1. Kent Stewart – Chief Coroner Ministry of Justice
Embracing Life – Northern Saskatchewan Working Together – Prince Albert “When A Death Occurs”
Kent Stewart – Chief Coroner
Ministry of Justice
Sgt. Brent Olberg
RCMP – Major Crimes
Saskatoon

2. The Coroners Act, 1999 (Legislative Authority)
The Coroners Act, 1999 of Saskatchewan is the provincial legislation that provides Chief Coroner/Coroners with the Coroners with the statutory authority and power to investigate deaths in Saskatchewan.

3. Mandate Purpose (legislation)
The purpose of the Act is to facilitate a coroner system that:
provides for independent and impartial investigations into, and public inquests respecting, the circumstances surrounding unexpected, unnatural or unexplained deaths;
determined the identity of a deceased person and how, when, where and by what means that person died;

4. uncovers dangerous practices or conditions that may lead to death;
d. educates the public respecting dangerous practices and conditions; and
e. publicizes and maintains records of and the circumstances surrounding causes of death.

5. Saskatchewan Coroners Service Statistics (Deaths Reported)
Classification
2005
2006
2007
2008
2009
2010
2011
2012
Natural
816
785
775
773
683
671
643
543
Accident
362
380
393
501
470
500
502
445
Suicide
124
114
139
131
161
142
138
120
Homicide 43 44 28 30 40 34 26
Undetermined 51 42 36 31 55 27
Incomplete 1 10 6
102
Non-coroner 46 92
184
236
388
427
447
547
TOTAL:
1442
1459
1561
1708
1769
1811
1825
1810
2002 – 8906 deaths
2003 – 8829 deaths
2004 – 8881 deaths
2005 – 8844 deaths
16 – 17% of all deaths are investigated by coroners.

6. Role of the Coroner
To direct a thorough examination of the death which includes the scene, the body & the history/circumstances to focus on answering the questions who, when, where, how and why
To assist police in a criminal investigation
To order an autopsy and/or toxicology tests as required
Coroner has jurisdiction over the body in all cases including suspicious deaths
Coroner is responsible for transportation of body
Currently there are approximately 150 coroners located throughout the Province.

7. Role of the Police Officer
In most cases, the first investigator at the scene is a police officer
The police officer wears two (2) hats
Firstly, he/she is a criminal investigator or responsible for determining whether there is any evidence to suggest that the death is suspicious or homicide (secure scene, notify major crime). In these circumstances, the primary role of the coroner is to assist the police
Secondly, in cases that are not suspicious, the police officer wears another hat, assisting the coroner with the investigation
The police officer must be aware of which hat he/she wears as their role and powers in each are often different

8. Authorities Under The Coroners Act
enter and inspect any place where the body and any place from which the coroner has reasonable grounds for believing the body was removed;
conduct any investigation that he or she considers necessary;
Examine and make copies of any record relating to the deceased or his of her circumstances;
take possession of the body, if the body is in Saskatchewan and conduct an examination of the body;
cordon off and protect the scene of death and remove any objects; and
direct the assistance of any peace office to carry out the investigation.

9. Death Investigation must be centered on three essential elements (“the Cornerstones” or “the Golden Triangle”)
The History/Circumstances
The Scene
The Body
The coroners/police are the eyes and ears of the pathologist and in some circumstances the family.

10. Primary Focus of any Death Investigation is to answer five questions
Who died? Properly identify the decedent
Where they died?
When they died? What was the date and time?
Why did they die? What was the medical cause of death? (autopsy/external examination, toxicology)
How did they die? What was the manner of death; (natural, accident, suicide, homicide, undetermined)
In addition, a primary focus of the Coroner is prevention.

11. Conclusions The coroner’s investigation is finalized by: Or
Completing the Report of Coroner (may contain recommendations in relation to prevention) Or
Inquest

12. The Investigation – Non Criminal
Police are notified of a death usually by EMS, family or others
Police attend and secure the scene and complete preliminary inquires.
In cases that are not suspicious ie: natural, accident, suicide
Police notify the coroner who may attend the scene
The body can not be altered or moved without the authorization of the coroner
The police will assist the coroner
The coroner will examiner the scene and the body in order to document and collect information that may be critical to the outcome of the investigation (ie: is this a suicide, accident).
The coroner will determine the need for further investigation including the need for an autopsy and make the appropriate arrangements for transport.

13. Investigation – Criminal/Suspicious
Police are notified of a death usually by EMS, family or others.
Police attend and secure the scene and complete preliminary inquires.
In cases that are criminal in nature or suspicious usually the major crime unit are summoned from Saskatoon.
The crime scene must be thoroughly examined, photographed and documented .
The coroner assists the police and will take control of the body usually after the scene has been processed.
The coroner will make the necessary arrangements for transport and postmortem examination.

14. Challenges
Our goal is to complete a thorough investigation in a respectful and timely manner however, there are challenges:
Distance
Resources ie: coroners, transportation
Weather

15. The Work of the Coroner is a Barometer of the Health of our Communities
Physical Health
Drug and Alcohol Use
Mental Health (depression and suicide)
Homelessness
Violence