New York State: Fee-for-Service Forensic Pathology in a Multiple Coroner System

Abstract

Having served as a board-certified forensic pathologist in the southern tier of New York for over 23 years, the author has received cases from over a dozen rural New York State coroner counties. While some coroners are physicians, none of them is a pathologist, and most are not in the medical profession. Some are appointed by their county legislature, whereas others are elected. Levels of coroner training and experience in death investigation, terms of office, multiple coroners per county, and turnover of coroner staff are all challenges for the consultant forensic pathologist. Functioning as an autonomous independent contractor, a forensic pathologist can bring standardization, medical knowledge, and reliability to the determination of cause, mechanism, and manner of death, even when resources are less than optimal. As fewer hospital pathologists perform autopsies, and as community hospitals opt to close their morgues entirely, regional centers emerge to absorb the workload. In such a setting, the forensic pathologist must establish a working relationship with an institution such as a regional hospital to support an adequate physical plant for an autopsy service. Until such time as adequate manpower and financial resources are available, a coroner-based death investigation system is still a necessary complement to the medical examiner system in New York State. There are both drawbacks and advantages to such a practice for the independent forensic pathologist. Yet the citizens of this area of New York State are served by a death investigation system that is functional and meets basic needs.