STATE COLLEGE – In a Pennsylvania county, the coroner’s office relies on an autopsy facility with rusting equipment that does not meet federal workplace standards. Forensic pathologists under contract carry out more than 325 autopsies there per year.
A coroner from another county claimed his part-time deputies don’t really investigate deaths. In place, “They just pick up the body and use it to direct the business to their funeral home.”
And only five of Pennsylvania’s 67 counties have accredited coroner’s or medical examiner’s offices, which the state doesn’t require, but “is seen as a validation of forensic best practice in death investigation”, according to a new study from the Center for Rural Pennsylvania.
The state agency’s August report determined that Pennsylvania County’s coroners and medical examiners — the people who investigate suspicious deaths and report crimes — lack adequate funding, transparency and training. .
In Pennsylvania, most coroners are elected and subject to only two conditions: being at least 18 years old and having resided in a county for at least one year. Coroners investigate and adjudicate deaths, initiate autopsies, complete death certificates, and report information vital to legal, public health, and public safety issues. Their work aids law enforcement investigations and helps families come to terms with the death of a loved one.
The decentralized system allows each coroner to run their office differently, according to the report. In practice, this causes the accessibility of death data, accreditation and training – as well as policies and procedures – to vary widely from municipality to municipality. In short, the place of your death determines the quality of the investigation into your death.
In rural counties, the challenges are exacerbated because many coroners lack access to labs and specialists who help investigate deaths, researchers said. Meanwhile, they bear the burden of additional transportation costs and understaffing due to their location. They are also less likely to have the certification and training that coroners in urban areas have, the study found.
Coroners’ offices act independently of other county entities, but county commissioners determine much of their funding. Additionally, the state legislature has limited the funding coroners’ offices receive for cremation authorization permits and death certificates.
Rising costs and fees for death certificates have reduced statewide orders, further affecting funding for coroners. A dollar from each death certificate order — which costs $20, plus $10 for online purchases — goes to coroners’ offices, but the remaining $19 is split between the state health department and the fund. general.
The researchers argue that the legislature should increase the amount coroners’ offices receive per death certificate from $1 to $5 and raise the cap on cremation permits from $50 to $100. The study also recommends that lawmakers standardize coroner salaries.
When a person dies of natural causes, a doctor can certify their death. But if another cause of death is suspected, the death is investigated. In Pennsylvania, elected coroners investigate deaths in all counties except Allegheny, Delaware and Philadelphia, which appoint medical examiners, and Luzerne and Northampton, which appoint coroners.
Public health experts have long debated whether to elect coroners.
Coroners-elect work independently of counties, so they don’t have to abide by what a district attorney or county commissioners want them to say, said Christina VandePol, former Chester County coroner-elect and l one of the authors of the study. This autonomy can be important for investigating deaths like those in county jails. VandePol explained that because of her office’s independence, she was able to publish the names of nursing homes that had more COVID-19 deaths when she was under pressure not to.
Public health experts who oppose elected corners note that voters could choose unqualified candidates. Hired coroners and medical examiners, they point out, do not have to meet residency requirements, allowing counties to attract applicants from across county lines.
The study also found that the death investigation system lacks transparency and may not provide county-level death data to the public in a timely or reliable manner. In addition to this, a state law passed in 2008 requires autopsy records to be kept confidential to protect the privacy of the deceased. This prevents residents and journalists from accessing information that could be used to hold coroners’ offices to account.
As part of the study, coroners’ offices in 67 counties were asked to complete surveys and participate in an interview. Researchers received full participation from 11 offices and partial responses from 26. In north-central Pennsylvania, only the Mifflin and Lycoming county coroners’ offices participated fully. Blair County Coroners’ Office completed the survey, while Clinton County Coroners’ Office authorized an interview.
Harry Holt, an associate professor in West Chester University’s Department of Health and another study author, said researchers called and emailed each of the coroners’ offices in the state multiple times.
Center County Coroner Scott Sayers, who serves on the board of the Pennsylvania State Coroners Association, said he didn’t participate in the study because he was busy.
“No one comes to our office to die” said Sayers. “We have to go to them. Our work is on the ground – whether in a hospital, a residence, a road.
Death investigations conducted by coroners can range from a review of medical records to a full autopsy and report. Autopsies, which involve the surgical examination of a corpse, require more qualifications than most coroners possess. They are usually outsourced to medical examiners, who are physicians with additional license and training to perform the procedure. Forensic pathologists also have the qualifications to perform them.
According to the study, coroners, especially in rural communities, do not have easy access to medical examiners. Coroners must rely on autopsy services in laboratories that are sometimes hours away. Autopsies, VandePol said, are the gold standard for death investigations, but lack of funding and staffing in some rural coroners’ offices puts them at a disadvantage compared to their urban counterparts.
This lack of resources can prevent important details of a death from being determined. The National Association of Medical Examiners says autopsies should be performed for 13 categories, including child deaths, deaths involving police, deaths that occurred in the custody of a local, state or federal institution, and overdoses. of opioids.
Sayers said he was working with a pathologist at Mount Nittany Medical Center, the local hospital, for autopsies. But when the pathologist is away, his office works with pathologists in Johnstown or the Lehigh Valley. Sayers said his office performs autopsies for all overdose deaths, in case the district attorney wants to prosecute the person who distributed the drugs that caused the death.
Sullivan County coroner Wendy Hastings, who also sits on the state coroners association board and was involved in the study, said she was more selective about autopsies performed by her desk.
“Sometimes things are cut and dry”, Hastings said, in the case of overdose deaths. If the county district attorney’s office is considering bringing charges against the person who distributed the drugs, that warrants an autopsy, she said.
Hastings said she supports standardizing death investigations, but believes coroners’ offices should have the flexibility to investigate deaths based on the resources they have.
The researchers conclude that more standardization and regulation are needed.
They recommend that all coroners’ or medical examiners’ offices have written operating procedures; stricter requirements for the qualification, certification and training of coroners; and that the state investigate the effectiveness of a more centralized medical examiner system.
They also advocate incentives for people studying forensics. The researchers suggest inspections of autopsy facilities, a minimum number of morgue spaces and more investment in forensic facilities.
Hastings and Sayers agree that education would be more frequent and better if coroners could organize the training. Hastings said they would be able to do this if the Pennsylvania State Coroners Education Board that educates coroners – which is currently run by the Attorney General’s office – were to operate under the aegis of the Pennsylvania Commission on Crime and Delinquency.
The change would allow the crime commission to handle the coroners association’s money, Hastings said.
Legislation that would place the Board of Education under the authority of the Crime and Delinquency Commission has passed the Senate and is pending in the House. Currently, the Attorney General’s office receives funding to facilitate the training of coroners through the Pennsylvania State Coroners’ Board of Education.
One of the biggest barriers to further training, VandePol said, is that many assistant coroners work part-time and have second jobs. Better funding would make full-time jobs in coroners’ offices more viable.
The Pennsylvania State Coroners Association is trying to increase minimum annual continuing education requirements from eight hours to 12 or even 4 p.m., Sayers said.
But like so many things, it’s up to the state legislature to make changes.
Ashad Hajela is a member of the Report for America body and writes on rural affairs for the regional office of State College in Spotlight PA.