Replacing the Lake County Coroner with a Medical Examiner

A few months ago an adult patient of mine died under questionable circumstances. The patient's mother called me with the sad news and alerted me that she had informed the Coroner's office that her child had been under my Psychiatric care. Three weeks later, having not heard from their office, I decided to initiate a call to the Lake County Coroner.

I wasn't connected to the Coroner directly. Instead, I was directed to the Deputy Coroner who told me he was “in charge of the case.” He went on to say that he'd already spoken to the patient's Primary Care Physician and drawn a picture of suicide based on personality attributes such as “a history of saying things to please the doctors.” To say the least, I was disappointed. Certainly many of the signs pointed to suicide. However, the patient had also discussed both with a therapist and me a fear of the significant other. The patient had spent money frivolously and said the significant other “is gonna kill me.” The Coroner's office make a distinction between this statement and a true fear of being harmed. Another fact I shared, and their office found unhelpful, was the patient's idea of leaving the significant other upon graduating from school and starting a career. Whether the significant other was aware of this at any point I have no idea. Neither, frankly, was the Coroner's office.

The fact is that sometimes suicides look like homicides or natural causes of death and homicides look like suicides or natural causes of death. And one may intentionally be made to look like another. The expertise necessary to make these determinations and evaluate the many nuances suggests the need to have people in charge who have the highest level of education and experience in forensic science. Going to the website of the Lake County Coroner's office (http://www.lakecountyil.gov/Coroner/Pages/Staff.aspx) I found that the office has seven employees who may indeed be highly qualified. However, of the seven five have Bachelor's degrees (none in forensic science), one has an Associate's degree and one has no degree. The Coroner, an elected official, has no picture nor description of his background on the web site.

I was surprised to learn from the Lake County Health Department that the coroner doesn't perform autopsies. Deaths of a suspicious nature may be investigated by the Coroner's office, but the autopsy is performed by a pathologist (not a forensic pathologist). The Coroner allegedly coordinates the investigation and has some leadership relationship with the staff for as long as he/she remains in office.

So why does Lake County, unlike Cook County, have a Coroner rather than Medical Examiner (who has expertise in Forensic Science)? Historically, more populated areas have tended to have Medical Examiners and less populated areas, Coroners. Interestingly, coroners are elected and do not have to be physicians. Here's a link to an an article on Medical Examiners you might find informative:

http://science.howstuffworks.com/autopsy3.htm

Our Coroners have been physicians with varying backgrounds in recent years, but not in forensic science. And, to be sure, previous Lake County Coroners have been the subject of much controversy. Despite this, and prior Lake County Board reviews considering the creation of a Medical Examiner office, the current system has prevailed. In March 2011, before his elevation to the post of Chairman of the Lake County Board, Aaron Lawlor wrote an article in the Daily Harold recommending the elimination of the Coroner's post and implementation of a Lake County Medical Examiner position. He was unable to get the proposal for a Medical Examiner out of committee to allow Lake County voters to make the decision to de-politicise the office.

Some have suggested that a Medical Examiner system would be more costly than the current Coroner system. However, a high-ranking administrator of the Lake County Health Department disputed this, telling me that Medical Examiner would perform autopsies him/herself and eliminate the need for and cost of a separate pathologist. An additional argument supporting the Medical Examiner position would be the ability of the County to extend or cancel the contract of that individual based on performance, something that cannot be done with an elected office. Additionally, previous Coroners and their offices have been suspect in the past, with arrests, possible political tampering and accusations of office mismanagement. I've had patients who, in previous years have reported concern that not all suspicious deaths have been investigated, and some bodies have been quickly cremated or released.

Hopefully, our politicians will place enough faith in the voters of this County to allow us the power to determine which position we prefer.  I, for one, believe that individual's education, experience and expertise should be valued above political considerations.