Jay, is it necessary for a coroner to have a medical background?
I have a sufficient medical background to be able to determine when an autopsy is appropriate, and when not. That’s all that is needed.
In Colorado, the Coroner is set-up as a management position. The law provides in Article 30-10-606, (2) “The coroner shall, if he or the district attorney deems it advisable, cause a post-mortem examination of the body of the deceased to be made by a licensed physician to determine the cause of death.” As you can see, this is a legal determination to be made by people familiar with legal issues. The District Attorney has no medical background, but has equal authority to order an autopsy as does the Coroner.
Some medical background is important, but it is even more important that the Coroner be able to blend medical knowledge, with the legal and investigative aspects of the job.
When you have a Coroner who has nothing but a medical background (and no legal background), then you set things up for a real problem, as I will show below.
There are only eight counties in Colorado where the Coroner is also a Pathologist. The remainder function just fine without a doctor on staff at all. At first blush, having a Coroner who is also an FP would seem to shorten the decision-loop and expedite the process. However, it creates an immediate conflict of interest. When the Coroner is also the physician, he is divided into halves. In this situation, it is far more likely that the Coroner-half will assign the doctor-half to perform an autopsy. If this happens to a significant degree, it will dramatically increase costs to the county. Then the Coroner-half will lobby the Commissioners for more money because the doctor-half is doing so many autopsies. It soon spirals out of control. With a legally-trained Coroner in charge of the Medical Examiner doctor, the process can find some balance.
A prime example of this problem is seen in Arapahoe County, where the Coroner is a doctor, and he has also hired a Medical Examiner, who also is a doctor. According to the AMA, the national average is that autopsies are performed in 12% of cases. Public records tell us that in Jefferson County the average is also 10%. But in Arapahoe County, the average is 75%. This is six times the national average. Why? The incumbent Arapahoe County Coroner, a doctor, cannot seem to tell himself not to do an autopsy, even when it is unnecessary. So, we have two doctors in the Arapahoe County Coroner’s office, each doing too many autopsies, when nearly every other county in Colorado is doing just fine with no doctor on staff at all.
This situation has led to a bloated budget of $1.5 million, and the two doctors account for between $400,000 to $500,000 of that budget. Some simple math tells you a lot. When you take the budgets of all the metro counties, and divide into it the number of autopsies being performed in that county, you find that Arapahoe County is spending more dollars per autopsy than the rest.
It is essential that the Coroner has an understanding of death investigations, and some of the medical aspects of that process, but there is certainly no need for the Coroner to be a physician. I have sufficient medical training to know when an autopsy is appropriate, and when not. In the Army, my unit had no medic, so I self-trained in that area. I carried the medical kit and gave medical treatment to my soldiers. They called me “Doc” as often as not. Since then, after many years of dealing with medical-legal issues, and after having taken Coroner-specific training in death-scene investigation, I am well-equipped to make the decisions without prejudice.
Another serious problem arises when the Coroner is a medical doctor. Medical doctors demand much larger pay than the statutory Coroner’s salary permits. In Arapahoe County, the statutory salary is $87,300 annually by Art. 30-2-102. That law also declares, “The salaries of county commissioners, sheriffs, treasurers, assessors, clerk and recorders, coroners, and surveyors have been fixed by law through the enactment of this section”. So, there is no room for any other body to increase such a salary.
The medical doctor in the position of Coroner in Arapahoe County has become a prime illustration of a hidden problem. The incumbent Coroner has been lobbying the Commissioners for a salary of much more. From 2002-2006, his annual salary was $196,000. In the current term, his base salary is $222,000. When you add the generous benefits of government employment, this amount grosses-up to closer to $260,000.
Without more information, one might be tempted to say that the Coroner who is a doctor is worth this exorbitant salary. But that doesn’t matter. The statutes set the salary of the Arapahoe County Coroner at $87,300. They also provide that nobody other than the Legislature can either increase the salary, or decrease it. And in 2006 the people of Colorado added Article XXIX to the Constitution, commanding elected officials to be worthy of the public trust, and “Any effort to realize personal financial gain through public office other than compensation provided by law is a violation of that trust”. It could not be more clear. The Coroner should graciously accept the salary he is given under the law, and that should be the end of it.
Beyond that, the current Coroner has been running a personal business out of the Coroner’s office. He uses County personnel, and the county facilities, to conduct autopsies for other counties. He has an arrangement by which he pays the County a whopping $125 for using the facilities, but he pockets from $1,500 to $1,800 per autopsy. He admits that he and the other staff doctor do about 100 of those outside autopsies per year, so this practice generates something like $150,000 of extra income to these two doctors per year. Assuming the incumbent pockets only $75,000 of that money, this practice still would constitute an effort to “realize personal financial gain through public office”, as is prohibited by law.
These abuses could never have arisen if the incumbent were like the other Coroners in the state – a manager who directs the efforts of doctors under his control.
