SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 1

Status of and Perceived Need for 

Regional Medicolegal Death Investigation Centers

A Report and Recommendations 

Prepared by the System Infrastructure Committee of the 

Scientific Working Group on Medicolegal Death Investigation (SWGMDI)

Executive Summary

Recommendation 11a of the National Research Council (NRC) report, “Strengthening Forensic 

Science in the United States: A Path Forward,” is that funds be provided to build regional 

medical examiner offices (1). As a follow up to that recommendation, the SWGMDI embarked 

on a process to establish the perceived need for regional centers in the United States. Following 

analysis of survey results, the following recommendations are made:

 The Coroner Summit proposed for 2013 should include agenda time and further 

information collection to better identify the need for regional centers in states with 

coroners, as well as the types of services that may be needed to serve the region. 

 Accredited forensic pathology training positions that are not currently funded should 

be funded with a combination of state and federal funds, and efforts are needed to fill 

those positions.

 Consideration should be given to establishing a federally funded armamentarium of 

forensic pathologists. 

 Generic plans should be developed for regional centers that could be the model for all 

newly constructed regional centers. 

 Further study of state-specific needs should be conducted.

 Consider regional centers that may serve jurisdictions in adjacent states, especially in 

areas near state lines. 

 Federal support should be provided.

 Criteria for regional centers need to be developed.

This report contains the methodology, background methodology, and survey results that were 

used in developing the above recommendations. It is important to realize that this report 

describes perceived need, which may not correspond to real need or be justifiable. The 

SWGMDI is undertaking other projects related to regional center construction and staffing and 

forensic pathologist workforce locations. It is critical for more study to be conducted within 

states and among states before the idea of regional centers is seriously planned or implemented. 
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 2

Status of and Perceived Need for 

Regional Medicolegal Death Investigation Centers

A Report and Recommendations 

Prepared by the System Infrastructure Committee of the 

Scientific Working Group on Medicolegal Death Investigation (SWGMDI)

INTRODUCTION

Recommendation 11a of the NRC Report, “Strengthening Forensic Science in the United States: 

A Path Forward,” is that funds be provided to build regional medical examiner offices (1). As a 

follow up to that recommendation, the Scientific Working Group on Medicolegal Death 

Investigation (SWGMDI) embarked on a process to document the perceived need for regional 

centers in the United States. 

METHODS

On April 17, 2012, email notification of the National Association of Medical Examiners 

(NAME), American Board of Medicolegal Investigators (ABMDI), and International 

Association of Coroners and Medical Examiners (IAC&ME) members was made regarding an 

on-line survey to collect information about the status and perceived need for regional 

medicolegal death investigation centers in each state.

The number of email notifications to each organization numbered 1103, 1295, and 600, 

respectively. There is a small overlap in membership among those organizations, so the number 

of people receiving notification probably numbered less than 2998. Information requested 

included:

 Name of the responder’s state

 Whether or not regional centers currently exist in the state

 Whether there is a perceived need for additional regional centers

 The suggested locations for future regional centers

 The approximate number of counties that would be served by each center

 The approximate number of additional forensic pathologist FTEs that would be needed to 

staff the regional centers

 Whether these centers would need autopsy services, on-site investigators, toxicology 

services, and/ or a more extensive crime lab

 Open ended comments/clarifications

The on-line survey was closed on May 13, 2012. The Presiding Officer of the SWGMDI System 

Infrastructure Committee tabulated the survey results and prepared an initial draft report. The 

draft report was reviewed by members of the Committee and appropriate edits were made to the 

draft. The entire SWGMDI Board of Directors then reviewed the draft and approved it for public 

review and comment.
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 3

Assuming that “medical examiners” will eventually work in any regional centers that are 

established, and that the term “medical examiner” is variably used among states, the SWGMDI 

defines a medical examiner as a physician certified in forensic pathology by the American Board 

of Pathology or its international equivalent, and who performs or oversees official medicolegal 

autopsies for a coroner or medical examiner death investigation system. 

RESULTS AND COMMENTS

There were 110 responses. At least one response was obtained from each state except Hawaii. 

The number of responses per state ranged from 1 to 8 (see Table 1). Sixty-eight (62%) of 

responders were forensic pathologists; the remaining responders included coroners (n=22), 

administrators (n=9), and death investigators (n=6). (See Table 2)

Although the response rate of 4% may seem very low, it is quite possible that a single responder 

could fully understand the need or lack of need for regional centers in a given state. For example, 

for the 26 states with a state medical examiner, it could be assumed that the state medical 

examiner would have a good perception of need. In fact, the SWGMDI conducted a separate 

survey of the 26 State Medical Examiners to determine their perceptions about need for 

additional facilities, and the results were concordant with those presented in this report (2). In 

other states, a single coroner, death investigator, or forensic pathologist might be quite familiar 

with needs in the state. Thus, the low response rate does not necessarily undermine the validity 

of the results. 

Although in some states there was disagreement about whether additional regional centers were 

needed, in 30 states at least one respondent perceived a need for at least one regional center (see 

Figure 1 and Appendix 1). In 16 states, multiple respondents agreed that one or more regional 

centers were needed. 

It must be remembered, however, that the survey reflects the perceived need by responders of 

various types and with various perspectives, without regard to the logistics of implementation. In 

some cases, it is possible that a responder had a desire for a regional center near his/her area, but 

for one or more reasons, actually having a regional center in that area may not be practical or 

feasible. For example, seven different locations in Wyoming were suggested as needing a 

regional center, yet the population is sparse and funding and caseload may not support such a 

large number of regional centers.

In some states, the need for regional centers indicated that new facilities would need to be built 

in selected cities/towns. Others indicated that existing county or regional centers needed to be 

more formally organized within a state to serve specific groups of counties. Further, at least two 

states reported regional centers that exist but are not open because of budget and staffing 

problems (GA, MS) (See Figure 1 and Appendix 1). 
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 4

Overall, approximately 46 locations were suggested to host regional centers in the various states 

(See Figure 1 and Appendix 1), while renovation, restructuring, or re-opening of existing centers 

was mentioned for approximately 20 additional areas. 

Results indicate that up to 160 forensic pathologists would be needed to staff the new regional 

centers. The actual number may be somewhat less because some responders appear to have 

reported the total number of FPs that would be needed in the state, including some who are 

already working in the state. At a minimum, it appears that at least 125 FP FTE’s would be 

needed (see Table 2). 

For the 30 states whose responders perceived a need for regional centers, responders in 10 states 

expressed need for centers that had autopsy services and on-site investigators, responders in 7

states expressed need for autopsy services only, responders in 9 states indicated that need varies

by location, responders in 3 states expressed need for autopsy services, toxicology, and/or crime 

lab services, and responders in 2 states said the state could benefit from reopening existing 

centers (See Appendix 1).

Some relevant generalizations from data in Appendix 1 include:

 In some states, there are discrepant opinions about whether additional regional centers are 

needed. (CA, KY, MI, MO, NV, OH, TN, TX, WA)

 In some states, there are existing facilities that serve multiple counties, but they do not 

formally function as regional centers via a state-level organization. (CA, IL, MN, MO, NE, 

NY, SC, TX, WA)

 In some states, there is a recognized need for regional centers, but their possible locations 

have not been identified. (CA, LA, MN, NE, PA)

 Small states with State ME offices, in general, do not see a need for regional centers. (VT, 

NH, CT, DE etc.)

 Even some large states with State MEs see no need for regional centers. (NM, UT)

 In some states, regional centers exist, but they are not open because of budget issues. (GA 

(2), MS (1))

 In some states, regional centers exist, but they need renovation/expansion, or reorganization 

of the counties served. (ND, NV, NY) 

A variety of comments were received. (See Appendix 2.)

From these data, it may be possible to produce estimates for facility costs and forensic 

pathologist and other salaries. 
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 5

Table 1. Number of responders by job title and state, SWGMDI survey on the need for 

regional forensic autopsy centers, July 2012.

State Administrator Death 

Investigator

Forensic 

pathologist

Law 

enforcement

Nonphysician 

Coroner

Toxicologist Other

AL 2

AR 1

AZ 4

CA 2 1 6 1

CO 2

CT 1

DE 1

FL 3

GA 2

IA 2

ID 1 3

IL 1

IN 1

KS 1

KY 2

LA 2

MA 1

MD 1

ME 1

MI 1 1

MN 3 (1 also 

serves 

ND)

MO 3 1

MS 1 1 1

NC 1 1

NE 1

NH 1

NJ 1

NM 1 1

NV 1 1 2 1

NY 2

OH 1 3

OK 1

OR 1

PA 1 3 (+1 

MD 

coroner)
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 6

State Administrator Death 

Investigator

Forensic 

pathologist

Law 

enforcement

Nonphysician 

Coroner

Toxicologist Other

RI 2

SC 1 1

SDX 1

TN 1 2

TX 4

UT 1

VA 1

VT 1

WA 3 2

WI 1 1 2

WV 1

WY 1 4

TOTAL 9 6 67 1 23 1 2
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 7

Figure 1. Locations Suggested by Responders as Places Needing Regional Centers

For most of the suggested regional center locations indicated in Figure 1, the locations 

correspond to more densely populated areas within the relevant state when compared with U.S. 

population density maps (3). Idaho is a good example because the dots shown in Figure 1 

correspond exactly with the more densely populated areas of the state. For some states in which 

there was no perceived need for regional centers, already existing district centers (such as FL) or 

county-based coroner offices (such as CA) may be the explanation. Perceived need for only one 

regional center in Montana, for example, may reflect sparse population and small numbers of 

deaths in many areas of the state. A seemingly excessive number of suggested locations in 

Wyoming, for example, may reflect a responder’s desire to have a regional center nearby when, 

in fact, having so many regional centers in close proximity may not be practical, feasible, 

affordable, or needed. Finally, some responders perceived a need for regional centers with 

forensic pathologists but did not perceive a need for additional investigators. This most likely 

reflects a plan to use the coroners or similar personnel as the investigators. States shown with “0” 

had at least one responder who indicated that new regional centers were not needed, and states 

shown with “?” had uncertainty about specific locations for regional centers. 
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 8

Table 2. Perceived Needs for Forensic Pathologist and Service Types

State Additional 

FPs for 

Regional 

Centers

Services Needed Comments

Alabama 4 Autopsy only

Alaska 2* Autopsy only

Arizona 4 Autopsy + Investigators

California 10 Varies by locale

Georgia 5 Reopen 2

Idaho 6 Autopsy+Inv+Tox

Illinois 8 Autopsy only One reviewer suggested 

that at least 10 

additional FPs are 

needed in IL.

Indiana 3 Varies by locale

Iowa 4 Autopsy + Investigators

Kansas 10 Autopsy + Investigators This number may 

include some FP 

positions that already 

exist

Kentucky 4 Autopsy + Investigators

Louisiana 10 Autopsy + Investigators This number may 

include some FP 

positions that already 

exist

Michigan 2 Autopsy only

Minnesota 2 Autopsy+Inv+Tox

Mississippi 3 Autopsy+Inv+CrimeLab

Reopen

Missouri 2 Autopsy + Investigators

Montana 2* Autopsy only

Nebraska 3 Autopsy only

Nevada 4 Autopsy + Investigators

New Jersey 12 Autopsy + Investigators This number may 

include some FP 

positions that already 

exist

New York 10 Varies by locale

North 

Dakota

2 Varies by locale

Ohio 10 Varies by locale

Oregon 3* Autopsy + Investigators
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 9

Pennsylvania 8 Varies by locale

South 

Carolina

10 Autopsy + Investigators This number may 

include some FP 

positions that already 

exist

Texas 5 Varies by locale

Washington 3 Varies by locale

Wisconsin 4 Autopsy only

Wyoming 4 Varies by locale

TOTAL 160

*Based on the bare minimum of 1 FP per location. 

RECOMMENDATIONS

Based on data derived from the survey and on other existing data, the following 

recommendations are offered:

1) The Coroner Summit proposed for 2013 should include agenda time and further 

information collection to better identify the need for regional centers in states with 

coroners, as well as the types of services that may be needed to serve the region.

The vast majority of states for which a perceived need for regional centers was expressed are 

coroner states. The Coroner Summit would be an appropriate venue to more fully discuss status 

and needs in those states. The Coroner Summit must also include other participants such as, but 

not limited to, State Medical Examiners from states that also have coroners.

2) Accredited forensic pathology training positions that are not currently funded should 

be funded with a combination of state and federal funds, and efforts are needed to fill 

those positions.

Recent studies show that the number of forensic pathologists being produced per year is not 

sufficient to meet projected need and that 25 of 79 approved positions were not funded (4, 5). 

Funding and filling the positions that are not currently funded could theoretically nearly double 

the production of forensic pathologists per year. Another SWGMDI report that deals with 

increasing the supply of forensic pathologists in the United States is available (under review). 

Although this recommendation may seem unrelated to the topic of regional centers, it is relevant 

because the establishment of new regional centers would require forensic pathologists to staff 

them.

3) Consideration should be given to establishing a federally funded armamentarium of 

forensic pathologists. Federal funds could be used to fund forensic pathology training 

positions and to provide incentives to trainees such as low cost loans or loan forgiveness. 

Perhaps a corps of forensic pathologists could be established, analogous to the Armed 
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 10

Forces Medical Examiner (but non-military), that could be deployed to regional centers 

in states but be federal employees or state employees funded, at least in part, with 

federal dollars. Such persons would live and work in the area to which they are 

assigned. 

Such a program could be initiated with the idea of providing a minimum of 125 forensic 

pathologists to staff the scores of regional centers for which there is real need. 

4) Generic plans should be developed for regional centers that could be the model for all 

newly constructed regional centers. 

Developing generic and universally applicable regional autopsy center design and construction 

plans could reduce architectural and construction costs. Each regional center could have the same 

layout and vary only in size based on projected case load and needed support staff size. It is 

conceivable that such centers might even be of the “pre-fab” type in which the building 

components could be made at a common site, shipped to the location, and assembled. Allowance 

would be given for exterior treatments so building appearance would conform to local building 

codes and community design requirements. Sharing of non-generic architectural plans might be 

an option. Regardless, allowances would have to be made for unique or specific building 

requirements in the area being served, such as being flood proof, earthquake resistant, etc.

5) Further study of state-specific needs should be conducted.

Data collected in this study suggest locations for regional centers that, as expected, tend to be 

located near higher populated counties and regions within a given state. However, the number of 

responses to the survey is small, especially for some states, and further documentation needs to 

be collected. Also, there are states in which suggestions for regional centers obviously omitted 

logical places in the state where such a center could be of value (IN, for example), and other 

states in which perceived need for, and location of regional centers is controversial or 

complicated (CA , PA, and NY, for example). Much more state-based study is needed to verify 

data in this report and to collect additional information. Such studies should also include the 

need for and feasibility of regional centers that serve more than one state.

6) Consider regional centers that may serve jurisdictions in adjacent states, especially in 

areas near state lines. 

It may be advantageous to establish regional centers that can serve areas of two or more states. In 

some states, referral medical centers may exist in one state very close to the state line, serving 

areas of an adjacent state. The same model may apply to death investigation. Such arrangements 

already exist to some extent in western Nebraska, which provides medical examiner services for 

eastern counties in Wyoming, and in eastern North Dakota, which provides medical examiner 

services for some western counties in Minnesota. Similar and even more formal regional centers 

could be appropriate elsewhere.

7) Federal support should be provided.
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 11

Although deficiencies within a given state’s death investigation system may be state-specific, the 

collective deficiencies among the states collectively result in a national problem. The current 

national picture is one of a hodge-podge of death investigation systems of varying quality and 

inconsistency in practice. The effort of federally directed Scientific Working Groups to establish 

standards of practice will be fruitless if the substrate on which those standards are imposed is not 

capable of complying with the standards. Federal support to states and/or regionalized systems 

serving needs from several states could help rectify such problems. 

8) Criteria for regional centers need to be developed.

In addition to identifying perceived need for regional centers, specific criteria should be 

developed to guide the location of proposed regional centers. For example, the following criteria 

might be considered as a reasonable starting point for further discussion: 

 In those states without a state-wide ME system, no county should be more than 250 

miles from a fully staffed, accredited regional medicolegal center.

 Counties within one state should have access to a regional medicolegal center located in 

an adjacent state, if no intrastate center is located within 250 miles of the county.

 Every regional medicolegal center should serve a geographic "catchment" area with a 

population of at least 500,000 people. The catchment area, if appropriate, could extend 

across state boundaries. For example, a center in Rapid City, South Dakota, might serve 

Western South Dakota, Southeastern Montana, Northeastern Wyoming, and 

Northwestern Nebraska.

 Concepts of consolidation of multiple small offices and decentralization of single offices 

need to be explored

FINAL COMMENT

SWGMDI reiterates that this document describes perceived need, which may or may not 

correspond to real or justifiable need. The potential location of regional centers is a complex 

issue that needs to consider population, death rates, travel distances, travel times (not all roads 

allow the same speed limit), availability of forensic pathologists in the area, the nature and 

location of already existing services, the places where court testimony may be needed, and many 

other factors. Ongoing SWGMDI projects and related reports will study and make 

recommendations about estimating generic facility construction, staffing, and ongoing operating 

costs as well as areas that may need to be identified and addressed as underserved by quality 

medicolegal death investigation. 

Because medicolegal death investigation is typically state-based and performed in conjunction 

with state laws, policies, funding, and other factors, the SWGMDI cannot make 

recommendations for specific states without state input. It is imperative that states take it upon 

themselves to study the issue of regionalization and how that may involve better use of existing 

facilities, construction of new facilities, decentralization where appropriate, and consolidation of 

small jurisdictions with inadequate resources. 
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 12

At the time of this final report, it appeared that the proposed Coroner Summit may not occur in 

2013. The SWGMDI still considers such a summit to be potentially useful and will further 

pursue its organization 

SUMMARY

The SWGMDI conducted a survey to establish perceived need for regional medicolegal death 

investigation centers in the United States. There was a perceived need for approximately 46 

regional centers among 30 different states that would require up to 160 forensic pathologists to 

staff. In some states, the perceived need for regional centers may exceed real need, and in other 

states, some currently existing medicolegal autopsy centers could be transformed to regional 

centers but are not currently and formally operating in such a manner. The SWGMDI has offered 

10 recommendations for further action. 

References

1. National Research Council. Strengthening Forensic Science in the United

States: A Path Forward. Committee on Identifying the Needs of the Forensic Sciences 

Community, National Research Council. National Academies Press. Washington, DC. 2009.

2. State Medical Examiner Survey. SWGMDI. Available at:

http://www.swgmdi.org/images/iscommrpt4smeneedsjan2012.pdf

Accessed July 25, 2012

3. United States Population Density- Britannica Online Encyclopedia. Available at:

http://www.bing.com/images/search?q=us+population+density&view=detail&id=BA4C3423C9

250AD1C3BE09D804AC87CC1A75A928&first=1

Accessed July 26, 2012. 

4. Scientific Working Group on Medicolegal Death Investigation. Increasing the Supply of 

Forensic Pathologists in the United States. 2012. Available at:

http://www.swgmdi.org

Accessed August 1, 2012

5. Hanzlick R. Work Location and Effort of Forensic Pathology Fellows Who Completed 

Training in 2012. Acad For Path. 2012: 2(3);290-293. 
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 13

The SWGMDI Infrastructure Committee members who participated in data collection, 

analysis, and report preparation include:

Barbara Butcher, MPH

John Fudenberg

Randy Hanzlick, MD (Presiding Officer)

R. Gibson Parrish, MD

Mary Ann Sens, MD PhD

Lindsey Thomas, MD

J Scott Denton, MD (Advisor)

Joe Prahlow, MD (Advisor)

Reade Quinton, MD (Advisor)

This document was approved for final publication by the SWGMDI Board on July 19,

2013. At that time, the SWGMDI Board Members were:

Barbara Butcher, MPH

Steve Clark, PhD

Laura Crandall, MA

Tim Davidson, MBA-HA

John Fudenberg

Roberta Geiselhart, BSN

Randy Hanzlick, MD

Marie Herrmann, MD

Julie Howe, MBA

Bruce Hyma, MD

Donald Jason, MD JD

David (Zeb) Johnson

Danielle McLeod-Henning, MFS

R. Gibson Parrish, MD

Keith Pinckard, MD PhD

Lakshmanan Sathyavagiswaran, MD

Mary Ann Sens, MD PhD

Lindsey Thomas, MD

Frederick Upchurch

Margaret Warner, PhD

Amy Wyman 
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 14

Appendix 1. State, number of responses, and perceived need for regional autopsy centers, 

SWGMDI survey on the need for regional forensic autopsy centers, July 2012.

State Responses Need 

More

Need 

No 

More

Comments/Suggested Locations

Alabama 2 2 Houston County (Dothan) (10 counties)

Tuscaloosa (5 counties)

Jacksonville/Gadsden (8 counties)

Alaska 1 1 Fairbanks

Juneau

Arizona 4 4 Flagstaff (4 or 5 counties)

Arkansas 1 1

California 8 4 4 No specific recommendations. Further 

thought is needed.

Colorado 2 2

Connecticut 1 1

Delaware 2 2

Florida 2 2

Georgia 3 1 2 Regional Centers exist in Trion and 

Moultrie but are closed because of budget 

shortfalls. No newly constructed centers are 

needed.

Hawaii 0

Idaho 4 2 2 Coeur d’Alene (4 counties)

Boise (10 counties)

Twin Falls (7 counties)

Pocatello (5 counties)

Idaho Falls (12 counties)

Lewiston (10 counties)

Illinois 1 1 Existing places just need more formal 

organizations

Indiana 1 1 South Bend (about 5 counties)

Lafayette (5-7 counties)

Iowa 2 2 Sioux City (10-15 counties)

Council Bluffs (about 5 counties)

Kansas 1 1 Great Bend or Dodge City

Kentucky 2 1 1 East Kentucky 

Ashland/Pikeville/Hazard/London?) (20 

counties)

Far West Kentucky (Paducah?) (about 15 

counties) 

Louisiana 1 1 ???

Maine 1 1
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 15

Maryland 1 1

Massachusetts 1 1

Michigan 2 1 1 Traverse City (about 20 counties)

Minnesota 2 2 Duluth

Minneapolis/St Paul

Rochester

Mississippi 3 2 1 Gulfport (Harrison County) is constructed 

but not open due to budget shortfalls.

Missouri 4 2 2 Springfield

Montana 1 1 Billings. Hope to get a free-standing facility 

there. 

Nebraska 1 1 ????

Nevada 4 2 2 Reno needs a new facility.

One needed in Elko?

New 

Hampshire

1 1

New Jersey 1 1

New Mexico 1 1

New York 2 2 Albany (8 counties)

Binghamton (8 counties)

Valhalla (5 counties)

*Existing centers need to expand to cover 

additional counties

North 

Carolina

2 2

North Dakota 1 1 Bismarck*

Grand Forks*

*These exist but counties they serve need to 

be restructured

Ohio 4 1 3 Zanesville or Marion 

Oklahoma 1 1

Oregon 1 1 Clackamas (13 counties)

Eugene (4 counties)

Central Point (5 counties)

Bend (13 counties)

Pennsylvania 5 3 2 ???? (Need 4- 6)

Bradford County

Rhode Island 1 1

South 

Carolina

2 2 Greenville/Spartanburg (10 counties)

Columbia/Richland (10 counties)
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 16

Charleston (10 counties)

Myrtle Beach (6 counties)

Florence (10 counties)

South Dakota 1 1

Tennessee 3 1 2

Texas 4 3 1 Abilene or San Angelo

Amarillo*

Dallas/Ft Worth*

San Antonio*

Corpus Christie*

El Paso*

NE Texas

*Centers exist in these cities but more 

formal regionalization is needed

Utah 1 1

Vermont 1 1

Virginia 1 1

Washington 5 3 2 Costal/Olympic Peninsula

Ellensberg (5 counties) (North central)

Tri-Cities (about 6-8 counties) (South 

Central)

Eastern Washington NOS

West Virginia 1 1 Current centers need 

renovation/replacement

Wisconsin 5 3 2 Current centers need more formal 

organization

Wyoming 4 3 1 Natrona (12 counties)

Laramie (8 counties)

Rock Spring (6 counties)

Casper (8 counties)

Cheyenne (5 counties)

Lander /Riverton (5-12 counties)

Cody (5 counties)

TOTAL 105 55 50

Comments:

 In some states, there are discrepant opinions about whether additional regional centers are 

needed. (CA, KY, MI, MO, NV, OH, TN, TX, WA)
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 17

 In some states, there are existing facilities that serve multiple counties but they do not 

formally function as regional centers via a state-level organization. (CA, IL, MN, MO, NE, 

NY, SC, TX, WA)

 In some states, there is a recognized need for regional centers, but their possible locations 

have not been identified. (CA, LA, MN, NE, PA)

 Small states with State ME offices, in general, do not see a need for regional centers. (VT, 

NH, CT, DE etc.)

 Even some large states with State MEs see no need for regional centers. (NM, UT)

 In some states, regional centers exist but they are not open because of budget issues. (GA (2), 

MS (1))

 In some states, regional centers exist but they need renovation/expansion, or reorganization 

of the counties served. (ND, NV, NY) 
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 18

Appendix 2. Comments from responders to SWGMDI survey on the need for regional 

forensic autopsy centers, July 2012.

State Comments 

AL Huntsville, AL. Morgue desperately needs renovation! Present equipment is 

old, heavily worn and rusted.

AZ NW Arizona or combination of NW AZ and Colorado River Border could 

utilize a new office and new doctors to cover that area of the state

SE Arizona could support about 1.5 doctors

Yavapai office could support 1.5 doctors 

AZ major hurdles in Arizona are extremely long travel times and large areas of 

rural/remote and difficult terrain and many overlapping jurisdictions (large 

areas of federal lands and very large sovereign Native American reservation 

lands, both in rural and urban areas).

Lack of qualified board certified forensic pathologists. 

CA 'different strokes for different folks'. There's no cookie cutter mechanism for 

stamping out a regional svc. Some counties might require or use more 

services if available than other counties who might spurn anyone else doing 

what they consider "their" death investigation. Turf issues not unlike city PD's 

vs county SO's.

CA The regional centers in California that I know something about basically like 

the Sacramento County Coroner Facility that provides autopsy and some 

related services to near-by smaller population sheriff-coroner counties via 

individual county by county financial for services rendered contracts.

CA I am not interested in regional center

CO CO has a coroner system, and most rural coroners contract (formally or 

informally) with bigger coroner's offices that are staffed by FP's for autopsy 

services--not widely distributed data, but each FP would know which counties 

are covered by their office.

CO Colorado is served by an archaic coroner system. 5 large autopsy facilities are 

clustered in adjacent Denver metro counties and most compete for forensic 

cases from other counties. Many of the pathologists have a financial incentive 

to do more cases than recommended by NAME guidelines. In my opinion 

some offices should be consolidated. Some offices should be expanded. The 

goal should be uniform application of death investigation standards with 

contemporaneous quality control and utilizing economy of scale where 

appropriate. 

DE We added a regional (southern) office in 2007. It has met our needs very well.
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 19

FL I think there is a need for regional autopsy centers for non-forensic cases. I

think this would improve the current patchwork system that is serviced by exME's, 1-800-CRAPPYAUTOPSY, physician assistants, and other marginal 

"professionals." Pricing would be more consistent and service (turn-around 

times, etc) to the customer would improve.

GA Offices in Trion and Moultrie formerly staffed, but now closed.

GA Trion and Moultrie have facilities but they are currently closed due to budget 

problems. DeKalb county performs autopsies for the coroners in White, Hall, 

Henry, and Rockdale counties). Fulton, Cobb, and Gwinnet counties each have 

their own medical examiner facilities and do not have coroners. 

IA Iowa City has only autopsy services. IOSME has MDIs but they are usually not 

used by the 99 ME counties. Polk is the only county to use both BC-FP and 

ABMDI certified MDIs. Current system does not control the local county MEs 

on how they do investigations, what cases are autopsied or where the autopsies 

are done

Added after Public Review and Comment:

This above statement is inaccurate. Iowa City, which is under the jurisdiction 

of the Johnson County Medical Examiner Department, has 2 board certified 

forensic pathologists who are also deputy medical examiners and provide 

autopsy service, 5 D-ABMDI investigators, and 1F-ABMDI 

investigator/administrator. No one in our office has received any surveys 

regarding the SWGMDI, and we would appreciate the opportunity to 

participate.

ID Our state has one forensic pathology autopsy lab that we can use. That lab is in 

Boise and we have to travel anywhere from 30 minutes to 7 hours one way to 

have an autopsy done. I have to travel .5 hours one way to have an autopsy 

done. We need at least 3 regional centers to have autopsies done so the travel 

time is cut down as well as expenses for our counties.

IL We have too many individual coroner's offices with their own small morgues, 

especially in Northern Central IL. For coroners, having their own morgue 

seems important. No coroner wants to take their cases "out of county". There 

is a state of the art regional facility in South Central IL in Marion, IL but no 

one will live there. We need more forensic pathologists, not regional autopsy 

facilities.
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 20

IN This is a very complex issue in Indiana. There are several "regional centers," 

but for some, they do not necessarily fit the description that you provide. In 

other words, they serve several counties, but the autopsies are not necessarily 

performed by FPs. I'm not sure that any of the offices that I listed above have 

ONLY FPs doing the autopsies. For example, there is a group of 3 

pathologists at one center, but only one of them is a FP. In addition to the 3 

FPs listed above, I would suggest that Indiana needs another 4-6 FPs at least. 

There are many counties in Indiana where only some of the autopsies are sent 

to the FPs at regional centers. Other autopsies are done by local pathologists.

KS We (Sedgwick County) probably would need additional office (administrative) 

and storage space. Some of this may be gained by renovation and 

reconfiguration of certain areas. There is a morgue in Wyandotte County 

(Kansas City, KS) but I do not think it has very good capacity. Shawnee 

County (Topeka, KS) has facilities that are adequate. If it became a regional 

office, it would need additional square footage or be replaced.

As far as toxicology and crime labs, there are multiple satellite offices run by 

the KBI. But they are woefully understaffed (and underfunded) and TAT is 

very long in most cases. 

KY # of additions depends on how currently assigned FP's might be relocated

KY Two regional offices (OCME & NKME) need new facilities. Small regional 

offices in rural areas, especially solo practices, are difficult to staff with 

competent Board certified forensic pathologists. 

LA Some parishes are using just board certified pathologists or not even 

pathologists to do minimal *autopsies* such as just looking at the heart in 

suspected cardiac deaths, just opening head to retrieve bullet, just opening 

chest if MVC, etc. There is no consistency in either performance of autopsies 

or death investigation. I trained in a ME system and prefer that but that will 

never happen in LA in my lifetime. But that's the way to ensure the basics 

across the state (in my opinion).

LA The coroner system in LA is not funded at all by the state but by the 64 

individual parishes with each parish having their own elected coroner. The 

state of LA needs to adopt a ME system but I don't see that happening anytime 

soon.

MA The number of Forensic Pathologists is the number of additional FTEs that we 

need to operate based on caseload. The scope of service is not applicable.
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 21

ME The current facility is adequate for the current number of autopsies and the 

current number of employees. However, the number of autopsies that are 

currently done is bare minimum and in order to really increase autopsy 

percentages additional staff, space and equipment would be needed, which 

would require expansion of the existing facility. Having additional regional 

facilities might be helpful but the expense of running additional independent 

facilities with all needed personnel might not make sense in a state with a 

population of only 1.2 million. I think expanding the current facility and 

recognizing that we need to do more autopsies, transport more bodies and 

increase the transportation budget makes the most sense."

MD Maryland geographically is such that most population is near Baltimore. There 

are 23 counties and the city served by a single large facility. Bodies are 

transported up to 3 hours to reach this facility. This provides the economy of 

scale, and improved QA control inherent within single units.

MI Michigan has mostly hospital based ME offices/autopsy facilities outside of 

Detroit metro area. The need is for more hospitals/pathologists to participate, 

which may occur if community pathologist's income decreases with the 

changes in healthcare. Forensic pathologists should support our community 

pathologists by providing consultation, being available to send complex cases, 

etc. The system should remain as a private, fee for service function, as this 

provides better quality and efficiency over a government run system.

MN We are currently trying to merge our office with Hennepin County and are 

hoping to serve as a model for others in the state as we move to creating a 

regional center of excellence in medicolegal death investigation.

MN The MN "system" is a disconnected mix of ME Offices and county coroners 

that each operate independently. Some natural sites for autopsy services 

are/have developed, but the specifics of how cases are handled in particular 

regions of the state are not clear.

MN, ND In the large rural areas, local death investigation (directed at distance by FP) is 

needed instead of on site death investigators based in autopsy location. Tox 

and Forensic services are less critical to offices since send outs are easy and 

case load modest compared to large systems.

MO Existing regional centers need to be replaced.

MO Our regional centers are not official through state government. They involve 

private pay for service centers working on behalf of county coroners who 

along with law enforcement provide death investigation of varying levels of 

expertise.
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 22

MS Mississippi has 82 counties (coroner system) with an OCME & full crime lab 

in Jackson with 2 FPs serving the entire state. Currently in process of getting 

two more FP in next few months. Would like to have 5 total FPs. Plan is to 

staff Gulfport (southern) region with one FP & staff, and have another FP & 

staff in a northern region facility.

MS Would be useful to have the regional autopsy facility in use, and to have lab 

services available there as well.

NC If you want statewide data, you should probably contact the OCME office in 

Raleigh. It is not clear that regional medical examiners would be aware of 

strategic plans of a central office, and perceived needs will represent a bias 

related to issues that may represent internecine political issues rather than 

actual needs. For instance, I personally think there should be *fewer* regional 

offices in NC, because my office would benefit if it could absorb another 

county or two.

I notice that the desire for fewer regional offices is not one of the options. It 

should be listed -- the argument for regionalization is that some degree of 

centralization provides benefits from scale and infrastructure. Those same 

benefits would accrue if there are too many small offices. Thus, a better option 

other than *more* regional offices would be *bigger* and *better* staffed, but 

fewer regional offices. Thus, the survey has in inherent bias.

NE Nebraska is a Coroner State and the County Attorney is the appointed Coroner. 

The medical autopsies are contracted out to area pathologists with in 

Omaha/Douglas County. Omaha does have a hospital morgue that the medical 

autopsies are completed.. It is not defined as a Regional Center, but rather a 

facility that is designated for Coroner /Medical death autopsies.

NH The current centralized state office, serving a population of 1.3 million with 2 

FTE's could use at least one more.

NJ There needs to be standardization of the Regional System to allow for 

uniformity of service.

NM Even though New Mexico is large geographically (>120,000 sq mi), it has a 

low population (approx 2,000,000). All medicolegal autopsies (approx 

2200/yr) can be managed at our facility in Albuquerque.
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 23

NV The two existing offices in Nevada, Reno and Las Vegas, would be sufficient 

as "North and South" regional centers; however, the office facilities should 

each be replaced with new offices, and supplemented with additional forensic 

pathologists. Reno operates from an old facility, 55 years old - most recently 

"renovated" 22 years ago. Based upon case load and service area (most of 

Nevada outside of Clark County and several north eastern California counties -

population 850,000+, > 100,000 sq. mi.) the Reno (Washoe County Medical 

Examiner's) office should be replaced with a new facility. The location and 

services provided make Washoe County "a perfect setting" for a Regional 

Medical Examiner Office. Economic circumstances within the State have 

prohibited moving forward with establishing a Northern Nevada Regional 

Medical Examiner Office. Las Vegas has a newer office facility, but is 

similarly inundated with cases and due for a new facility. 

NV This really is not part in the law enforcement community. While we work 

closely and efficiently with the coroner's office, I work the police department.

NV To have a medicolegal autopsy service with on-site crime lab, toxicology lab . 

Would cut the travel time for the outlying areas to receive this service. if you 

added an investigator service you could free up the Sheriff’s offices in some 

location. 

In the bottom your job type. Some of the rural areas do more than one. Like 

me I investigate and I am the non-physician Coroner. So you should be able 

to click more than one position. ( just a suggestion ) 

NY There are numerous coroner counties and some ME counties with only 2 

medical examiners. Some of these could be combined into one regional center. 

NY Existing regional centers do not perform field investigations at present. True 

regional centers should have trained investigators working for the center. This 

would require additional investigative staff and increased caseload would 

require pathologists, autopsy techs and toxicologists at these sites with likely 

expansion of the facilities. 

OH We need better local distribution of quality death investigators, and possibly 6-

12 more in the state.

OH We do not need official regional centers in Ohio. Essentially we presently 

have de-facto centers. There are several centers in every part of the state 

except the southeast. If one central county served by a well-respected 

university medical school began forensic activities, the entire state would be 

served.

OH The average age of our Ohio forensic pathologist is approx 58-60 years. There 

are approximately 28 FP's on Ohio. We need to replace the retiring ones and 

attract the next generation. 
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 24

OH Ohio has an elected Coroner system, and each county has an elected Coroner. 

They are required to be a physician in good standing, but not a pathologist. Our 

counties who have pathologists as coroners or on staff provide a professional 

courtesy to the other counties who do not have pathologists or facilities. It 

would not be beneficial (financially or logistically) for Ohio to be regionalized. 

OK Renovation plans are underway for both the Central and Eastern Offices. Ok 

state law mandates that the Central Division Office be moved to Edmond, OK, 

near the Oklahoma State Bureau of Investigation Laboratories and the Forensic 

Sciences Institute of the University of Central Oklahoma. A new structure is 

presently being drawn up, and legislative funding mechanisms are being 

discussed in the present session.

OR Bend - new center constructed

Eugene - replacement center constructed

Central Point - current center added to

All regions - satellite outpost offices added

PA We need forensic autopsy services and on-site toxicology services. In lieu of 

on-site tox services, we could continue to use an outside lab such as NMS. But 

forensic autopsy services are critical.

PA The closet center for Bradford County is 2 1/2 hours driving distance. This is a 

huge problem for our county.

PA Scope of services...forensic pathologist AND toxicology.

In Pa. Additional investigators NOT needed...each county coroner has several 

death scene investigators on staff and can and does rely on the assistance of the 

local 

Pa. State police crime scene investigators.

PA There should be an offer of Medicolegal autopsy service & Toxicology Lab. 

Currently there is no need for regional office but may in the future. 

SC Autopsy and toxicology labs only.

Number of FP's needed, I believe that would have to be determined by the case 

volume.

TN We are getting a new regional center in Shelby County in 2012.

TN The regional center in Knoxville is probably in need of 

replacement/renovation. 

TX Our office has begun plans to convert to a regional forensic center when we 

open our new facility (~2015)
SWGMDI’s Infrastructure Committee: Report on the Status of and Perceived Need for Regional 

Medicolegal Death Investigation Centers 

Published 7/19/2013 Page 25

TX Texas has a varied death investigation landscape. Some of the existing centers 

are full ME operations, while others are autopsy services only. In general, 

there are nearly sufficient forensic pathologists to examine all medicolegal 

cases in the state, but investigation suffers in the non-ME counties. True 

regionalization, with formation of ME districts in which a forensic pathologist 

controlled all investigation in his/her district would greatly improve things. A 

new West Texas center would preferably be a full ME district, with 

investigators both on and off-site. In house toxicology would be preferable 

also.

UT Although we do not need any additional autopsy centers at this time, we will 

probably need one more center in the southern part of the state within the next 

decade.

VA The Western District OCME needs renovation in the upcoming decade. 

WA Washington State has 39 counties with a mixture of appointed county medical 

examiners/forensic pathologists (6), and elected coroners (currently all nonphysicians) or elected prosecuting attorney-coroner (33)

Coroners are responsible for on-site investigations, but refer cases for autopsy 

to a regional facility or have a private-practice pathologist travel to their county 

for performance of autopsies (often in a funeral home)

WA Autopsy facilities are in place. 2 are located in hospitals. Might need to 

expand cooler space in the hospital facilities.

WA It is getting more and more difficult to find pathologist's willing to travel to the 

far reaches of eastern WA to do posts. We really need a pathologist who is 

based in eastern WA to cover Eastern WA 

WA I really don't have this information as jurisdiction is county by county,

WI Our regional facility in Milwaukee is surely in need of replacement; renovation 

is more likely given current fiscal realities.

WV As above. Our current facilities lack adequate storage and table space. The 

physical constraints of both facilities prevent adequate expansion. Decomposed 

bodies that cannot be accepted by our satellite office result in large 

transportation fees. Subsequent testimony in distant counties incurs additional 

travel expense.

WY For the number of FT Pathologists listed - 2 for Casper, 2 for Cheyenne, 1 each 

for Lander and Cody. These numbers are based on the number of forensic 

autopsies currently conducted by the counties contained within these proposed 

regions.

WY Wyoming has NO board certified forensic pathologists in the entire state who 

perform autopsies. ALL coroners transport bodies out of state for autopsies.

Note: One reviewer questioned whether comments about private forensic pathology services 

being of better quality can be substantiated.