Lesson 14: Hire investigators with varying backgrounds and skills and train them well.

The next three lessons cover the role of the medical examiner investigator. The people who serve as death investigators in the office are extremely important to the well being and functioning of the operation. They are essentially the “linchpin” of the operation. Without competent death investigators, the chief medical examiner will be lost.

Why is this? Well, for one, the chief can perform the most careful autopsies ever performed. The chief can check every minute detail of every organ system, submitting numerous slides for microscopic examination, checking the conduction system of every heart, examining every square centimeter of the intestinal mucosa. The chief can write long reports that describe every detail in painfully accurate prose. The chief can perform examinations that any academician would love. Still, without accurate information derived from well-done death investigations, these elaborate and painstakingly accurate autopsies will lead the chief and any pathologist to the wrong conclusions every time. And if the opinions and conclusions are wrong, what is the point? Would we serve in that chief position for the right reasons if we find the wrong answers and draw the wrong conclusions?

The truth is painful but it still is true: we are no better than the investigators who work for us. We perform only as well as they perform. We are only as accurate as they are accurate. As it is with computers, it is with death investigation: Garbage in, garbage out!

If you fail to see that what I am writing here is true, it is because you have not been a forensic pathologist long enough. You have not seen the consequences that come with bungled death investigations. You have not seen that most mistakes come from drawing wrong conclusions and performing inadequate procedures on the basis of inaccurate or ignored investigative information. It is essential to have accurate initial information to choose the proper procedure—an autopsy, an autopsy with special dissections, an external examination, or a sign-out—and accurate initial and follow-up information to reach the proper opinions and conclusion about a death.

Since this is true, then the new chief better pay close attention to the individuals who serve the office as medical examiner investigators. The chief must choose them carefully and train them well.

I recognize that there are offices that do not rely on investigators in house. They would rather rely on the local sheriff or other law enforcement agency to do their investigations. I also recognize that law enforcement can play a very important role in a death investigation. There are some jobs that only they should do, such as notifying the next-of-kin of a death. I believe, however, that coroners and medical examiners must train investigators who work solely for them. Law enforcement investigators focus on law enforcement issues. Frequently if there is no crime committed, deputy sheriffs and police officers quickly loose interest in the death investigation. We need to have investigators working for us who are interested in the issues we need to address and are willing to find answers to the questions we ask. We need investigators who are accountable to us and trained by us if we hope to do a good job as a chief medical examiner.

Many pathologists are quick to express opinions about the types of training and the backgrounds that make the best lay death investigators. Some believe nurses make the best medical examiner investigators. Some believe that only individuals with a law enforcement background will fit the bill. Some want to rely on physician assistants.

Since there are no set prerequisites or college courses required for death investigation, medical examiner death investigators come from all these different backgrounds. In my former office, some investigators had law enforcement backgrounds, some were paramedics, some had forensic science training, some were crime scene technicians, some were medics in the military, some worked for the government in the department of social services, and some worked in funeral homes. I never worked with nurses or physician assistants, although I could see how their backgrounds could help—if one could afford to hire them on a county salary.

I believe the diversity in training of these investigators enhanced the work of the office as a whole. Each brought their individual perspective to death investigation challenges. They supported the varying needs of the office in their own ways. Some were excellent at deciphering and interpreting medical records. Some were excellent photographers. Some had excellent computer skills. Some were excellent at evaluating human skeletal remains. No one person can possess all of these skills, so a variety of skills are good.

Although diversity in training and experience is good, I believe all investigators should have certain characteristics in common: all must possess good investigative judgment, all must possess common sense, all must be incredibly curious, and all must like what they do. These characteristics do not necessarily emerge with training. The investigator candidate brings these characteristics with him or her to the job. The chief must discern the extent of these characteristics in each of his or her investigators.

While serving as a chief medical examiner, I carefully studied each of my investigators. Particularly with follow-up investigations, I sized up each job and gave it to the particular investigator I could trust to do outstanding work. I also carefully scrutinized the investigators in training, assessing to what degree they could do certain investigative tasks. As I described in the previous lesson, it was a pleasure to see their talents emerge as they handled each new investigative challenge.

The chief medical examiner must be freely willing to share his or her thinking and time. The investigators need to know what the chief is thinking and why he or she thinks that way. The investigator needs to know what questions the chief has. The investigator needs to know how the chief approaches getting the answers. The chief should also sense when the investigator has done as much as can be done. If not enough has been done, the chief needs to keep asking.

Eventually, the investigators in time will think about issues the way the chief thinks about them. They will anticipate the questions that are asked. They will also learn the items that do not interest pathologists. Eventually, the investigators will professionally become an extension of the chief. More about this will be covered in the next lesson.