death investigation systems 41
requires completion of a course of medical study, culminating in a doctor of
medicine or doctor of osteopathy degree, completion of three or more years
of residency training in anatomic pathology, completion of an accredited year
of fellowship training in forensic pathology in an accredited training program
(usually a large medical examiner’s office), and passage of national certification
tests in both anatomic and forensic pathology, administered by the American
Board of Pathology. The physician can then use the title of forensic pathologist
and is considered board certified in that field.^24 W h i le not a l l med ic a l ex a m i ner
positions require the incumbent to be a forensic pathologist, many do, and it
is highly desirable that all physicians involved in medicolegal death investiga-
tion be board-certified forensic pathologists.
The formation of an academic specialty of forensic pathology owes much
to early chairs of forensic medicine established in Europe and Scotland, but
the first endowed chair of legal medicine in the United States was established
at the Harvard Medical School in 1937.10,25 In this program, a training pro-
gram for physicians was established, as well as programs for law enforcement
officers and other investigators. Forensic pathology was first recognized as a
medical subspecialty in 1959, when examinations were administered and the
first cadre of physicians was certified as forensic pathologists.
Over the years, the medical examiner system has been refined somewhat
to include some fairly standard elements. Ideally the medical examiner is:
- A physician trained in the field of forensic pathology. This ensures
that the highest possible level of expertise is brought to bear on
the cases that come before the ME. Forensic pathologists working
under the direction of a coroner should not be referred to as medical
examiners, since the coroner is the actual official imbued with the
authority to investigate and certify death, not a physician. - Appointed, not elected. In this way, the office of medical examiner
becomes a professional position, not a political one, and the office
holder is not concerned with currying favor with an electorate and
periodically campaigning for reelection. - Protected by civil service laws. Ideally the ME cannot be dismissed
without good cause (such as incompetence or dereliction), and then
only after appropriate due process procedures have been followed.
This provides some protection for the ME, who must make decisions
that might prove to be politically unpopular. - The sole authority for investigation and certification of deaths in his or
her jurisdictional area, and is independent of law enforcement, pros-
ecutorial, or judicial agencies. This ensures that the ME is independent
and is an impartial witness for the truth in our adversarial legal system.
It also gives the ME full authority to perform any type of examina-
tion or investigation necessary to determine cause and manner of