Forensic Dentistry, Second Edition

42 Forensic dentistry

death, without seeking permission of families or other authorities.

Though many medical examiners retain the authority to hold public

inquests, such proceedings are rare in a modern ME system. Rather,

the ME makes determinations based on a thorough investigation of the

circumstances of death, along with findings of a scientific examination

by autopsy, toxicology, or other disciplines. Only a trained and experi-

enced physician has the knowledge to obtain and analyze such data and

to synthesize a rational cause and manner of death conclusion from it.

During the first half of the twentieth century, medical examiner systems
progressively replaced coroner jurisdictions throughout the United States.
However, this replacement trend began to plateau in the mid-1980s, and new
M E ju r isd ic t ions a re now for med i n f requent ly.^26 Cu r rent ly about ha l f of t he pop-
ulation of the United States is served by a medical examiner, with the rest under
the jurisdiction of a coroner. However, coroner offices outnumber ME offices by
a factor of five in the United States. The disparity is due to the fact that ME offices
tend to be clustered in highly populated counties, such that a single office will
serve a much greater population than the average coroner’s office.
The accompanying table (Table 4.1) shows a general distribution of ME
versus coroner systems within the United States.^26 The country is served by a
patchwork of different types of death investigation systems,26,27 and the type
of system is generally determined on a state-by-state basis. At this time, the
populations of twenty-two states are served solely by medical examiners,
eleven by coroners, and seventeen by a combination of medical examiner and
coroner systems. Even within these broad groups, there are many variations.
Some medical examiner states are under the authority of a statewide medi-
cal examiner. Others have authority vested at the regional or county level.
In some states, the coroner function is subsumed by other office holders. For
instance, in Texas, justices of the peace perform coroner duties in counties
without a medical examiner. In many California counties, the sheriff has
coronial authority. For these reasons, it is difficult to effectively categorize
medicolegal death investigation systems in the United States, as the various
systems often have little resemblance to each other.

4.5 Death Certification

A major common denominator in any modern death investigation system is

the documentation of death and the determination of its cause and manner ,

also referred to as death certification. In early times, records of birth and

death were kept inconsistently, if at all, but in 1538, clergy in England were

required to keep a ledger of births, deaths, and marriages in their parishes.

This custom of registration persisted for many years, but gradually became a