The impacts of governing agency: A comparison of resources in the patchwork of medicolegal death investigation systems

In the United States, medical examiners and coroners (MECs) fill critical roles within our public health and public safety systems. These professionals are primarily charged with determining the cause and manner of death as they investigate deaths and respond to associated scenes and mass fatalities and can also help identify trends in public health crises through medicolegal death investigations. Despite their instrumental role, they are organized in disparate systems with varying governing structures, functions, staffing, caseload, budget, and access to resources. This paper examines data from the 2018 Census of Medical Examiner and Coroners to evaluate MEC operations in the United States. The findings show that MEC offices’ organizational and operational governance structures greatly influence resources, workloads, and access to information and services. Standalone MEC offices were generally better resourced than those affiliated with law enforcement, public health, forensic science, district attorneys, or other agencies.1 •MEC offices' governing agency affects their budget, staffing, and other resources.•Of the 1326 MEC offices for which data are available, 51% were standalone.•Standalone MEC offices had more overall capacity than other types of MEC offices.•MDIs would be better handled by a national system of standalone MEC offices.