopsy
of all tissues and archives them in formalin to maintain them for future reference.
In medicolegal autopsies, all tissues other than the biopsies are replaced in the
body, except for perhaps the brain or heart, which may be retained and exam-
ined by consultants for diagnoses causing or contributing to death. For hospital
autopsies, depending on the list of permissions given by the person qualified to
give permission, tissues and organs may be retained for study, research, or other
investigations. The pathologist submits small 2 × 2 cm sections of tissue to the
histology laboratory, where thin slices a few microns thick are subjected to chemi-
cal treatment to preserve them. The tissue blocks are shaved, so that a thin layer
can be mounted on a glass slide and stained with dyes to differentiate cells. The
pathologist can recognize diseases in the stained tissue. Medicolegal autopsies
are conducted to determine the cause of death; assist with the determination of
the manner of death as natural, suicide, homicide, or accident; collect medical evi-
dence that may be useful for public health or the courts; and develop information
that may be useful for reconstructing how the person received a fatal injury.
systems.32 Lack of direct access to laboratories and insufficient funding for
testing impair the expertise of coroners. Some coroners are amenable to
protocols that would ensure the use of forensic pathologists for autopsy.
However, even with these improvements, the assessment of the dead for
disease, injury, medical history, and laboratory studies is a medical decision,
as opposed to a decision that would be made by a lay person with investiga-
tive and some medical training. The disconnect between the determination
a medical professional may make regarding the cause and manner of death
and what the coroner may independently decide and certify as the cause
and manner of death remains the weakest link in the process.
In contrast, medical examiners are almost always physicians, are ap-
pointed, and are often pathologists or forensic pathologists. They bring
32 Murphy, op. cit.
MEDICAL EXAMINER AND CORONER SYSTEMS
249
the body of knowledge of medicine to bear when assessing the history and
physical findings and when deciding on the appropriate laboratory studies
needed to determine the cause and manner of death. In statewide systems,
cities and counties have local medical examiners that are physicians trained
to receive the reports of death, decide jurisdiction, examine the body, and
make a determination of the cause and manner of death. They certify lo-
cally many obvious natural and accidental deaths. In statewide and region-
alized statewide systems, local medical examiners do not need to be forensic
pathologists and do not perform autopsies, but they do refer, according
to protocols, deaths from violence—particularly suicides, homicides, and
deaths occurring under suspicious circumstances—to a central or regional
autopsy facility for autopsy and further follow-up by a forensic pathologist.
In hybrid or mixed state systems, coroners may refer cases for autopsy to
forensic pathologists, but there is no supervision or quality assurance to
ensure that the coroner’s certification of the cause of death and manner of
death is concordant with the pathologist’s conclusions.
ME/C ADMINISTRATION AND OVERSIGHT
ME/Cs have varying forms of organizational oversight. Forty-three
percent of the U.S. population is served by systems that are independent,
33 percent by offices residing administratively in public safety or law en-
forcement organizations, 14 percent by offices in health departments, and
10 percent by offices within a forensic laboratory. Government reports over
the years have recommended that a medical examiner system should be
an independent agency or should report to a commission so that it avoids
any conflicts of interest and so that it reports directly to the jurisdictional
governing body. When this is not possible, incorporation into a health de-
partment, instead of into law enforcement agencies, seems to provide the
next most compatible location.33
ME/C STAFFING AND FUNDING
ME/C offices serving populations of less than 25,000 people employ 1
to 2 full-time equivalent (FTE) staff members, while offices serving popu-
lations of 1 million or more employ an average of 50 FTEs.34 Competent
death investigations require that trained medical death investigators attend
scenes; medically credentialed persons perform external physical examina-
tions; and forensic pathologists perform medicolegal autopsies, employ and
33 V. Weedn. “Legal Impediment to Adequate Medicolegal Death Investigation.” Presenta-
tion to the committee. June 5, 2007.
34 Downs, op. cit.
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STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
interpret radiographs, prepare records, maintain databases, and provide
competent and credible testimony in courts. Staff requires training and
expensive equipment to utilize and integrate new technologies. Efforts are
restricted by budgets, and budgets vary widely, ranging from $18,000 to
$2.5 million annually for county systems, depending on the size of the pop-
ulation. A 2007 survey conducted for the National Association of Medical
Examiners (NAME) by Hanzlick revealed that county systems’ per capita
cost ranged from $1.31 to $9.19, with a mean of $2.89. State systems
benefit from economies of scale and function more economically at $.64 to
$2.81, with a mean of $1.76. 35 The large variation in qualifications, staff-
ing, budgets, and the multiple skills required for competent death investiga-
tions, especially in small jurisdictions, has resulted in marked variation in
the quantity and quality of death investigations in the United States.
Physical facilities also vary in adequacy. Only one-third of offices have
in-house facilities to perform the histology needed to make microscopic
diagnoses on tissues sampled at autopsy. Only one-third have in-house
toxicology capabilities to identify drugs present in the deceased that either
contributed to or were the primary cause of death. One-third do not have
radiology services in-house that would allow the identification of missiles,
disease, bony injury or identification features in decedents.36 Some coroner
systems do not have any physical facility at all.
It is clear that death investigations in the United States rely on a patch-
work of coroners and medical examiners and that these vary greatly in the
budgets, staff, equipment, and training available to them, and in the qual-
ity of services they provide. No matter what the level of quality of other
forensic science disciplines that are supported by a particular jurisdiction
may be, if the death investigation does not include competent death inves-
tigation and forensic pathology services, both civil and criminal cases may
be compromised.
All ME/Cs share the following deficiencies to some degree:
• imperfect legal structure/code controlling death investigations;
• inadequate expertise to investigate and medically assess decedents;
• inadequate resources to perform competent death investigations;
• inadequate facilities and equipment for carrying out body views
and conducting autopsies;
• inadequate technical infrastructure (laboratory support);
• inadequate training of personnel in the forensic science disciplines;
35 R. Hanzlick. “An Overview of Medical Examiner/Coroner Systems in the United States—
Development, Current Status, Issues, and Needs.” Presentation to the committee. June 5,
2007.
36 Murphy, op. cit.
MEDICAL EXAMINER AND CORONER SYSTEMS
251
• lack of best practices and information standards;
• lack of quality measures and controls;
• lack of information systems; and
• lack of translational research and associations with university
research.37
THE MOVEMENT TO CONVERT CORONER SYSTEMS TO
MEDICAL EXAMINER SYSTEMS
As mentioned above, the movement to improve death investigations
by bringing in medical expertise in the form of medical examiner systems
is not new. Early NRC reports were followed in 2003 by an Institute of
Medicine Workshop on the Medicolegal Death Investigation System, which
also concluded that the medical examiner system is the best organizational
structure for utilizing medical expertise to assess the presence or absence of
disease and injury and for correlating the medical findings and investigative
information to arrive at a determination of cause of death and manner of
death. Progress has been very slow.
Additional impediments to progress include the need for some states to
change state constitutions or codes, the political constituent base underpin-
ning local coroners, insufficient population and budget to support a com-
petent independent system in small localities, an unwillingness to develop
cooperative regionalization for provision of autopsy services, the shortage
of physicians—especially pathologists and forensic pathologists—and lack
of interest, advocacy, or the perception of need.38 To implement such con-
versions, the United States will require a national vision, a model code,
increased numbers of forensic pathologists, and funding for infrastructure,
staff, education, training, and equipment.
One possible model for providing incentives for these conversions could
be an initiative similar to the Law Enforcement Assistance Administration
(LEAA). LEAA was a federal agency operating from 1968 to 1982 with
the purpose of funneling federal funding to state and local law enforce-
ment agencies. The agency created state planning agencies and funded
educational programs, research, and matching grants for physical plants
and a variety of local crime control initiatives. For example, an $8 million
grant to Virginia established the Virginia Department of Forensic Science,
a premier state forensic laboratory that provides forensic science services
to all state agencies and the Medical Examiner System in Virginia. 39 If
37 Downs, op. cit.
38 Downs, op. cit; Weedn, op. cit., Hanzlick, op. cit.
39 Law Enforcement Assistance Administration at www.archives.gov/research/guide-fed-
records/groups/423.html.
252
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
the capitalization of a medical examiner system is the major impediment
to progress, an LEAA model can remove that barrier. However, a Medical
Examiner Assistance Administration, or MEAA, would need to be struc-
tured so that the medical examiner would not be considered a servant of
law enforcement and thus would not be placed in a position in which there
is even an appearance of conflict of interest. Sensitive cases, such as police
shootings and police-encounter deaths, jail and prison deaths, deaths in
public institutions, and others, require an unbiased death investigation
that is clearly independent of law enforcement. All previous studies have
recommended that the medical examiner be independent of other agencies,
or if they are to be under the umbrella of a central agency that the report-
ing chain should be through a health department. The medical examiner is
first and foremost a physician, whose education, training, and experience
is in the application of the body of medicine to situations that have a legal
dimension that must be answered by a practitioner of medicine.
UTILIZATION OF BEST PRACTICES
The tremendous variation in death investigation systems also impedes
interagency and interjurisdictional communication and the development of
standardized best practices both in death investigation and in the perfor-
mance of medicolegal autopsies.
NIJ and NAME have attempted to provide guidance for best practices.
The NIJ document Death Investigation: A Guide for the Scene Investiga-
tor; Medicolegal Death Investigator: A Systematic Training Program for
the Professional Death Investigator; the NAME Autopsy Standards and
Inspection Checklist; and NAME’s Forensic Pathology Autopsy Standards
are available, but there is no incentive for death investigation systems to
adopt them for use.40
Compliance is further limited because of heavy case loads, deficiencies
in trained staff, absence of equipment, nonavailability of required day-to-
day and consultative services, and the presence of contradictory policies
and practices.
40 U.S. Department of Justice, Office of Justice Programs, National Institute of Justice.
Death Investigation: A Guide for the Scene Investigator. Available at www.ojp.usdoj.gov; S.C.
Clark, M.F. Ernst, W.D. Haglund, and J.M. Jentzen. 1996. Medicolegal Death Investigator: A
Systematic Training Program for the Professional Death Investigator. Occupational Research
and Assessment. Grand Rapids; NAME Autopsy Standards and Inspection Checklist at www.
thename.org; and G. Peterson and S. Clark. 2006. Forensic Autopsy Performance Standards
MEDICAL EXAMINER AND CORONER SYSTEMS
253
POTENTIAL SCIENTIFIC ADVANCES THAT MAY ASSIST ME/Cs
In addition to current technologies, which are often unavailable and
underutilized, new technologies are on the horizon to assist death investiga-
tors, medical examiners, and forensic pathologists.
Computerization of case records and the development of case infor-
mation databases should be standard in any death investigation office, so
that death data may be tracked for trends, response to public health and
public safety interventions can be streamlined and accelerated, and continu-
ing quality assurance measures can be implemented. There is no standard
method of sample and data collection for ME/C systems. Multiple systems
are commercially available that can be structured to meet the particular
needs of any death investigation system. The initial cost of such systems
is significant, and they require continuing maintenance, which rules out
their utilization by small and/or underfunded offices. Even if such com-
puter systems were present in each office, there is no standardization that
would allow them to talk to one another, a necessity in a multijurisdictional
event such as the Hurricane Katrina disaster, for which databases across
states were critical to the identification of the dead and the tracking of
survivors.
Laboratory information systems are available for the management of
medical evidence, laboratory specimens, laboratory data, forensic samples,
and personal effects. Effective database management allows information to
be gathered and utilized by staff and analyzed for trends and quality issues.
Effective databases are essential for managing any multiple fatality event.
Rapid electronic transmission of reports is feasible if encryption software
is available. At this time, ME/C information systems are less interoperable
than current Automated Fingerprint Identification Systems (see Chapter
10). Although the standard autopsy report generally covers the internal
examination by organ systems, reporting formats are not standardized
among jurisdictions. And, although the NAME Forensic Autopsy Perfor-
mance Standards provide a model for reporting autopsy findings,41 it is not
widely used.
Imaging equipment is critical to documenting findings sufficient for
courts, for review by outside experts, and for reevaluation as medical
knowledge advances. Fluoroscopy is helpful for locating missiles. Com-
puted tomography scanning and nuclear magnetic resonance imaging may
often present a better visual picture of some injuries and would likely re-
duce the number of autopsies carried out to rule out occult injury and to
document in greater detail the extent of injury in accidents. The “Virtual
41 G. Peterson and S. Clark. 2006. Forensic Autopsy Performance Standards. Available at
254
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
Autopsy,” or “virtopsy,” utilizes multislice computed tomography and mag-
netic resonance imaging combined with 3-D imaging technology to create
vivid images of the interior of the human body.42
The advantages of the virtopsy are that it is not invasive or destruc-
tive of tissue and can provide dramatic pictures of skeletal and soft tissue
injury. It also provides some information when there is a religious objection
to autopsy. Virtopsy has the potential to detect internal bleeding, missile
paths, bone and missile fragmentation, fracture patterns, brain contusion,
and gas embolism, in addition to occult fractures that are technically dif-
ficult to demonstrate during the traditional autopsy. Although a standard
forensic autopsy is needed to recover evidence such as bullets or bomb frag-
ments within the body and to collect specimens for testing, virtopsy offers
a valuable tool for examination when dissection of the body is not feasible,
when evidence is hard to visualize, or when a more complete assessment
of injury is desired in noncriminal cases. For example, instead of a simple
external examination for an obviously lethal injury in a vehicular violence
death, virtopsy would permit more extensive cataloging of the injury to
help automotive engineers design safer vehicles. The same technology can
enhance bite mark impressions and some patterned injuries. Only a few
ME/Cs have access to virtopsy at this time, and very few have the budget
to purchase the expensive equipment or to build a suitable facility and staff
and maintain it.
Scanning electron microscopy is not new but few ME/Cs have access
to it to assist in identifying the metal conductor(s) in electrocution injuries,
gunpowder residues in gunshot injuries, and other trace metals on skin or
in tissues.
The anthrax bioterrorism attack that occurred in Connecticut, Mary-
land, New York, Virginia, and Washington, DC, highlighted the need to
have biosafety capability for autopsy facilities. Currently, most autopsy
facilities are 20 years old, on average, and are outdated in physical plant,
technology, and biosafety capability. One-third of them lack design/airflow
control of pathogens, and most function at biosafety level 2 rather than
level 3.43 Upgrading facilities to handle the potential biohazards associated
with bioterrorism will require a massive infusion of funds that localities
currently are unable or unwilling to provide. Laboratory safety in an era in
which bioterrorism is a real threat remains an ongoing issue.
In-house toxicology services utilizing state-of-the-art equipment are
essential for identifying drugs, intoxicants, and poisons and for detecting
unsuspected homicides, suicides, and child and elder abuse. Yet only 37
43 Downs, op. cit.
MEDICAL EXAMINER AND CORONER SYSTEMS
255
percent of systems have in-house toxicology capabilities.44 The cost for
complete toxicology utilizing private sector laboratories for cases is high,
resulting in insufficient toxicology screening and minimal testing on cases
even when they are clearly indicated.
Molecular diagnosis conducted on blood and tissue samples is routine
in hospital laboratories to diagnose disease. Investigations of unexplained
sudden deaths, especially in young people and infants, would benefit
from greater access to molecular diagnostics. Molecular diagnostic pro-
cedures are available, but most ME/C offices cannot afford to conduct
these procedures and do not have the medical expertise to request them
or the skills to interpret them. For example, testing for inborn errors of
metabolism should be a part of any examination of the unexpected death
of an infant or toddler, and testing for long QT syndrome is important in
determining the cause of cardiac death in young people or in those whose
family pedigree discloses other sudden unexpected deaths. Molecular
testing is available for the etiology of multiple causes of sudden cardiac
death, including abnormalities in ion channels in cell membranes or chan-
nelopathies, hypertrophic cardiomyopathy, long QT syndrome, Marfan
syndrome, right ventricular cardiomyopathy, dilated cardiomyopathy, and
Ehlers-Danlos syndrome.45
Some testing can be carried out on a dried blood sample long after
death has occurred.46 Some molecular diseases are heritable, and it could
be argued that the ME/C has a duty to identify these diseases and alert
families about their presence. Many medical examiner offices archive a card
with a dried blood sample on decedents, primarily to document personal
identification, should the need arise, but also for future study. In the future,
kin may request the archived blood cards, as the molecular diagnosis of
disease improves and families seek to identify their risk. Thus, ME/Cs need
education and training in and access to the specialized laboratory testing
available to establish the molecular basis of disease and of sudden unex-
pected natural death.
44 Ibid.
45 S.E. Lehnart, M.J. Ackerman, D.W. Benson, R. Brugada, C.E. Clancy, J.K. Donahue, A.L.
George, A.O. Grant, S.C. Groft, C.T. January, D.A. Lathrop, W.J. Lederer, J.C. Makielski, P.J.
Mohler, A. Moss, J.M. Nerbonne, Y.M. Olson, D.A. Przywara, J.A. Towbin, L.H. Wang, A.R.
Marks. Inherited arrhythmias: a National Heart, Lung, and Blood Institute and Office of Rare
Diseases workshop consensus report about the diagnosis, phenotyping, molecular mechanisms,
and therapeutic approaches for primary cardiomyopathies of gene mutations affecting ion
channel function. Circulation 13;116(20):2325-2345.
46 Personal communication between M.J. Ackerman and Marcella Fierro. June 16, 2008.
256
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
THE SHORTAGE OF MEDICAL EXAMINERS AND
FORENSIC PATHOLOGISTS
Medical examiners are physicians who are appointed and charged with
determining the cause and manner of death. In some states, medical exam-
iners are forensic pathologists, while in other statewide systems, local, city,
and county medical examiners are physicians but do not need to be forensic
pathologists. They receive death investigation training and are responsible
for examining bodies that do not require medicolegal autopsy and, accord-
ing to system guidelines, for referring cases that need autopsy to regional
offices where forensic pathologists perform the examinations and initiate
further investigation as needed. Well-trained local medical examiners keep
costs in line by reducing transportation costs to regional or central offices
and are more accessible than pathologists in distant offices. Changes in the
delivery of health care, increased patient caseloads, the inconvenience of
attending scenes, the need for before and after hours examination of de-
cedents, and the level of remuneration have made it difficult for statewide
systems to recruit busy physicians to serve as community or local medical
examiners. If this trend continues, systems will rely more heavily on lay
medical death investigators and will need to develop training programs that
assure competency.
Forensic pathology is the subspecialty of medicine devoted to the in-
vestigation and physical examination of persons who die a sudden, unex-
pected, suspicious, or violent death. Forensic pathology derives its name
from “forensis” (public), or pertaining to the forum, and “pathos” (suf-
fering), referring to pathos or suffering. The term ultimately evolved to
encompass the study of deaths due to injury and disease and of deaths that
are of interest to the legal “forum.” Forensic pathologists are physicians
who have completed, at a minimum, four years of medical school and three
to four years of medical specialty training in anatomical pathology or ana-
tomical and clinical pathology, followed by an accredited fellowship year
in forensic pathology. They are certified by examination and assessment of
their credentials by the American Board of Pathology in, at a minimum,
anatomical pathology, and by subspecialty examination, as having special
competence in forensic pathology.
As of 2008, approximately 38 forensic pathology residency programs
accredited by the Accreditation Council for Graduate Medical Education
sponsored approximately 70 training fellowships. Some positions are un-
funded, and others did not find suitable candidates. Forty-two candidates
were certified in forensic pathology by the American Board of Pathology in
January 2008. Pathologists must recertify by examination every 10 years
to maintain their certifications, in addition to maintaining a professional
license in the state in which they are practicing, by submitting a descrip-
MEDICAL EXAMINER AND CORONER SYSTEMS
257
tion of practice for pathologists that do not practice as hospital staff and
by earning continuing medical education credits.47
Forensic pathologists examine the dead to identify specific classes of
injury, collect medical evidence, determine the presence or absence of natu-
ral disease, and determine the physiological cause of death. They docu-
ment their findings in reports for the civil and criminal courts and provide
information to family members and others who have a legitimate need to
know. They may sign the death certificate describing the manner or circum-
stances under which death occurred (natural, accident, suicide, homicide,
or undetermined). The examinations forensic pathologists carry out may be
inspections or “views” of the external surfaces of a body or a medicolegal
autopsy, which comprises an external and internal examination of the head,
thorax, abdomen, and any other body region pertinent to the case. The
nature of the death and its circumstances dictate which type of examination
the forensic pathologist performs on an individual case. Pathologists who
are not certified in forensic pathology perform many of the medicolegal
autopsies in the United States.
Forensic pathologists practice in multiple settings. Most operate within
death investigation systems and are appointed as civil servants and serve as
medical examiner forensic pathologists. Some function as private practitio-
ners, while others serve as consultants. They may operate under a fee-for-
service agreement or be under contract to a city or county jurisdiction to
provide medical examiner services. Others may serve as coroner’s patholo-
gists, and perform autopsies and prepare reports for coroners, who by stat-
ute assign the cause and manner of death and sign the death certificate.
An estimated 1,300 pathologists have been certified in forensic pathol-
ogy since the American Board of Pathology first offered the certification in
1959 (about 5,000 medical residents enter internal medicine programs each
year). Currently, approximately 400 to 500 physicians practice forensic pa-
thology full time. Although there are only about 70 positions available each
year, recent data indicate that only 70 percent of the slots are filled. NAME
recommends an autopsy caseload of no more than 250 cases per year. The
estimated need is for about 1,000 forensic pathologists; about 10 percent
of available positions are vacant because of manpower shortages and/or
insufficient funding of pathologist positions.48 Although many forensic
pathologists earn between $150,000 and $180,000 annually, this range is
much lower than the average income of most hospital-based pathologists
starting at the entry level.
An Association of American Medical Colleges (AAMC) survey indi-
January 1, 2008 at www.abpath.org/200802newsltr.htm.
48 Hanzlick, 2007, op. cit.
258
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
cates that the average medical school graduate in 2006 finished with debt
in excess of $130,571 (including premedical school borrowing), with 72
percent having a debt of at least $100,000.49 Interested pathology residents
are less likely to elect to practice forensic pathology as a career if they are
already burdened by debt load, and a program of loan forgiveness for years
of service in a medical examiner system would be a major enticement to stu-
dents who are considering a career in pathology. The shortage of qualified
forensic pathologists required to staff aspiring medical examiner systems
constitutes a major challenge not only for offices that are currently seeking
staff, but for the future as well.
STANDARDS AND ACCREDITATION FOR
DEATH INVESTIGATION SYSTEMS
Currently, the standard for quality in death investigation for medical
examiner offices is accreditation by NAME. Accreditation attests that an
office has a functional governing code, adequate staff, equipment, training,
and a suitable physical facility and produces a forensically documented
accurate, credible death investigation product. Of all ME/C systems nation-
ally, only 54 are accredited by NAME. The NAME accreditation checklist
is available online and describes the requirements for accreditation.50 Ac-
creditation is for a period of five years. NAME also offers an individualized
assessment program to enable jurisdictions to identify what they need to
meet accreditation standards. Impediments to developing systems that meet
accreditation requirements include the following:
• Most coroner systems cannot qualify for accreditation because of
problems related to size, insufficient staff and equipment, and in-
sufficiently trained personnel, which inhibit their ability to perform
a competent physical examination, make and/or exclude medical
diagnoses on dead bodies, and make determinations of the cause
and manner of death. The historic role of the coroner is insufficient
to accurately perform the medicolegal and public health functions
related to sudden, unexpected, or violent death.
• Many medical examiner systems are constrained by budget, lack of
staff, lack of equipment, and insufficient facilities and cannot meet
NAME standards.
• The accreditation process requires considerable staff work, includ-
ing written policies and procedures.
49 Association of American Medical Colleges at www.ama-assn.org/ama/pub/category/5349.
html.
50 NAME Autopsy Standards and Inspection Checklist at www.thename.org.
MEDICAL EXAMINER AND CORONER SYSTEMS
259
• The process requires renewal.
• There is administrative cost of the process.
• Many offices do not see any benefit to accreditation.
Federal incentives are lacking for states to perform an assessment of
death investigation systems to determine status and needs, using as a bench-
mark and goal compliance with NAME current professional standards,
guidelines, and accreditation requirements.
QUALITY CONTROL AND QUALITY ASSURANCE
Quality control and quality assurance begin with the implementation
of standardized policies and procedures by qualified staff. For lay medi-
cal investigators, registration and certification by the American Board of
Medicolegal Death Investigators requires standard performance procedures
as outlined in the NIJ document Death Investigation: A Guide for the Scene
Investigator and other published education and training documents.51 For
forensic pathologists, basic competence is initially documented by examina-
tion and certification and subsequently by recertification by the American
Board of Pathology. Written office and morgue policies and procedures with
scheduled reviews and updates help ensure consistent performance over
time. Professional performance parameters, such as the NIJ investigation
guidelines for investigators and the NAME forensic autopsy standards, are
offered as national documents that all systems should be able to follow.
Professional continuing education must be available and supported, and it
should be mandatory.
CONTINUING MEDICAL EDUCATION
For pathologists to maintain professional standing they must earn Con-
tinuing Medical Education (CME) credits in accordance with the number
required by their state medical licensing board. Attendance at forensic edu-
cational meetings, such as the annual meetings of NAME and the American
Academy of Forensic Sciences (AAFS), help keep medical staff current.
Other opportunities that offer valuable CME credits are meetings that focus
on pediatric forensic issues and general pathology updates. AAFS meetings
are multidisciplinary and afford an opportunity for updating in foren-
sic anthropology, forensic odontology, and other forensic disciplines. The
American Society of Clinical Pathologists offers CheckSample exercises and
51 U.S. Department of Justice, Office of Justice Programs, National Institute of Justice. Death
Investigation: A Guide for the Scene Investigator. Available at www.ojp.usdoj.gov.
260
STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES
quizzes on forensic subjects prepared by experts.52 Regular in-house train-
ing on emerging technologies in pathology and forensic science, and journal
clubs covering a broad spectrum of journals, can help educate and reedu-
cate forensic pathologists and investigators. Medical death investigators
may attend the same meetings. The College of American Pathologists offers
self-assessment programs in anatomical and forensic pathology, as well as a
continuing education program of forensic pathology case challenges.53
HOMELAND SECURITY
As part of homeland security, the National Response Plan (National
Response Framework as of March 2008) identifies ME/Cs under Emergency
Support Function 8 as responsible for management of the dead resulting
from any hazardous event.54 All deaths resulting from any form of ter-
rorism are under the jurisdiction of the ME/C. MED-X, the bioterrorism
surveillance program provided by the Centers for Disease Control and
Prevention (CDC) for ME/Cs, utilizes syndromic surveillance of primar-
ily out-of-hospital deaths (deaths occurring before the opportunity occurs
for hospitalization and medical assessment and testing) to quickly identify
deaths resulting from bioterrorism.55
With the exception of some large city, county, and state systems, the
level of preparedness of ME/C jurisdictions is generally very low. Larger
medical examiner systems may be able to manage events causing several
hundred simultaneous single-site recoverable bodies with minimal outside
assistance. Any event with thousands of fatalities would require federal
assistance. Some statewide systems have developed consortia with neigh-
boring states to supplement staff and equipment, but smaller cities and
counties will need to rely entirely on federal assets such as Disaster Mor-
tuary Operational Response Teams and the DOD Joint Task Force Civil
Support.56 Homeland security and disaster response would be well served
by universal improvement in ME/C offices to manage mass fatality events
such as the multistate Hurricane Katrina tragedy and the World Trade
Center attacks, while also surveilling for the links between bioterrorism
52 American Society of Clinical Pathologists CheckSample. Available at www.ascp.org/
Education/selfStudyPublications/checkSample/default.aspx.
54 Homeland Security National Response Plan (known as the National Response Framework
after March 2008) at www.dhs.gov.
55 Ibid; K.B. Nolte, S.L. Lathrop, M.B. Nashelsky, J.S. Nine, M.M. Gallaher, E.T. Umland,
J.L. McLemore, R.R. Reichard, R.A. Irvine, P.J. McFeeley, R.E. Zumwalt. 2007. “Med-X”: A
medical examiner surveillance model for bioterrorism and infectious disease mortality. Human
Pathology 38:718-725.
56 Disaster Mortuary Operational Response Team at www.dmort.org; Joint Task Force Civil
Support at http://jtfcs.northcom.mil.
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