1. STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES: A PATH FORWARD Committee on Identifying the Needs of the Forensic Science Community February 2009

2. Marcella F. Fierro, MD Forensic Pathologist Emerita Professor and Chair Department of Legal Medicine Virginia Commonwealth University School of Medicine and Chief Medical Examiner Commonwealth of Virginia, Retired

3. Charge to the Forensic Science Committee Relative to Medical Examiners, Coroners and Forensic Pathology (1) Assess the present and future resource needs of the forensic science community to include…..medical examiners and coroners (ME/C) (2) Make recommendations for maximizing the use of forensic technologies and techniques to solve crimes, investigate deaths, and protect the public;

4. Charge to the Forensic Science Committee Relative to Medical Examiners, Coroners and Forensic Pathology (4) Make recommendations for programs that will increase the number of qualified forensic scientists and medical examiners available to work in public crime laboratories; (5) Disseminate best practices and guidelines……to solve crimes, investigate deaths, and protect the public;

5. Issues Covered Issues covered during deliberations: Structure and function of ME/C Structure and function of ME/C The effectiveness of coroner systems as compared with medical examiner systems The effectiveness of coroner systems as compared with medical examiner systems Future needs, and priorities of the …coroner and medical examiner systems Future needs, and priorities of the …coroner and medical examiner systems Accreditation, certification and licensing of ….medical death investigation systems Accreditation, certification and licensing of ….medical death investigation systems

6. History 9 th /10 th century Coroner – crowner in common law to identity, C&M, confiscate property, collect death duties, investigate treasure troves… transplanted to USA 9 th /10 th century Coroner – crowner in common law to identity, C&M, confiscate property, collect death duties, investigate treasure troves… transplanted to USA 1860 MD -coroners may require MD at inquests 1860 MD -coroners may require MD at inquests 1877 First ME system in MA 1877 First ME system in MA 1890 ME in Baltimore, MEs did autopsies 1890 ME in Baltimore, MEs did autopsies 1918 NYC institutes ME system 1918 NYC institutes ME system

7. History – Attempts to Improve 1928 NAS “The Coroner and Medical Examiner” 1928 NAS “The Coroner and Medical Examiner” Abolish Coroner (an “anachronism”) Abolish Coroner (an “anachronism”) Vest medical duties of Coroner in an ME system Vest medical duties of Coroner in an ME system Led by trained pathologist under civil service Led by trained pathologist under civil service ME be provided with tox, bacti, and other sciences ME be provided with tox, bacti, and other sciences Develop medicolegal institutes to affiliate with hospitals and universities Develop medicolegal institutes to affiliate with hospitals and universities 1932 NRC again produced review – advised larger role for physicians 1932 NRC again produced review – advised larger role for physicians 1954 Nat. Conf. of Commissioners on Uniform State Laws (CCUSL) - produced Model Post- Mortem Examination Act – need pathologists 1954 Nat. Conf. of Commissioners on Uniform State Laws (CCUSL) - produced Model Post- Mortem Examination Act – need pathologists

9. Deficiency in any one area results in inadequate/faulty death investigation

10. Death Investigation In the US ME/C Systems Structure and Function Missions: Missions: Aid criminal justice and the public health Aid criminal justice and the public health Investigate sudden, unexpected, violent death – collect medical evidence Investigate sudden, unexpected, violent death – collect medical evidence Determine cause and manner of death Determine cause and manner of death 500,000 of 1,000,000 reported cases / year 500,000 of 1,000,000 reported cases / year 1 in 6 deaths investigated and examined; 1 in 6 deaths investigated and examined; N 50%, A 27-40%, S 12-15%, H 7-10, U 1% N 50%, A 27-40%, S 12-15%, H 7-10, U 1%

11. Death Investigation In the US ME/C Systems Structure and Function 2,342 separate death investigation jurisdictions 2,342 separate death investigation jurisdictions 54 are accredited by NAME 54 are accredited by NAME Distribution: Distribution: 16 State ME systems 16 State ME systems 14 County Coroner 14 County Coroner 7 County ME systems 7 County ME systems 13 Mixed county C/ME 13 Mixed county C/ME 8 hybrid C/ State ME system 8 hybrid C/ State ME system DC has ME DC has ME Cleveland/Cuyahoga Co Coroner is forensic pathologist Cleveland/Cuyahoga Co Coroner is forensic pathologist Hodgepodge and multiplicity of systems makes standardization of performance difficult? Actually it is IMPOSSIBLE!

12. ME v Coroner Physicians Physicians CME required CME required Appointed - based on credentials Appointed - based on credentials As civil servants are insulated As civil servants are insulated Subject to peer and other review – licensed Subject to peer and other review – licensed Selection pool is national Selection pool is national Position Requirements: Position Requirements: Licensed MD Licensed MD Pathologist with boards Pathologist with boards Forensic Pathologist Forensic Pathologist Required CME Required CME Peer Review Peer Review Varies by state; not all are physicians 82 % elected constitutional officers Independent but report to public Selection pool is local, small Minimum requirements: Registered voter Minimum age 18-23 Not a felon Complete training course of weeks Other qualifications per jurisdiction

13. Shared Deficiencies of ME/C Systems Imperfect code/legal structure Imperfect code/legal structure Inadequate expertise to medically assess deaths Inadequate expertise to medically assess deaths Inadequate resources Inadequate resources Shortage of forensic pathologists Shortage of forensic pathologists Inadequate facilities, equipment and new technologies Inadequate facilities, equipment and new technologies Inadequate forensic laboratory support Inadequate forensic laboratory support Lack of best practices and standards Lack of best practices and standards Lack of QA Lack of QA Lack of laboratory information systems Lack of laboratory information systems Lack of translational research and associations with medical universities Lack of translational research and associations with medical universities

14. Validity of Forensic Pathology For forensic pathology validity of the science is less of an issue than the establishment and distribution of the science throughout death investigation systems For forensic pathology validity of the science is less of an issue than the establishment and distribution of the science throughout death investigation systems The science of forensic pathology is the science of medicine The science of forensic pathology is the science of medicine Need incentives for jurisdictions to adopt and adhere to standards and best practices of medicine Need incentives for jurisdictions to adopt and adhere to standards and best practices of medicine A carrot and what stick are needed to improve the situation A carrot and what stick are needed to improve the situation

15. The Core Questions Should medical diagnoses for cause of death and for manner of death be made by physicians with specialized training or by elected officials who may or may not have any medical training? Multiple studies say YES! If competency in death investigation matters, how shall the present system be fixed?

16. Recommendation #11 To Improve Medicolegal Death Investigation : Establish NIFS Establish NIFS Congress to provide Incentive funding for states/jurisdictions to establish ME systems with the goal of replacing coroner systems (LEAA model) Congress to provide Incentive funding for states/jurisdictions to establish ME systems with the goal of replacing coroner systems (LEAA model) Fully fund Coverdell NFSIA – only source for MEs Fully fund Coverdell NFSIA – only source for MEs Fund building regional ME offices, equipment, staffing, education and training and for modernization Fund building regional ME offices, equipment, staffing, education and training and for modernization Congress to fund NIH and NIFS and allocate funding for collaborative basic forensic pathology research with medical universities Congress to fund NIH and NIFS and allocate funding for collaborative basic forensic pathology research with medical universities

17. Recommendation #11 Fund fellows training in forensic path Forgive medical student loans if train in FP as career Fund fellows training in forensic path Forgive medical student loans if train in FP as career Establish SWG with NAME and ABMDI to develop and promote standards, best practices, admin, staffing, education, training, and CME for MEs and MDIs Establish SWG with NAME and ABMDI to develop and promote standards, best practices, admin, staffing, education, training, and CME for MEs and MDIs Restrict funding to accredited offices or those working toward accreditation Restrict funding to accredited offices or those working toward accreditation Require accreditation of all ME/C offices Require accreditation of all ME/C offices Require board certified forensic pathologists to perform or supervise all medicolegal autopsies Require board certified forensic pathologists to perform or supervise all medicolegal autopsies

18. STRENGTHENING FORENSIC SCIENCE IN THE UNITED STATES: A PATH FORWARD Committee on Identifying the Needs of the Forensic Science Community February 2009