How many people in the US have died from COVID? We know it’s over half a million, but the official count could miss tens of thousands of deaths. In television police proceedings, those investigating premature deaths are portrayed as highly qualified, objective experts. In reality, the US system is far less strict. The majority of states rely at least in part on coroners to determine the circumstances of unexpected or suspicious deaths – and contrary to what most of us are likely to believe, forensic doctors are often laypeople with no medical training. In addition, they are often elected officials, making them vulnerable to political pressure from individuals or organizations seeking to influence their conclusions. This system must be abolished.
The coroner’s office dates back to medieval England, where it was first established to protect the crown’s financial interests. Death examinations were important as coroners collected the taxes involved, among other things.
Today, most death examinations of people who are not under medical care – including those who die at home or in police custody – are carried out by medical examiners and coroners. Medical examiners are doctors who are often board certified in forensic pathology. Coroners are usually not doctors. In fact, in many states, coroners only need to be of legal age and not have a criminal conviction to qualify for the job. Yet they often have the final say on how someone died. There is no federal oversight of death examination systems and no national standard to be followed. Instead, states decide whether to use medical examiners or coroners, or a combination of both – and determine the qualifications for the job. Most states have coroners in some or all of the counties.
To make matters worse, nearly 80 percent of the country’s medical examiner are elected to the office. This rule exposes investigations to corruption and political influence. After all, elected coroners are committed to the electorate.
This relationship can have serious public health consequences. Take the current coronavirus pandemic, for example. SARS-CoV-2, the virus responsible for the disease, is a leading cause of pneumonia. If someone dies without having had a COVID test, a coroner can attribute the death to a direct cause such as pneumonia without mentioning COVID as the underlying cause on the death certificate. A recent analysis for science intelligence agency STAT found tens of thousands of deaths from COVID go unreported, mostly in counties that backed former President Donald Trump. It was also found that counties that deploy elected coroners are more likely to experience non-COVID deaths than counties that deploy appointed medical examiners. “The numbers suggest that political leanings have helped suppress the true extent of the deaths,” stated STAT.
Voters are not the only source of influence over coroners. Death investigations are closely linked to law enforcement agencies. Indeed, in many counties the sheriff is the coroner. This arrangement creates an obvious conflict of interest. For example, in 2017 the public radio station KQED reported the resignation of two forensic pathologists in San Joaquin County, California, who alleged the sheriff coroner disrupted their investigation into deaths during police arrest or custody to protect the officers involved . According to the California State Association of Counties, the sheriff will act as coroner in 41 of California’s 58 counties.
Leading medical and scientific organizations have long criticized the coroner system. As early as 1857, a committee of the American Medical Association recommended replacing elected coroners with court-appointed medical officers. In 1928 the National Academy of Sciences requested that the medical duties of the Forensic Medicine Office be transferred to the medical examiner’s office, which the organization further argued should be headed by a pathologist. The Academy reaffirmed the need to switch to a medical examination system in 2009. However, the Centers for Disease Control and Prevention report that only 16 states and Washington, DC have centralized medical screening systems.
It is long gone to heed the advice of the experts. The introduction of a medical examination system is not without its challenges. For one, there aren’t enough medical examiners to go around. In the face of some of society’s most pressing problems, it has never been more important for states to calm the archaic coroner system.