U.S. Department of Justice
Office of Justice Programs
Bureau of Justice Statistics
Special Report

Medical Examiners and Coroners' Offices, 2004

June 2007, NCJ 216756


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This file is text only without graphics and many of the 
tables. A Zip archive of the tables in this report in
spreadsheet format (.csv) and the full report including
tables and graphics in .pdf format are available from:
http://www.ojp.usdoj.gov/bjs/abstract/meco04.htm
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Matthew J. Hickman, Ph.D.
Kristen A. Hughes
Bureau of Justice Statistics

Kevin J. Strom, Ph.D.
Jeri D. Ropero-Miller, Ph.D., DABFT
RTI International

About 2,000 medical examiners and coroners'(ME/C) offices
provided death investigation services across the United 
States in 2004. These offices were responsible for the 
medicolegal investigation of death. They may conduct death 
scene investigations, perform autopsies, and determine the 
cause and manner of death when a person has died as a 
result of violence, under suspicious circumstances, without 
a physician in attendance, or for other reasons.

As of 2004, 16 States had a centralized statewide medical
examiner system (see map). Fourteen States had a county 
coroner system, 7 had a county medical examiner system, 
and 13 had a mixed county medical examiner and coroner 
system. Eight States with decentralized death investigation 
systems also had a State medical examiner office performing 
medicolegal duties (Alabama, Arkansas, Georgia, Iowa, 
Kentucky, Montana, North Dakota, and Tennessee). The
District of Columbia reported a city medical examiner 
office, which functioned similar to a statewide system. 

ME/C offices employed an estimated 7,320 FTE employees.
Estimated annual budgets for these offices totaled $718.5 
million, an average of $387,000 per office. The majority of 
ME/C offices in 2004 were county coroners' offices (1,590 
or 80%), most of which served small jurisdictions(less than 
25,000 persons).

Nearly one million human death cases were referred by medical
and law enforcement personnel to the Nation's ME/C offices in 
2004, accounting for approximately 40% of all deaths in the
United States that year.***Footnote 1: For more information 
about the total number of deaths in the United States, see the 
Center for Disease Control's website on "Deaths/Mortality" at
<http://www.cdc.gov/nchs/fastats/deaths.htm>.*** Depending on 
the circumstances of the death, characteristics of the death 
scene, the decedent's medical history, and other factors, 
death cases may be cleared without the medical examiner or 
coroner accepting jurisdiction and conducting an additional 
investigation to determine the cause and manner of death. 
Overall, ME/C offices in 2004 accepted about half of all 
referred cases for further investigation.

The 2004 Bureau of Justice Statistics'(BJS)Census of Medical 
Examiner and Coroners' Offices represented the Bureau's first 
effort to describe the medicolegal investigation of death in 
the United States. The census also gathered detailed 
information on unidentified human decedents handled by ME/C 
offices because they represent a critical component in the 
Nation's effort to resolve missing persons cases. In a 
typical year ME/C offices reported that they handled about
4,400 unidentified human decedents of which about 1,000
remained unidentified after one year. 

Sixteen States in 2004 had centralized, statewide 
medical examiner systems

Although the specific title and duties of medicolegal 
officials varied, each State had one of three basic types 
of death investigation systems: medical examiner, coroner, 
or mixed systems. States varied in the degree to which death 
investigation was centralized. Some States had a statewide
medical examiner system with no independently functioning
county entities, while other States had independent medical 
examiner or coroner offices in each county or in other 
political or geographic subdivisions, such as judicial 
districts. Some ME/C offices were responsible for a specific 
city, a county, multiple counties, or larger regions within 
a State.

Caution should be exercised when making comparisons by the
type of office. States differed in selection and qualification 
standards for medicolegal officials. The distinction between 
coroner and medical examiner systems varied by jurisdiction; 
and the qualifications, skills, and activities of medicolegal 
personnel cannot necessarily be inferred from the title 
attached to the office.

In general, coroners were elected officials while medical
examiners were appointed. Coroners may be lay persons while 
medical examiners were generally required to be physicians 
and may have specialized training (such as forensic pathology). 
Among many exceptions, there were forensic pathologists who 
had been elected to the position of coroner and served in a 
coroner's office. In addition, some medicolegal officials held 
the title of medical examiner or coroner, while the title of 
the office was the opposite. These factors complicate 
comparisons by type of office. 

Two-thirds of the nearly 2,000 ME/C offices in the 
United States served populations of less than 50,000 
persons

A total of 1,998 ME/C offices were enumerated in the BJS 
census, including offices in the District of Columbia and in 
each State except Louisiana. Due to Hurricane Katrina, data
collection was temporarily suspended in affected gulf-coast
States and ultimately canceled in Louisiana. Sixty-four 
offices were operating in Louisiana at the time of the 
census. In the aftermath of Hurricane Katrina, Louisiana 
created a centralized State medical examiner office.

Most ME/C offices served relatively small jurisdictions.
About two-thirds of the offices in the BJS census (1,361 
offices, or 68%) served populations of less than 50,000 
persons. Nearly 1 in 5 served populations of less than 
10,000 persons. Of the 57 offices that served jurisdictions 
with populations of 1 million or more, 12 were centralized 
medical examiner offices serving an entire state.

County coroners' offices accounted for 80% of all 
ME/C offices in the United States 

The majority of ME/C offices in the United States were county
coroner offices (1,590 offices, or 80%), most of which serve 
relatively small jurisdictions. County medical examiner 
offices were the next most common type of office (316 
offices, or 16%), the majority serving medium-sized 
jurisdictions (25,000 to 249,999 persons). The remainder 
consisted of State medical examiner offices, district or 
regional medical examiner and coroner offices, and city
medical examiner offices.

ME/C offices employed an estimated 7,320 full-time 
personnel nationwide; over half worked in offices 
serving 500,000 or more persons.

ME/C offices employed an estimated 7,320 full-time equivalent
(FTE) personnel in 2004. Most of the personnel were employed 
in offices serving jurisdictions of 500,000 or more persons.
While only 6% of all offices served populations of 500,000 
or more persons, these offices employed over half of all FTE 
personnel.

Offices serving 100,000 or more persons, representing 20% of
all offices, employed more than two-thirds (69%) of all FTE 
personnel. County coroner offices employed nearly half (48%) 
of all FTE personnel in 2004, and county medical examiner 
offices employed 28%.

ME/C offices serving large jurisdictions had an average of
over 20 FTE personnel, while those serving medium and small 
jurisdictions averaged about 1 to 2 FTE positions. Offices 
serving jurisdictions of 1 million or more persons had an 
average of about 50 FTE personnel.

Among offices serving large jurisdictions (250,000 or more
persons), most of the FTE salaried employees (40%) were 
categorized as ancillary death investigation personnel, such 
as medical death investigators, autopsy technicians, and 
photographers. Forensic pathologists (13%) and other medical 
examiners and coroners(7%)comprised 20% of all FTE employees.
Thirteen percent were laboratory support personnel, such as
lab technicians, analysts, and toxicologists. Forensic 
specialists, such as odontologists, entomologists, and 
anthropologists, comprised less than 1% of all FTE employees.

Some ME/C offices did not have FTE salaried personnel and the
individuals performing medicolegal duties were compensated 
on a per case, per diem, fee-for-service, or other "as
needed" basis. ME/C offices may also use full- or part-time
consultants and contractors, including pathologists, 
forensic specialists, on-call field investigators, and 
others. 

Nearly 1 million human death cases referred in 2004; 
about 500,000 accepted

In general, when a human decedent is discovered by law
enforcement, medical personnel, or other persons, the 
decedent case is referred to the ME/C office that has 
jurisdiction. An estimated 956,000 cases were referred to 
the Nation's ME/C offices during calendar year 2004.

Referred cases were generally screened to determine if they
can be cleared based on death scene characteristics, medical 
history, and other factors, or if it was necessary to assume 
jurisdiction and conduct additional investigations, including
toxicological screens, autopsies, and specialized procedures. 
About 487,000 cases, or 51% of all cases referred in 2004, 
were accepted, meaning that the office conducted additional 
investigations and completed the death certificate or 
otherwise determined the cause of death. These cases
represented about a fifth of all human deaths in 2004.

About three-quarters(74%)of all referred cases in 2004 were
handled by ME/C offices serving jurisdictions of 250,000 or 
more persons. These offices handled about two-thirds(64%)of 
all accepted cases.

The percentage of referred cases accepted for further
investigation was higher in smaller jurisdictions. About 85% 
or more of referred cases were accepted in jurisdictions 
serving less than 25,000 persons, compared to less than half 
of referred cases in jurisdictions serving 250,000 or more. 
These differences may be due to variations in referral and 
screening practices, workload, and other factors. 

Overall an average of about 480 cases were referred to ME/C
offices in 2004. About 240 of the referred cases were accepted. 
The average number of cases referred in 2004 ranged from 40 to 
70 among county coroner and medical examiner offices serving 
small jurisdictions to over 3,500 among county medical examiner 
offices serving large jurisdictions. State medical examiner 
offices averaged about 4,800 referrals.

Accepted cases in 2004 ranged from an average of 30 to 50 in
county coroner and medical examiner offices serving small 
jurisdictions to more than 1,200 in large jurisdictions. State
medical examiner offices accepted an average of about 3,000
cases.

Completed autopsy in nearly half of accepted cases;  
autopsy more likely in large jurisdictions

Accepted cases may involve a variety of procedures related to
the medicolegal investigation of death. Among 1,087 offices 
reporting details on accepted death case procedures performed 
in 2004, about 62% of accepted cases included a death scene
investigation (not shown in table). Other common procedures 
included toxicology analysis (51%), complete autopsy (48%), 
and review of medical records (45%). Less common were 
radiology (13%), microbiology (7%), crime scene processing 
(5%), partial autopsy (4%), metabolic screen (3%), and 
characterization of skeletal remains (1%).

ME/C offices serving jurisdictions of less than 250,000
conducted death scene investigations in a greater percentage 
of accepted cases (72%), compared to jurisdictions serving 
250,000 or more (42%). This difference may be due to 
variation in screening practices; for example, death scene 
investigations may be part of the screening process prior 
to accepting a case in jurisdictions of 250,000 or more 
persons, but after accepting a case in jurisdictions of 
less than 250,000.

ME/C offices serving jurisdictions of 250,000 or more
conducted toxicology analyses (57%) in a greater percentage 
of accepted cases, compared to offices serving smaller 
jurisdictions (34%). Similarly, offices serving large 
jurisdictions conducted complete autopsies in a greater
percentage of accepted cases (45%), compared to offices
serving smaller jurisdictions (23%).

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Nearly 13,500 unidentified human decedents presently 
on record; total number affected by variation in 
record keeping practices

ME/C offices reported a total of 13,486 unidentified human 
decedents currently on record, with the largest jurisdictions 
(those serving 250,000 or more) accounting for 87% of all 
cases. Overall, an estimated 23% of ME/C offices reported one 
or more unidentified decedents on record (not shown in table).  
Both jurisdiction size and record keeping practices of offices 
affected the number of unidentified human decedents on record.

An estimated half (49%) of ME/C offices in 2004 had a policy 
for retaining records on unidentified human decedents, such 
as x-rays, fingerprints, or DNA. ME/C offices serving larger 
jurisdictions were more likely to have such a policy. More 
than 90% of those serving 250,000 or more persons had a 
policy to retain records of unidentified human decedents. In 
comparison, 29% of ME/C offices serving jurisdictions of less 
than 2,500 persons reported such a policy. 

A forthcoming BJS report will compare the information on 
unidentified human decedents obtained in the BJS census with 
data available in the Federal Bureau of Investigation's 
National Crime Information Center. The report will also explore 
different methods for generating national estimates of the 
total number of unidentified human decedents. Understanding 
the number and distribution of unidentified human decedents 
is critical to improving national databases, particularly 
regarding missing persons investigations.  
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4,400 unidentified human decedents reported in an 
average year; 1,000 remained unidentified after 1 year

Medical examiners and coroners are occasionally faced with 
a human decedent that cannot be identified. ME/C offices 
estimated that a total of about 4,400 unidentified human 
decedents were reported in an average year. Ninety percent 
of these estimated annual unidentified decedents were 
reported by offices serving jurisdictions of 250,000 or 
more persons (not shown in figure).

After one year an estimated 1,000 (or 23%) remained
unidentified and became "cold cases." Seventy percent of 
these estimated annual cold cases were reported by offices 
serving jurisdictions of 250,000 or more persons(not shown 
in figure).

ME/C offices reported that a total of about 600 cold cases
underwent final disposition (such as burial, cremation, or 
other means of disposition) in 2004. Seventy-one percent of 
these cases were reported by offices serving jurisdictions 
of 250,000 or more persons (not shown in figure).

Eighty percent of ME/C offices reported they "rarely or
never" used NCIC

An estimated 20% of ME/C offices reported they used the FBI's
National Crime Information Center(NCIC) "somewhat often" or 
"very often," while 80% said they used the NCIC "rarely or
never". Frequent use of NCIC was more common among offices 
serving larger jurisdictions, including 59% of those serving 
1,000,000 or more persons.

Direct access to NCIC by ME/C offices was not permitted 
at the time of the census. Typically, information on 
unidentified human remains was entered by law enforcement 
agencies on behalf of ME/C offices. In May 2006 direct 
access to NCIC was granted to ME/C offices by the FBI. 
Greater use of NCIC might be expected as a result, but 
increased workload and the cost of access remain obstacles.

As of February 2005 the NCIC Unidentified Person file 
contained about 5,800 unidentified human decedent records. 
Twenty-seven percent of these unidentified persons were 
determined to be homicide victims. The cause of death for 
more than half of the victims could not be determined.

California was the only State that mandated information about
the unidentified be reported to NCIC within a specified period. 
About 42% of all records in the NCIC unidentified persons file
were from California.

Estimated annual budgets totaled $718.5 million or 
about $387,000 per office

ME/C offices had estimated overall annual budgets of nearly
$718.5 million, an average of $387,000 per office. The 
median budget was $37,000. 

County medical examiner budgets averaged $715,000,
ranging from an average of $2.5 million among those serving
large jurisdictions to $18,000 among those serving
small jurisdictions.

County coroner budgets averaged $225,000, ranging from
an average of about $1.4 million among those serving large
jurisdictions to $41,000 among those serving small jurisdictions.

Overall, ME/C offices had annual budgets equivalent to about
$99,000 per FTE employee. Among county coroner and medical 
examiner offices, per FTE amounts were higher in medium
jurisdictions and lowest in small jurisdictions. County
medical examiner offices serving small jurisdictions had the 
lowest per FTE budget, at $11,400. County coroner offices 
serving medium jurisdictions had the highest per FTE budget, 
at $143,400.

Methodology

Data collection for the 2004 Census of Medical Examiner and
Coroner Offices was conducted by RTI International (RTI) on 
behalf of BJS under cooperative agreement 2005-MU-MU-K011. BJS
provided an initial draft questionnaire and respondent list
to RTI. RTI reviewed the draft questionnaire for general 
content and design and coordinated a forensic expert panel 
review of the instrument to obtain feedback on specific items.

The initial list of ME/C offices operating in the United
States was provided to BJS by the Centers for Disease Control 
and Prevention, U.S. Department of Health and Human Services. 
RTI updated the list and conducted telephone verification of
contact information for each office.

Data were collected by mixed mode. In addition to mail-out
packages, RTI created a web site on which respondents could 
access the questionnaire and provide responses electronically.
Follow-up efforts included Computer Assisted Telephone
Interviewing (CATI) and e-mail. Seventy-one percent of 
respondents used mail or facsimile transmission of data, 13% 
responded via the Internet, and 16% responded by telephone.

A total of 1,998 ME/C offices were enumerated in the census.
Despite extensive follow-up efforts, 281 ME/C offices did not 
respond to the request for information, yielding an overall
response rate of 85.9%. By population served, the response
rate was lowest among ME/C offices serving 10,000 to 49,999 
persons (83.9%), and generally higher among those serving 
100,000 or more.

By type of office, the response rate was lowest among county
medical examiner offices serving small jurisdictions (77.3%). 
Response rates for other types of offices were as follows: 
State medical examiner offices (100.0%); city medical 
examiner offices (100.0%); district or regional medical 
examiner offices (94.3%); county coroner offices (85.9%); 
county medical examiner offices (84.2%).

Five States had overall response rates below 80%, including
Kansas (79.4%), Wyoming (78.3%), Tennessee
(77.4%), Arizona (64.3%), and Illinois (60.4%). In counties
in Texas, justices of the peace are not death investigators
or coroners. They may make cause and manner of death
determinations but were out of scope for this census.

Imputations were made for missing continuous data elements
including FTEs, budgets, and workload items (cases referred 
and accepted, and unidentified decedents handled in an 
average year). Imputation cells were based on the State in 
which an ME/C office was located, type of office, and 
population served.

For FTE data the median ratio of FTEs to population served
was calculated within imputation cells and multiplied by the 
population for offices with missing data to produce the 
imputed values. Imputations for FTE data in sheriff-coroner 
offices were based on agency employment data from the BJS 
Law Enforcement Management and Administrative Statistics 
(LEMAS)program. 

For budget data the median ratio of budget to FTEs was
calculated within imputation cells and multiplied by the 
total FTEs in offices with missing data to produce the 
imputed values. 

For referred cases, accepted cases were divided by the median
ratio of cases accepted to those referred. For accepted cases, 
referred cases were multiplied by the median ratio of cases 
accepted to those referred. If both elements were missing, 
the median ratio of cases referred to population served was 
multiplied by the population for offices with missing data 
to impute referred cases. The median ratio of cases accepted 
to those referred was multiplied by the number of referred
cases to impute accepted cases.

For unidentified decedents reported annually, remaining
unidentified after 1 year, and undergoing final disposition, 
the median value within imputation cells was used as the 
imputed value.

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The Bureau of Justice Statistics is the statistical 
agency of the U.S. Department of Justice. Jeffrey L. 
Sedgwick is director.

This Special Report was written by Matthew J. 
Hickman and Kristen A. Hughes of BJS, under the 
supervision of Steven K. Smith, and Kevin J. Strom 
and Jeri D. Ropero-Miller of RTI International. Tracey 
Kyckelhahn provided statistical review. Data collection 
for the 2004 Census of Medical Examiner and Coroners' 
Offices was conducted by RTI International on behalf of 
BJS under cooperative agreement 2005-MU-MU-K011.

The National Association of Medical Examiners
(NAME) and the International Association of
Coroners and Medical Examiners (IACME) provided
valuable assistance in development of the data
collection instrument and in encouraging participation
in the study. (See <http://thename.org> and <http://
www.theiacme.com> for more information.)

Carolyn C. Williams edited the report, with assistance 
from Joanna S. Bradford, and Jayne Robinson prepared 
the report for final printing, under the supervision 
of Doris J. James.

June 2007, NCJ 216756
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This report in portable document format and in ASCII 
and its related statistical data and tables are 
available at the BJS World Wide Web Internet site:
<http://www.ojp.usdoj.gov/bjs/abstract/meco04.htm>
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End of file 
06/06/07 ih