Editing Medical examiner

{{Globalize|date=December 2024}}
{{Short description|Post-mortem investigation forensic pathologist }}
{{distinguish|coroner}}
[[File:MedicalExaminerVan.jpg|right|thumb|Hawaiian medical examiner van]]

The '''medical examiner''' is an [[wikt:appointment|appointed]] [[official]] in some American [[Jurisdiction|jurisdictions]]<ref name=nrcnap/> who is trained in [[pathology]] and investigates deaths that occur under unusual or suspicious circumstances, to perform [[post-mortem examinations]], and in some jurisdictions to initiate [[inquest]]s.<ref name=CvM>{{cite web|title=Coroner vs. medical examiner|url=https://www.nlm.nih.gov/visibleproofs/galleries/cases/examiner.html|website=Visible Proofs|access-date=12 October 2014}}</ref><ref name=":0">{{Cite web|url=https://www.crimesceneinvestigatoredu.org/medical-examiner/|title=Forensic Medical Examiner Jobs in Forensic Criminal Investigations|website=www.crimesceneinvestigatoredu.org|date=8 October 2013|language=en-US|access-date=2018-03-30}}</ref>

In the US, there are two death investigation systems: first, the [[coroner]] system based on [[English law]]; and second, the medical examiner system, which evolved from the coroner system during the latter half of the 19th century. The type of system varies across jurisdictions, with over 2,000 separate jurisdictions for investigating [[Manner of death|unnatural deaths]]. In 2002, 22 states had a medical examiner system, 11 states had a coroner system, and 18 states had a mixed system. Since the 1940s, the medical examiner system has gradually replaced the coroner system and serves about 48% of the US population.<ref>{{citation | editor=Jason Payne-James | title=Encyclopedia of Forensic and Legal Medicine | entry=Death Investigation Systems/United States of America | year=2005}}</ref><ref>{{citation | author1=Randy Hanzlick | author2=Debra Combs | title=Medical Examiner and Coroner Systems | journal=[[JAMA (journal)|JAMA]] | volume=279 | issue=11 | year=1998 | pages=870–874 | doi=10.1001/jama.279.11.870| pmid=9516003 }}</ref> The largest medical examiner's office in the United States is located in [[Baltimore]], [[Maryland]].<ref>{{Cite book |last=Engelhaupt |first=Erika |title=Gory details: adventures from the dark side of science |date=2020 |publisher=National Geographic Partners, LLC |isbn=978-1-4262-2098-2 |location=Washington, DC}}</ref>

The coroner is not necessarily a [[Physician|medical doctor]]. They may be a [[lawyer]] or a layperson. In the 19th century, the public became dissatisfied with lay coroners and demanded that the coroner be replaced by a physician. In 1918, New York City introduced the office of the Chief Medical Examiner and appointed physicians experienced in the field of pathology. In 1959, the medical subspecialty of [[forensic pathology]] was formally certified.<ref>{{cite book | title=Medicolegal Death Investigation System: Workshop Summary | chapter=Overview of the Medicolegal Death Investigation System in the United States | publisher=[[Institute of Medicine]] | year=2003 | url=https://www.ncbi.nlm.nih.gov/books/NBK221926/}}</ref>

The types of death reportable to the system are determined by federal, state, or local laws. Commonly, these include violent, suspicious, sudden, and unexpected deaths, death when no physician or practitioner was present or treating the decedent, inmates in public institutions, those in custody of [[Law enforcement agency|law enforcement]], deaths during or immediately following [[Therapy|therapeutic]] or [[Diagnosis|diagnostic]] procedures or deaths due to [[neglect]].

==Duties==
A medical examiner's duties vary by location, but typically include:
* investigating human organs like the [[stomach]], [[liver]], and [[brain]]
* determining [[cause of death]]
* examining the condition of the body<ref name=":0" />
* studying tissue, organs, cells, and bodily fluids<ref name=":0" />
* issuing [[death certificates]]
* maintaining death records
* responding to deaths in mass disasters
* working closely with [[law enforcement]]<ref name=":1">{{Cite web|url=https://explorehealthcareers.org/career/forensic-science/forensic-pathologist/|title=Forensic Pathologist {{!}} explorehealthcareers.org|website=explorehealthcareers.org|language=en-US|access-date=2018-03-30}}</ref>
* identifying unknown dead
* performing other functions depending on local law.

In some [[jurisdictions]], a [[coroner]] performs these and other duties. It is common for a medical examiner to visit [[crime scene]]s or to testify in [[court]].<ref name=":1" /> Medical examiners specialize in [[Forensic science|forensic]] knowledge and rely on this during their work.<ref name=":0" /> In addition to studying [[cadaver]]s, they are also trained in [[toxicology]], DNA technology and [[forensic serology]] (blood analysis).<ref name=":1" /> Pulling from each area of knowledge, a medical examiner is an expert in determining a cause of death.<ref name=":0" /> This information can help law enforcement solve cases and is crucial to their ability to track criminals in the event of a [[homicide]] or other related events.<ref name=":0" />

Within the United States, there is a mixture of coroner and medical examiner systems, and in some states, dual systems. The requirements to hold office vary widely between jurisdictions.

==Qualifications==

===United Kingdom===
In [[England]] and [[Wales]], a new statutory Medical Examiner system based in NHS Acute Trusts commenced in 2019 and is expected to be fully operational several years later. A medical examiner is always a [[Bachelor of Medicine, Bachelor of Surgery|medical doctor]], whereas a [[Coroner#England and Wales|coroner]] is a [[judicial officer]].<ref>{{cite news|title=National Medical Examiners Report 2022|url=https://www.england.nhs.uk/wp-content/uploads/2021/04/PRN00146-nme-report-for-2022.pdf}}</ref>

Pilot studies in [[Sheffield]] and seven other areas, which involved medical examiners looking at more than 27,000 deaths since 2008, found 25% of hospital death certificates were inaccurate and 20% of causes of death were wrong. [[Suzy Lishman]], president of the [[Royal College of Pathologists]], said it was crucial there was "independent scrutiny of causes of death".<ref>{{cite news|title=Medical examiners help expose patient safety risks|url=http://www.hsj.co.uk/news/exclusive-medical-examiners-help-expose-patient-safety-risks/5081968.article#.VP9HiPzkdc4|access-date=10 March 2015|publisher=Health Service Journal|date=12 February 2015}}</ref>

===United States===
Qualifications for medical examiners in the US vary from jurisdiction to jurisdiction.  In [[Wisconsin]], for example, some counties do not require individuals to have any special educational or medical training to hold this office.<ref>Coroners and Medical Examiners: A Comparison of Options Offered by Both Systems in Wisconsin Jenifer Keach, Rock (WI) County Coroner, April 6, 2010</ref> In most jurisdictions, a medical examiner is required to have a [[medical degree]], although in many there is no requirement for specialized training in pathology. Other jurisdictions have stricter requirements, including additional education in [[pathology]], law, and [[forensic pathology]]. Medical examiners are typically appointed officers.<ref name=nrcnap>{{cite book |url=https://www.ojp.gov/pdffiles1/nij/grants/228091.pdf |location=Washington DC |publisher=[[National Academies Press]] |title= Strengthening Forensic Science in the United States: A Path Forward |date=2009 |pages=241–253}}</ref>

== Education ==
In the United States, medical examiners require extensive training in order to become experts in their field.<ref name=":1" /> After high school, the additional schooling may take 11–18 years.<ref name=":1" />  They must attend a [[college]] or [[university]] to earn a [[bachelor's degree]] sufficient for admission to medical school.<ref name=":0" /> [[Biology]] is usually the most common.<ref name=":2">{{Cite news|url=https://learn.org/articles/Medical_Examiner_How_to_Become_a_Medical_Examiner_in_5_Steps.html|title=How to Become a Medical Examiner in 5 Steps|access-date=2018-03-30|language=en}}</ref> A [[medical degree]] (MD or DO) is often required to become a medical examiner.<ref name=":3">{{Cite news|url=http://www.forensicsciencecareers.net/medical-examiner.html|title=Medical Examiner – Forensic Science Careers|work=Forensic Science Careers|access-date=2018-03-30|language=en-US}}</ref><ref name=":2" /> To enter medical school, the [[Medical College Admission Test|MCAT]] (Medical College Admissions Test) is usually required <ref name=":0" /> after which [[medical school]] is another four years with the first two dedicated to academics and the rest of the two used to gain [[clinic|clinical]] experience.<ref name=":2" />

To become experts in pathology, specifically, additional training is required after medical school. The first step is to complete pathological forensic training.<ref name=":3" /> This usually consists of anatomic and clinical pathology training which takes anywhere from four to five years to complete.<ref name=":0" /> After this, the physician may complete an anatomic pathology [[residency (medicine)|residency]] or a [[fellowship (medicine)|fellowship]].<ref name=":2" /> Before practicing as a medical examiner, the physician must also become board certified through the [[American Board of Pathology]].<ref name=":3" /><ref>{{Cite web|url=http://learningpath.org/articles/Becoming_a_Medical_Examiner_Salary_Info_Job_Description.html|title=Becoming a Medical Examiner: Salary Info & Job Description|website=learningpath.org|access-date=2018-03-30}}</ref>

== Career ==
The general job outlook for medical examiners in the United States is considered to be excellent.<ref name=":1" /> Remuneration varies by location, but it is estimated to average between $105,000 and $500,000.<ref name=":1" />

==Shortage==

In the United States, there are fewer than 500 board-certified forensic pathologists, but the National Commission on Forensic Science estimates the country needs 1,100–1,200 to perform the needed number of autopsies.  The shortage is attributed to the nature of the work and the higher pay in other medical specialties. It has caused long delays in some states and resulted in fewer investigations and less thorough investigations in some cases.<ref>{{cite news |url=https://www.cbsnews.com/news/families-suffer-due-to-medical-examiner-shortage/ |title=Families suffer due to medical examiner shortage |date=7 Dec 2015}}</ref>

==See also==
*[[Coroner]]
* [[List of fictional medical examiners]]

==References==
{{Reflist}}

==Further reading==
* {{cite book |author1=Judy Melinek |author2=T. J. Mitchell |year=2015 |title=Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner |url=https://books.google.com/books?id=hQA7BAAAQBAJ |location=New York |publisher=Scribner |isbn=978-1-4767-2726-4}}
* {{Cite web |last=Valdes |first=Robert |title=What Is the Difference Between a Medical Examiner and a Coroner? |url=https://science.howstuffworks.com/question732.htm |publisher=[[HowStuffWorks]] |access-date=21 June 2018}}
* {{Cite web |title=Public Health Law Program: Coroner/Medical Examiner Laws, by State |url=https://www.cdc.gov/phlp/publications/topic/coroner.html |publisher=[[Centers for Disease Control]] |access-date=21 June 2018}} See also the links at the bottom of the linked article.

{{Authority control}}

[[Category:Medical examiners| ]]
[[Category:Coroners]]
[[Category:Forensic occupations]]
[[Category:Health care occupations]]
[[Category:Pathology]]
[[Category:People involved with death and dying]]