1 Funding for Accreditation of Medicolegal Death Investigation Offices 1

and Certification of Medicolegal Death Investigation Personnel 2

3

4

Recommendation s 5

6

The National Commission on Forensic Science requests that the Attorney General of the United 7

States approve policy that recommends: 8

9

1. All Medicolegal Death Investigators be certified within 5 years. 10

2. All offices, facilities or institutions performing m edicolegal death investigation ac tivities 11

will be accredited within 5 years. 12

3. The Department of justice’s Office of Justice Programs will support a grant program or 13

allow funds within existing programs to be utilized to help defray the costs associated 14

with certification and accreditation to ensure compliance. 15

16

Background 17

18

The National Research Council’s (NRC) report on strengthening the forensic sciences 19

recommends that all medicolegal death investigation offices be accredited and that personnel be 20

certi fied in their area of expertise. In general, a ccreditation applies to institutions, facilities, and 21

offices performing a certain task to become accredited, while certification is for the professionals 22

working within a specific area of expertise

. This document discusses the need for mandato ry 23

accreditation and certification, as well as identifies potential funding for the implementation to 24

accredit all U.S. medicolegal death investigation offices and facilities and to certify all death 25

investigation professionals. 26

27

Accreditation of Office s 28

29

Unlike most crime laboratories which are accredited, most medicolegal death investigation 30

offices, medical examiners and coroner offices, are not accredited. Of the estimated 2

, 366 31

medicolegal death investigation offices in the United States (See Table 1), less than 100 are 32

accredited by either the National Association of Medical Examiners (NAME) or the International 33

Association of Coroners and Medical Examiners (IAC&ME) which are currently the only two 34

accrediting bodies in the United States for medicolegal death investigation institutions. 35

Although NAME and IAC&ME offer accreditation, neither are formally recognized by an 36

external standards organization which approves entities to offer accreditation, such as the 37

International Organization fo r Standards (ISO) or the American National Standards Institute 38

(ANSI )

. F ormal recognition of NAME or IAC&ME by an existing external standards 39

organization would likely require significant changes to these organizations current structure to 40

meet organizatio nal standards. 41

42

Certification of Staff 43

44

The number of board certified forensic pathologists in the United States is relatively small, in 45

comparison to the overall number of medicolegal death investigators and non

- physician coroners 462

currently employed. Fo r the purposes of this proposal, medicolegal death investigator is 47

considered an investigator employed by a coroner or medical examiner’s jurisdiction and has the 48

primary function of performing investigations to assist in determining the cause and manner o f 49

death. A study done by the Scientific Working Group on Medicolegal Death Investigation 50

(SWGMDI), suggested that approximately 9 medicolegal inves tigators are needed per million 51

population to operate at needed capacity, therefore the pool of certified in vestigators needed in 52

the United States would potentially be approximately 3,000. Additionally, there are also 53

approximately 2,000 coroners in the United States, so it is likely that the total certifications 54

required for all such professionals could appro ach 5,000. The American Board of Medicolegal 55

Death Investigators (ABMDI) estimates that the number may approach closer to 8,000. At 56

present, only about 1,500 professionals are certified by the ABMDI. Thus, the pool of persons 57

needing certification is la rge. 58

59

T raditional ly physicians seeking board certification bear the cost of certification through well

60

established certification bodies such as the American Board of P athology ( ABP )

. Such is not the 61

case for thousands of death investigators and non

- physician coroners who may wish (or need) to 62

become certified by ABMDI

. In most specialty areas of medicine, physicians have essentially 63

been required to possess certification s to work in their specialty area s , while the same has not 64

been true for coroners and death investigators. 65

66

Accreditation and certification are critical because they show compliance with industry and 67

professional guidelines, standards, and performance criteria. Unfor tunately, many government 68

bodies which fund death investigations offices do not give priority to death investigation systems 69

in comparison to other programs that require funding

. Thus, budget lines for accreditation and 70

certification expenses are often no n

- existent. 71

72

Funding Accreditation 73

74

In the past, some funding was available to pursue accreditation through the use of Paul Coverdell 75

F orensic S cience Improvement grant funds

. However, there were challenges; accreditation could 76

not be guaranteed, funding was short term, and there are associated ongoing costs to maintain 77

accreditation. A potential long term solution might be to reimburse offices and facilities for 78

expenses incurred to obtain initial accreditat ion and for maintaining accreditation after su ch 79

expenses have been incurred and accreditation has been secured. 80

81

Costs associated with reimbursement can be analyzed for several types of offices as shown in 82

Table 1. There are offices which are full

- service facilities (administration, scene investigation, 83

and autopsy) and others whose services are primarily administrative, investigative

- only, or 84

autopsy only. Regardless of type, costs of accreditation include fees charged for the accreditation 85

process as wel l as the purchase of equipment and supplies or hiring of needed personnel to 86

qualify for accreditation. There is a perception that a lack of motivation and devoted effort are 87

perhaps the primary reason for failure of offices to become accredited, however the accreditation 88

fees are a real and significant hurdle for almost all offices . The Commission believes that 89

reimbursement for accreditation fees will encourage and enable more offices to become 90

accredited, and that a reimbursement will ensure efficient and appropriate spending of federal 91

funds. A plan can be developed for gradual implementation over a 5 year period. 923

Table 1. Number of potentially accredited offices by state and type

. 93

94

State State ME

Office Branch State

ME Offices Autonomous County Medical

Examiner Offices Coroner Offices Total Potential

Acc r editations

AL 3 1 64 68

AK 1 1

AZ 15 15

AR 1 75 76

CA 4 54 58

CO 1 62 63

CT 1 1

DE 1 1 2

FL 24 (District ME Offices) 24

GA 1 2 5 54 62

HI 1 4 5

ID 44 44

IL 1 101 102

IN 92 92

IA 1 99 100

KS 31 (district coroners) 105 136

KY 1 3 120 124

LA 64 64

ME 1 1

MD 1 1

MA 1 1

MI 83 83

MN 44 43 87

MS 1 82 83

MO 6 109 115

MT 1 1 56 58

NE 93 93

NV 1 16 17

NH 1 1

NJ 1 2 15 18

NM 1 1

NY 24 38 62

NC 1 1 2

ND 1 1 43 45

OH 2 86 88

OK 1 1 2

OR 1 2 3

PA 3 64 67

RI 1 1

SC 46 46

SD 66 66

TN 1 4 5

TX 11 243 (multiple JPs) 254

UT 1 1

VT 1 1

VA 1 3 4

WA 6 33 39

WV 1 1 2

WI 13 59 72

WY 23 23

TOTAL 25 2 5 3 90 19 39 23 794

Potential Accreditation Costs 95

96

Fees charged by NAME and IAC&ME vary based on population, number of inspectors required, 97

whether the inspection is virtual (paper only) or on site, and whether the inspection is conducted 98

by NAME or I AC&ME. The costs shown in Table 2 are based on average costs and should give 99

a reasonable ballpark estimate of accreditation costs based upon the various types of offices. 100

101

It i s also important to take note that if NAME and IAC&ME were at some point accredited by 102

ISO or a similar body which approves entities to be accrediting bodies, the cost of initial 103

accreditation and ongoing accreditation costs would rise significantly above those depicted in 104

Table 2

. 105

106

ISO or similar approval for NAME and IAC&ME to be accrediting bodies 107

108

As it stands now, NAME and IAC&ME would probably have difficulty in obtaining recognition 109

from ISO accrediting bodies. They lack adequate staff to meet the requirements, the accred itation 110

processes have to be an entity separate from the organization itself and have their own physical 111

plant. It is estimated that such approval would cost $40,000 to $60,000 per organization based 112

on the experience of other groups, and the process coul d take several years. Partnering with 113

existing ISO approved entities may make more sense. 114

115

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117

118

119

120

121

122

123

124

125

126

127

128

129

130

131

132

133

134

135

136

137

138

139

1405

T able 2. Estimated costs for accreditation of each “tier” of office type

. 141

142

Office Type Number Estimated Cost Per Initial Cost Ongoing Yearly

Cost at $1000/per

State ME 25 $5,000 125,000 25,000

Branch State

ME 27 $5,000 135,000 27,000

County ME

or District

ME or

District

Coroner 375 $5,000 1,87 5 ,000 37 5 ,000

SUBTOTAL 42 7 $5,000 2,13 5 ,000 42 7 ,000

Coroner

Office (if

paper only) 19 39 $1,000 1,9 39 ,000 1,9 39 ,000

Coroner

office (if on

site visit) 19 39 $3,500 6,7 86

, 5 00 1,9 39 ,000

SUBTOTAL 19 39 $2,250 (average) 1,9 39 ,000

To

6,7 86

, 500 1,9 39 ,000

TOTAL 2366 4,07 4 ,000

To

8,92 1

, 5 00 2,366,000

143

144

145

Certification by ABDMI 146

147

It is difficult to know exactly how many professionals need to be certified by ABMDI. But 148

foundationally as discussed above and shown in Table 1, there are 1

, 940 Coroner jurisdictions, 149

plus the additional Deputy Coroners , Coroner Investigators, and Medical Examiner Investigators 150

who would need to be accounted for as they require certification as well. Historically, s ome 151

jurisdictions rely on police for conducting medicolegal death investigations , but this is gene rally 152

because these offices have not traditionally had the resources to have their own dedicated 153

professional medicolegal death investigators who would work closely with the forensic 154

pathologists investigating cases from a medical perspective and support t hem in their 155

determin ation of cause and manner of death. As previously outlined, b ased up on population, the 156

estimated number of medicolegal death investigators needed nationally is approximately 3

, 000, 157

however when accounting for all medicolegal professio nals that would require ABMDI 158

certification, the number approaches a total of 8

, 000

, i f all potentially eligible persons are 159

included. 160

1616

ABDMI certification costs $450 and annual maintenance fees are $50. Thus, estimated costs can 162

be calculated as shown in Table 3. 163

164

Table 3. Estimated cost of ABMDI certification 165

166

Group Number Already

ABDMI

Certified or

Registered

(Estimated) Need

Certification Initial Cost at

$450 Ongoing

Maintenance

Cost at $50

per year

Investigators 6061 1200 4,861 2, 187

, 4 50 303,050

Coroners 1939 300 1,639 737

, 550 96,950

Total 8000 1500 6,500 2,925,000 400,000

167

In addition to the initial costs for certification, ABMDI requires 45 hours of continuing education 168

credit every 5 years to maintain ABMDI certification. Some of this credit can be obtained via on

169

line continuing education programs, but it is recommended that funding be provided for the 170

registration fee for two, one week CE

- approved courses during the five year period for each 171

eligible person . Thus, assuming an es timated $600 registration fee for such courses, and that 172

potentially 8

, 000 people would need to attend two courses during a five year period, the 173

estimated costs to fund such training annually would be approximately $ 1,920,000

. 174

175

Funding Strategy 176

177

Federal funding to help defray costs associated with accreditation or certification could be 178

dispe rsed via existing or new grant programs through Department of Justice agencies or offices 179

such as the Office of Justice Program’s (OJP) National Institute of Justice ( NIJ )

, or other federal 180

entities such as the National Institute of Health ( NIH ) . Agency r eimbursement would occur 181

when an entity or person produces proof of accreditation or certification, respectively. 182

183

The estimated costs of such an endeavor, b ased on the assumption that a maximum expense 184

approach is taken to ensure accreditation and certification of all eligible entities and 185

professionals is as follows: 186

187

Initial accreditation of all offices $8,92 1

, 5 00

Initial certification of all personnel $2,925,000

Total initial cost $11,846,500

Annual maintenance cost for accreditation s $2,366,000

Annual maintenance cost for certifications $400,000

Annual cost of course registration fees $1,920,000

Total annual maintenance costs $4,686,000

ISO approval of NAME and IAC&ME $100,000 (plus staff and facility costs)

1887

Th e chart below shows an estimated need of federal funding to support reaching a 50% 189

certification rate goal and a 75% accreditation rate goal over the next five years

. 190

191

Certification

Rate Certification Costs Accreditation

Rate Accreditation Costs

10%

Year 1 Initial $292,500

Maintenance 40,000

Total $332,000 15% Initial $1

, 338,225

Maintenance 3 54,900

Total $1,693,125

10%

Year 2 Initial $292,500

Maintenance 80,000

Total $372,000 15% Initial $1338,225

Maintenance 709,800

Total $2,048,025

10%

Year 3 Initial $292,500

Maintenance 120,000

Total $412,000 15% Initial $1

, 338,225

Maintenance 1,064,700

Total $2,402,925

10%

Year 4 Initial $292,500

Maintenance 160,000

Total $452,000 15% Initial $1

, 338,225

Maintenance 1,419,600

Total $2,757,825

10%

Year 5 Initial $292,500

Maintenance 200,000

Total $492,000 15% Initial $1

, 338,225

Maintenance 1,774,500

Total $3,112,725

50% of eligible

persons certified

within 5 years Total $2,060,000 75% of all

eligible offices

accredited within

5 years Total $12,014,625

192

As shown, the total cost for certification and accreditation would increase annually from a first 193

year total of $2,025,125 in year one to a total of $3,604,725 by year five, with a total cost of 194

$1 4 ,074,625 over the five year period. This plan would enable certification of 50% of personnel 195

and accreditation of 75% of offices. Added to this would be an approximate $192,000 per year 196

for continuing education course registration fees. 197

198

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200