Coroner vs. medical examiner: Should Clark County switch systems?

With nearly 2.3 million residents, Clark County is one of the most populous jurisdictions with a coroner overseeing death investigations instead of a medical examiner.

Medical examiners’ offices are run by a licensed physician while coroners are usually appointed or elected officials with little or no medical training. Clark County coroner staff are responsible for determining the cause of suspicious and violent deaths, investigating suicides, and helping police identify victims through fingerprints and dental X-rays.

Washoe County operates with a medical examiner system, as do counties that include the large metropolitan areas of Denver, Seattle, San Diego, San Francisco, Portland, Oregon, and Phoenix. Los Angeles County has a medical examiner-coroner. Orleans Parish in Louisiana has a coroner who serves fewer than 400,000 people.

Dr. Marcella Fierro, who served as a chief medical examiner in Virginia and co-authored a key study for the National Research Council in 2009 that recommended all coroners’ offices convert to medical examiners, said Clark County should change its death investigation system.

“It would be good for Clark County to have a medical examiner-run office,” she said. “They have an interesting mix of cases and people from all over the world and need a high level of competency.”

But Clark County Assistant Manager Jeff Wells said there are so few certified forensic pathologists available that having one take up his or her time as a manager instead of completing autopsies would be a waste of the doctor’s medical skills.

Charleston County, S.C., Coroner Bobbi Jo O’Neal, who is president of the International Association of Coroners and Medical Examiners, said the quality of autopsies and investigations depends on the person running the office and the training provided to staff.

“There are some poor coroners’ offices around and very good and very poor medical examiners,” she said, adding that being an elected coroner gives her independence from outside influence.

Clark County Coroner Melanie Rouse, who was appointed in June, leads an office of 41 full-time staff, including an assistant coroner, 15 investigators and supervisors, a dozen forensic techs and assistants, five medical examiners and support staff. The office is funded for 53 full-time staff and about 30 part-time employees.

Rouse said small coroner’s offices that don’t have medically trained staff determining the cause and manner of death are the biggest concern.

“One of the important things is having medical examiners doing medical investigations,” said Rouse, who previously worked for 16 years at the Maricopa County medical examiner’s office, rising to chief death investigator and operations manager. “We do have that here.”