The Death Quiz

A look at places where any of us might end up: Medical Examiners and Coroners Offices (ME/C).

Death investigation in the United States definitely needs a closer look. Here are 25 questions that will test your knowledge.

So take our quiz and find out if your ideas about death investigation are based on fiction or fact. Answers and more information can be found at the end of the quiz.

Are you new to this subject? Questions marked with (E) are relatively Easy!

(E) 1. In tough times, we should cut back funding to coroners and medical examiners offices. After all, ME/C offices are just for dead people, who can’t be more important to us than the living.
a) True
b) False

(E) 2. In which of the following areas does the work of ME/C offices benefit the living?
a) public health
b) workplace safety
c) homeland security and disaster management
d) public safety
e) criminal justice
f) help for families of missing persons
g) financial survival of families
h) all of the above

3. The number of people who die each year in the U.S. is approximately:
a) 1.1 million
b) 1.8 million
c) 2.8 million
d) 3.1 million

4. The percentage of deaths in the U.S. that are reported to ME/C offices is approximately:
a) 10-15%
b) 30-40%
c) 70-80%
d) 90-100%

5. Among the deaths reported to ME/C offices, the percentage that are accepted for further investigation is approximately:
a) 10%
b) 30%
c) 50%
d) 80%

(E) 6. “Coroner” and “medical examiner” are terms that mean the same thing.
a) True
b) False

7. The first time the National Academy of Sciences, which advises Congress on science and technology, strongly recommended that the office of coroner be abolished and replaced with fully staffed and equipped medical examiners offices was in
a) 1928
b) 1954
c) 1975
d) 2009

8. Because of national laws, although coroners are elected or appointed, they must meet minimum requirements for education in death investigation.
a) True
b) False

9. In some states, the coroner’s office is held by an official in another office. For example, in the State of Nebraska, the coroner for each county is also
a) the medical examiner
b) the county attorney
c) the sheriff
d) the justice of the peace

10. State constitutions are often the legal authority that creates the office of county coroner. In many coroner system states, which of the following qualifications is not required by the state constitution?
a) 18 years of age
b) without felony convictions
c) a resident of the county
d) successful completion of a death investigation course

(E) 11. All medical examiners are forensic pathologists.
a) True
b) False

12. NCIC UP/MP is a federal database that can match information on unidentified bodies with police reports of missing persons. The percentage of ME/C offices that say they “rarely or never” use it is:
a) 10%
b) 25%
c) 50%
d) 80%

13. The number of ME/C offices in the U.S. is approximately
a) 500
b) 1800
c) 2300
d) 5200

14. How many ME/C offices meet the standards required to be accredited by the National Association of Medical Examiners?
a) fewer than 55
b) fewer than 550
c) fewer than 1500
d) fewer than 2500

(E) 15. By law, autopsies, when performed, must meet federal standards.
a) True
b) False

16. The percentage of ME/C offices that have the ability to perform essential toxicology tests (to detect alcohol, drugs, and poisons) at their facilities is approximately
a) 24%
b) 37%
c) 64%
d) 82%

(E) 17. The bad news is, there is a shortage of trained forensic pathologists.
a) True
b) False

(E) 18. The good news is, because television shows have increased interest in forensic science, a large number of forensic pathology students are nearing graduation.
a) True
b) False

19. The number of unidentified bodies (aka John/Jane Does) registered in databases in the U.S. is approximately
a) 4500
b) 8000
c) 10000
d) 13500

20. When a ME/C office is called and accepts a case for investigation, someone from that office then goes out to investigate the scene of the death.
a) Always
b) About six out of ten times
c) About three out of ten times
d) Never, that’s a job for the police

(E) 21. Complete autopsies are performed in fewer than half of cases accepted for investigation.
a) True
b) False

(E) 22. Autopsies are more likely to be performed in large jurisdictions (population over 250,000).
a) True
b) False

(E) 23. ME/C offices have been upgraded in recent years, and they are all now on computers and have modern, safe facilities in which to work.
a) True
b) False

24. In 2004, only half of ME/C offices had policies for retaining records on unidentified remains.
a) True
b) False

25. Which of the following did the National Academy of Science recently include in its recommendations regarding death investigation?
a) Congress should provide incentive funds for the replacement of coroner systems with medical examiner systems.
b) Congress should appropriate resources for research, education, and training in forensic pathology.
c) All medicolegal autopsies should be performed or supervised by a board certified forensic pathologist.
d) All of the above and more.

ANSWERS

1. In tough times, we should cut back funding to coroners and medical examiners offices. After all, ME/C offices are just for dead people, who can’t be more important to us than the living.
b) False
The living benefit in many ways from the work of the ME/Cs. Which doesn’t stop a surprising number of politicians from saying amazingly stupid things, like one in El Paso who once said that finding a new ME wasn’t a pressing matter because, “There’s only so much you can do with a dead body.” Or the Utah health department honcho who said of cutting funding to the state ME’s office, “He’s looking at dead people and many of our programs are looking at live people.”

2. In which of the following areas does the work of ME/C offices benefit the living?
h) all of the above
Here are a few of the ways the ME/Cs help in each of the areas listed:
a) public health — awareness of outbreaks of infectious diseases and increased knowledge of health hazards
b) workplace safety — investigation of workplace deaths and their causes can result in important changes
c) homeland security and disaster management — recovery and identification of remains in mass disasters
d) public safety — criminal investigations and identification of homicide victims
e) criminal justice — presentation of evidence and expert testimony
f) help for families of the missing — using DNA and other evidence to identify their loved ones
g) families’ financial survival — helping those who need death certificates in order to receive insurance benefits, access to assets of the deceased, or to settle estates

3. The number of people who die each year in the U.S. is approximately:
c) 2.8 million

4. The percentage of deaths in the U.S. that are reported to ME/C offices is approximately:
b) 30-40%, almost 1 million cases.
Many people mistakenly believe that all deaths are reported to ME/Cs, but the laws in each state usually limit reportable deaths to specific situations. These vary by state. They may include those in which a person has died violently, under suspicious circumstances, without a physician in attendance, in connection with a fire, within 24 hours of admittance to a hospital, in prisons or mental health institutions, and other circumstances.

5. Among the deaths reported to ME/C offices, the percentage that are accepted for further investigation is approximately:
c) 50% , about 500,000 cases, or 1 in 6 deaths.

6. “Coroner” and “medical examiner” are terms that mean the same thing.
b) false
The terms are not interchangeable. The office of the coroner originated in England about a thousand years ago and was brought to the colonies from that country. In the US it is an elected or appointed office. Medical examiners are physicians, but are not necessarily pathologists or forensic pathologists. You can hardly be blamed if you are confused, though. Each state defines the names and requirements for its death investigation system, so there is no uniform usage of these terms. For example, some systems that are essentially medical examiner systems, such as the one in Los Angeles County, retain the traditional name of coroner. Or, while a county in another state may happen to elect or appoint an individual who is a physician to be its current coroner, it may not require every holder of the office to have medical training, so that the next coroner might be a non-physician.

7. The first time the National Academy of Sciences, which advises Congress on science and technology, strongly recommended that the office of coroner be abolished and replaced with fully staffed and equipped medical examiners offices was in
a) 1928 Although many states and jurisdictions have changed their systems since then, the adoption of this repeated recommendation has come nearly to a halt in recent years. 80% of ME/C offices in the U.S. are coroner’s offices, and at least nine states use coroners as their only official death investigation professionals.

8. Because of national laws, although coroners are elected or appointed, they must meet minimum requirements for education in death investigation.
False There are no national laws governing requirements for death investigators in the U.S. At present, it is a confused patchwork determined by state and county government regulations and resources.

9. In some states, the coroner’s office is held by an official in another office. For example, in the State of Nebraska, the coroner for each county is also
b) the county attorney. Last year, the Omaha World-Herald ran a series of articles describing the present-day problems that result from this 1917 law. This year, the state legislature passed an important bill to improve death investigations and coroner training, but due to funding concerns, LB671 fell short of converting Nebraska to a medical examiner system. In other states, the other positions listed in this question are all offices which may do double duty as coroner in some jurisdictions. Undertakers without medicolegal training in death investigation have also served as coroners in many jurisdictions. Usually the people in coroners jobs are doing their best with limited resources — about 84% of coroners believe in the need for professional standards, including training.

10. State constitutions are often the legal authority that creates the office of county coroner. In many coroner system states, which of the following qualifications is not required by the state constitution?
d) successful completion of a death investigation course Many jurisdictions do not require — or provide funds for — any training for coroners.

11. All medical examiners are forensic pathologists.
False. Jurisdictions widely vary in their requirements. Some do require the ME to be a board certified forensic pathologist. Others only require a county medical examiner to be a physician. Some have little or no formal training in forensic science.

12. NCIC UP/MP is a federal database that can match information on unidentified bodies with police reports of missing persons. The percentage of ME/C offices that say they “rarely or never” use it is:
d) 80% rarely or never use this important database. In a 2004 study, only one state (California) mandated sending information on unidentified bodies to NCIC within a specified time. In fact, 42% of NCIC records were from California. The Department of Justice’s NamUs program and other efforts are being made to change the appalling — and shameful — problem of the failure to gather biological evidence and report information on the unidentified.

13. The number of ME/C offices in the U.S. is approximately
c) 2300

14. How many ME/C offices meet the standards required to be accredited by the National Association of Medical Examiners?
a) fewer than 55

15. By law, autopsies, when performed, must meet federal standards.
False There is no such federal law. Autopsy protocols are inconsistent, and in coroner systems, there is often no mechanism to ensure that the coroner’s findings are in agreement with a pathologist’s findings at autopsy.

16. The percentage of ME/C offices that have the ability to perform essential toxicology tests (to detect alcohol, drugs, and poisons) at their facilities is approximately
b) 37% For the other two-thirds of ME/C, tests may be sent out if funding is available, or otherwise, not done.

17. The bad news is, there is a shortage of trained forensic pathologists.
True Long hours, heavy workloads, lack of resources, and relatively low pay are among the reasons.

18. The good news is, because television shows have increased interest in forensic science, a large number of forensic pathology students are nearing graduation.
False There are only 38 forensic pathology residency programs in the U.S. Last year only 42 new forensic pathologists were certified by the American Board of Pathology. About 30% of positions available are unfilled.

19. The number of unidentified bodies (aka John/Jane Does) registered in databases in the U.S. is approximately
d) 13500 Given the inconsistent record-keeping practices and varying policies in ME/C offices across the country re what happens to the unnamed dead, the number of unidentified remains may actually be much higher. About 4400 unidentified human descendants are reported each year, and 1000 of those remain unidentified after one year.

20. When a ME/C office is called and accepts a case for investigation, someone from that office then goes out to investigate the scene of the death.
b) About six out of ten times. According to one large study of ME/C offices, about 62% of investigations include examination of the death scene.

21. Complete autopsies are performed in fewer than half of cases accepted for investigation.
True. There are a variety of reasons for this, but the biggest factor is cost. Autopsies average $2000 each, and as ME/C are often answerable to county boards or voters, budgets influence decisions in cases where the surrounding facts should carry more weight. Access to pathologists is another factor. Regional autopsy centers might be a solution to both problems.

22. Autopsies are more likely to be performed in large jurisdictions (population over 250,000).
True

23. ME/C offices have been upgraded in recent years, and they are all now on computers and have modern, safe facilities in which to work.
False Some county coroners have no offices of their own. Records may be stored in homes, leading to a number of difficulties, including record transfer problems when elections are held and a rival wins office. Some coroners have no refrigeration facilities where bodies could be stored. Many coroners offices are still on paper systems. ME/C offices that do have facilities of their own are often operating in extremely outdated facilities not designed for that use, or not updated in decades. Unsafe and poor working conditions often result.

24. In 2004, only half of ME/C offices had policies for retaining records on unidentified remains.
True

25. Which of the following did the National Academy of Science recently include in its recommendations regarding death investigation?
d) All of the above and more. See the link in the Sources list below to read this important document for yourself.

Sources of information for the above include:

Chapter 9, “Medical Examiners and Coroner Systems: Current and Future Needs,” in Strengthening Forensic Science in the United States: A Path Forward, by the National Academy of Science. (Prepublication edition now available online, free of charge.)

Medical Examiners and Coroners Offices, 2004, by Matthew J. Hickman, Kristen A. Hughes, Kevin J. Strom, and Jeri D. Ropero-Miller. Bureau of Justice Statistics, National Institute of Justice, Department of Justice. This study was published in 2007.

The National Association of Medical Examiners Website.

“Missing Persons and Unidentified Remains: The Nation’s Silent Mass Disaster,” by Nancy Ritter, in the National Institute of Justice Journal, issue 256. This study was published in January 2007.

About this post:

The image above is “Lost Pirate Log” © Gennaro Guarino | Dreamstime.com and is used with permission.

This post was created by Jan Burke for the Crime Lab Project. As part of its educational and charitable activities, the nonprofit Crime Lab Project Foundation gives scholarships for the training of death investigators.