In the United States, autopsies are overseen either by coroners, who are often elected officials with no medical background, or by medical examiners, who are typically doctors who specialize in forensic pathology.
There is no national standard for what qualifications are required to oversee autopsies, or for when an autopsy should be performed. Nor is there a single source of data for the kinds of systems that exist in each U.S. county or for how many autopsies they perform, their budgets and so forth.
As part of our Post Mortem investigative series, reporters and researchers at ProPublica, PBS' "Frontline" and NPR surveyed 69 of the largest medical examiner and coroner systems in the United States.
We selected the following systems:
- All 17 statewide medical examiner systems, including Washington, D.C.'s
- Two hybrid state medical examiner and county coroner systems, in which coroners refer all cases that need to be autopsied to the state medical examiner
- The systems in the 50 most populous counties that had county-based systems as of July 1, 2009 (counting all five counties in New York City as one)
Over the past month, we contacted each system and requested this information:
- The total number of completed autopsies for each year from 2004 to 2010
- The number of completed autopsies that were for contract cases, which are cases outside the jurisdiction of the office (for which the system charges a fee)
- The number of forensic pathologists working in the office for each year from 2004 to 2010
- The annual budget for the office for each year from 2004 to 2010
- Of their current team of forensic pathologists, the number who are board-certified in forensic pathology
- Of their current team of forensic pathologists, the number who are not board-certified in forensic pathology
- Of their current team of forensic pathologists, the number of "fellows," who are medical doctors undergoing an extra year of training at a coroner or medical examiner office in preparation for taking the boards in forensic pathology
Sixty-eight of the 69 systems surveyed -- all but Contra Costa County in California -- responded with full or partial data and are included in our application. For those systems that reported autopsy data by Jan. 27, 2011, ProPublica conducted an analysis using mortality data from the Centers for Disease Control. This data included total deaths and age-adjusted mortality rates per 100,000 people in six categories – unintentional, suicide, homicide, undetermined, legal intervention/operations of war and non-injury, no intent classified -- for each year from 2004 to 2007, the most recent year available.
We calculated the actual autopsy rate based on autopsies per 100,000 deaths. Then, using the CDC mortality data, we looked at the relationship between the autopsy rate and the rates of unintentional deaths and homicides. We found that the higher the homicide and unintentional-death rate in an area, the higher the autopsy rate tends to be.
We used this relationship to compute an expected autopsy rate. We then compared the expected autopsy rate and the actual autopsy rate to see whether counties and states performed fewer, more than or the expected number of autopsies, given their rates of unintentional deaths and homicides. We list the percent difference as the autopsy ratio on each system's page in our interactive data application.
Our analysis compared states to states and counties to counties. We did not include counties that performed fewer than 100 autopsies for a given year.
Here are some other things to bear in mind when exploring the data:
- In all, we found 105 uncertified forensic pathologists working in the systems we surveyed. In some cases, these physicians have recently completed their training and haven't had a chance to take the board certification test in forensic pathology, which is offered only once a year. Others are long-time practitioners who have no plans to become certified. Others have failed the exam, some of them multiple times.
- Some states and counties said they employ forensic pathologists on a part-time basis, a description that can mean anything from three days a week to an as-needed basis. We count each forensic pathologist employed in this way as part-time/provisional.
- Some counties in Florida and Texas work within a district consisting of multiple counties. In each of these cases, the autopsy, forensic pathologist and budget numbers cover all counties within the district.
- Offices responded with data following either the calendar year or the fiscal year, which often differed from state to state and county to county. For the fiscal years that ran July 1 through June 30, Oct. 1 through Sept. 30, and Dec. 1 through Nov. 30, we attributed the data to the later year. For fiscal years running Feb. 7 through Feb. 6 and March 1 through Feb. 28, we attributed the data to the earlier year.
- Unless otherwise noted, the source for annual budgets is the coroner/medical examiner system.
- Systems that did not report autopsy data for 2004 through 2007 by Jan. 27, 2011 were not included in our analysis of such data. This is noted on the system's page.
If you see any errors in our data, please contact us at Krista.Schmidt@propublica.org.
ProPublica interns Liz Day and Sydney Lupkin contributed research for this project as did Sheelagh McNeill, Kitty Bennett, Jackie Bennion of PBS "Frontline" and NPR’s Barbara Van Woerkom.