# A Question about Incompetent/Untrained Coroners **URL:** \ **Category:** Factual Questions\ **Created:** [July 3, 2015, 11:22pm UTC](https://boards.straightdope.com/t/a-question-about-incompetent-untrained-coroners/724174 "2015-07-03T23:22:09Z")\ **Posts on this page:** 12\ **Page:** 1
**Author:** ![ralph124c](https://avatars.discourse-cdn.com/v4/letter/r/8797f3/32.png) [@ralph124c](https://boards.straightdope.com/u/ralph124c)\ **Post date:** [July 3, 2015, 11:22pm UTC](https://boards.straightdope.com/t/a-question-about-incompetent-untrained-coroners/724174/1 "2015-07-03T23:22:09Z")
As i understand it, a coroner is a medical doctor trained in determining the cause of death. he/she autopsies a corpse, to determine if foul play was involved. The coroner’s work is vital in criminal investigations, and he/she must be well informed and capable of good judgement. But what happens in small towns, where the coroner is not qualified? I was watching a crime show, and it had the case of a suspected murder (of a fishing boat captain). The coroner was just the local undertaker-he was not an MD at all. He examined the body, and concluded that the mate had attacked him with a knife (the wounds on the captain’s arms were later found to be made by a boat propeller). The mate could have been found guilty of murder, except that a reporter wrote a story that led to a retrial. So, what standards exist for small town coroners? I find it incredible that an untrained undertaker could actually be one. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [July 4, 2015, 12:19am UTC](https://boards.straightdope.com/t/a-question-about-incompetent-untrained-coroners/724174/2 "2015-07-04T00:19:56Z")
A coroner is not necessarily a doctor, although could be, depending on the jurisdiction. A medical examiner is a different officer and is always an MD. ---
**Author:** ![CalBak](https://avatars.discourse-cdn.com/v4/letter/c/258eb7/32.png) [@CalBak](https://boards.straightdope.com/u/CalBak)\ **Post date:** [July 4, 2015, 12:22am UTC](https://boards.straightdope.com/t/a-question-about-incompetent-untrained-coroners/724174/3 "2015-07-04T00:22:26Z")
I personally can’t answer your question. The best I can do is tell you to watch a program that Frontline did in 2011 about the subject, it was very interesting and it’s free to watch online. What I took away from it was that there is a lot of incompetent and largely untrained coroners and even some medical examiners out there. [http://www.pbs.org/wgbh/pages/frontline/post-mortem/](http://www.pbs.org/wgbh/pages/frontline/post-mortem/) ---
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [July 4, 2015, 12:33am UTC](https://boards.straightdope.com/t/a-question-about-incompetent-untrained-coroners/724174/4 "2015-07-04T00:33:50Z")
In the US, coroners are like sheriffs. Each state & county is free to devise their own process for selecting the official and defining the duties & qualifications of the office. It could be by election, appointment by a council, or sold by the county executive to the highest under-the-table bidder. Required qualifications and standards of performance are equally sketchy. ---
**Author:** ![md2000](https://avatars.discourse-cdn.com/v4/letter/m/73ab20/32.png) [@md2000](https://boards.straightdope.com/u/md2000)\ **Post date:** [July 4, 2015, 4:36am UTC](https://boards.straightdope.com/t/a-question-about-incompetent-untrained-coroners/724174/5 "2015-07-04T04:36:15Z")
> **[Charles Smith (pathologist)](https://en.wikipedia.org/wiki/Charles_Randal_Smith)** > > Charles Randal Smith is a former Canadian pathologist known for performing flawed child autopsies that resulted in wrongful convictions. > As the head forensic pathologist at the Hospital for Sick Children in Toronto, Ontario, from 1982 to 2003, Smith performed more than 1,000 child autopsies. In 2002, Smith was reprimanded with a caution by the Ontario College of Physicians and Surgeons for his work on three suspicious-death cases, and in 2003 he was removed from performing autopsies. > In June 2... > [@](#): > > Charles Randal Smith is a former Canadian pathologist who was the head pediatric forensic pathologist at the Hospital for Sick Children in Toronto, Ontario, from 1982 to 2003. The quality of his autopsies, and the resulting criminal charges and convictions of several people, have been called into question and a full public inquiry was ordered. The inquiry found there to be fundamental errors made on the part of Smith and many of the cases in which he had testified are now being re-examined and appealed. > > In 2008, the chief forensic pathologist for Ontario began a public inquiry into 220 cases of shaken baby syndrome to determine if anyone was wrongfully convicted in the babies’ deaths.[1] Not to mention the Hospital for Sick Children’s baby murder case, where tens of millions were spent on a witch hunt over Susan Nelles. She was arrested because she asked for a lawyer when police began questioning her about an excessive number of baby deaths at the hospital, despite the fact that there were plenty of other suspects equally probable. For years the allegation was that a drug was used to kill the babies, until it was established that more likely the test for that drug was not correct, and probably all the children dies of natural causes. > **[Toronto hospital baby deaths](https://en.wikipedia.org/wiki/Toronto_hospital_baby_deaths)** > > The Toronto hospital baby deaths were a series of suspicious deaths that occurred in the Cardiac Ward of the Hospital for Sick Children in Toronto, Ontario, Canada between July 1980 and March 1981. The deaths started after a cardiology ward had been divided into two new adjacent wards. The deaths ended after the police had been called in, and the digitalis-type medication (digoxin) that had possibly been used for the alleged killings had begun to be kept under lock and key. Three nurses were at t... > [@](#): > > The Toronto hospital baby deaths were multiple alleged poisonings of babies at Toronto’s Hospital for Sick Children that occurred between June 1980 and April 1981, when charges of murder were laid against a nurse at the hospital. The story was a major news event throughout the year, and ended with the nurse being exonerated. Although suspicion was cast on other people, no further charges were ever laid. > > Later analysis suggests that the tests and methodologies that pointed to poisoning were flawed, and may have been generating false positives. Specifically, chemicals used in the manufacture of everyday medical items may have contributed to the test indicating high levels of the alleged poison. It was also demonstrated that a “wave” of similar alleged poisonings were occurring at that time. And that’s just two situations involving numerous deaths in one city in North America. I suppose the benefit of being a coroner is there’s no downside unless you are extremely incompetent. Your “patients” are already dead. Most times, the details of the death are obvious and the coroner just rubber stamps what the authorities want on the record. If you screw up - well, the evidence is buried and it takes a lot of effort to exhume a body, assuming there’s enough detail left over time to challenge the findings. Plus, being a doctor does not make the coroner immune to the desire also found in the criminal justice system to “go along” and slant evidence to favour the guilty. This is just one more point in the argument that not everyone charged in a crime is guilty. ---
**Author:** ![Hilarity\_N.Suze](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hilarity_n.suze/32/6223_2.png) [@Hilarity\_N.Suze](https://boards.straightdope.com/u/Hilarity_N.Suze)\ **Post date:** [July 4, 2015, 5:06am UTC](https://boards.straightdope.com/t/a-question-about-incompetent-untrained-coroners/724174/6 "2015-07-04T05:06:56Z")
A coroner doesn’t have to have any medical knowledge, and in some places is an elected official. In the small town where I grew up, the coroner for many years was a veterinarian. A friend of mine lives in a Colorado mountain town. One of the qualifications of a coroner is to have a station wagon or van–something big enough to haul corpses down the mountain to a metropolitan hospital, if an autopsy is required, or to the funeral home. ---
**Author:** ![Tom\_Tildrum](https://avatars.discourse-cdn.com/v4/letter/t/e95f7d/32.png) [@Tom\_Tildrum](https://boards.straightdope.com/u/Tom_Tildrum)\ **Post date:** [July 4, 2015, 6:39am UTC](https://boards.straightdope.com/t/a-question-about-incompetent-untrained-coroners/724174/7 "2015-07-04T06:39:56Z")
> [@ralph124c](#): > > But what happens in small towns, where the coroner is not qualified? I was watching a crime show, and it had the case of a suspected murder (of a fishing boat captain). The coroner was just the local undertaker-he was not an MD at all. He examined the body, and concluded that the mate had attacked him with a knife (the wounds on the captain’s arms were later found to be made by a boat propeller). The mate could have been found guilty of murder, except that a reporter wrote a story that led to a retrial. The show you saw may have been taking a lot of dramatic license; there was no retrial, no such newspaper story, and no such findings about the wounds. It’s possible that the coroner was not a doctor, but the prosecution had a doctor testify about the autopsy results. The coroner found that the captain died of a skull fracture before going into the water (no [water](http://www.hammondstar.com/autopsy-captain-died-from-fractured-skull/article_2bbd9617-5c74-5a3a-8ee8-fa75e6b52ebf.html) in his lungs), and, yes, found wounds on his arms that he considered to be defensive stab wounds. The prosecution offered that theory and presented expert testimony from a medical [doctor](http://www.mrt.com/import/article_aa6e596e-c669-5146-9edb-0a75bd576164.html). The defense raised the boat propeller theory and brought in its own [expert](http://jacksonville.com/apnews/stories/091102/D7LVNKM81.html) witness (a national cable-tv autopsy celebrity, in fact) to testify. There were other issues in the case. The defendant initially claimed that the captain had drowned, but later changed his story. The defendant ultimately confessed to murder, but the defense [argued](https://news.google.com/newspapers?nid=1696&dat=20020910&id=VPceAAAAIBAJ&sjid=I5gEAAAAIBAJ&pg=6772,1252992&hl=en) that the confession, which took place after two lengthy interrogations, was coerced. Both sides agreed that the defendant had an IQ of 74, although there was conflicting expert testimony as to the import of that fact. The jury initially deadlocked but ultimately [acquitted](https://news.google.com/newspapers?nid=1817&dat=20020918&id=nSMeAAAAIBAJ&sjid=_6cEAAAAIBAJ&pg=5117,6220060&hl=en) the defendant. Presumably this means that they doubted the at least some aspects of the autopsy report, but there is no way to know. ---
**Author:** ![ralph124c](https://avatars.discourse-cdn.com/v4/letter/r/8797f3/32.png) [@ralph124c](https://boards.straightdope.com/u/ralph124c)\ **Post date:** [July 4, 2015, 1:39pm UTC](https://boards.straightdope.com/t/a-question-about-incompetent-untrained-coroners/724174/8 "2015-07-04T13:39:54Z")
> [@CalBak](#): > > I personally can’t answer your question. The best I can do is tell you to watch a program that Frontline did in 2011 about the subject, it was very interesting and it’s free to watch online. > What I took away from it was that there is a lot of incompetent and largely untrained coroners and even some medical examiners out there. > > [http://www.pbs.org/wgbh/pages/frontline/post-mortem/](http://www.pbs.org/wgbh/pages/frontline/post-mortem/) Scary…what value is such a coroner? With no medical training, how could anything from such an official be of value? ---
**Author:** ![scr4](https://avatars.discourse-cdn.com/v4/letter/s/59ef9b/32.png) [@scr4](https://boards.straightdope.com/u/scr4)\ **Post date:** [July 4, 2015, 2:15pm UTC](https://boards.straightdope.com/t/a-question-about-incompetent-untrained-coroners/724174/9 "2015-07-04T14:15:28Z")
> [@Hilarity\_N.Suze](#): > > A coroner doesn’t have to have any medical knowledge, and in some places is an elected official. Not only that, but a _partisan_ elected official. A few years ago our long-time coroner lost the election because he identified as Democrat, and a lot of voters marked the straight-ticket Republican box. This was a problem because the former coroner was a funeral home owner and used his funeral home to perform his duties; the newly elected coroner did not have such facilities. Since then, the coroner’s election seems to have become a competition between 2 funeral homes. [Here’s the article](http://www.al.com/news/huntsville/index.ssf/2014/10/madison_county_coroners_race_e.html) about our most recent one. As for their medical qualifications, one has a Mortuary Science degree, the other is an EMT. ---
**Author:** ![RealityChuck](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/realitychuck/32/195_2.png) [@RealityChuck](https://boards.straightdope.com/u/RealityChuck)\ **Post date:** [July 4, 2015, 3:21pm UTC](https://boards.straightdope.com/t/a-question-about-incompetent-untrained-coroners/724174/10 "2015-07-04T15:21:59Z")
In a small town, a coroner may see only one or two suspicious deaths in his/her lifetime. Where I grew up, they don’t even have the position: a doctor would be on call to come to the scene and certify the cause of death. The various doctors in the town took turns on being on call. If there are any murders, there is usually no doubt as to cause or killer anyway. ---
**Author:** ![Captain\_Amazing](https://avatars.discourse-cdn.com/v4/letter/c/6de8d8/32.png) [@Captain\_Amazing](https://boards.straightdope.com/u/Captain_Amazing)\ **Post date:** [July 4, 2015, 4:21pm UTC](https://boards.straightdope.com/t/a-question-about-incompetent-untrained-coroners/724174/11 "2015-07-04T16:21:11Z")
> [@ralph124c](#): > > Scary…what value is such a coroner? With no medical training, how could anything from such an official be of value? That’s why they have staff. Coroner isn’t a medical position. It’s an investigative one. That’s why in Canada, coroners can issue reports recommending policy on public safety matters, and why in some places in the US, the Coroner’s office can execute arrest warrants. ---
**Author:** ![Fretful\_Porpentine](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fretful_porpentine/32/2873_2.png) [@Fretful\_Porpentine](https://boards.straightdope.com/u/Fretful_Porpentine)\ **Post date:** [July 4, 2015, 5:03pm UTC](https://boards.straightdope.com/t/a-question-about-incompetent-untrained-coroners/724174/12 "2015-07-04T17:03:04Z")
We had a [particularly infamous coroner](http://reason.com/archives/2007/10/08/csi-mississippi) in Mississippi for _years_, without anybody bothering to do anything about it.