CORONERS/MEDICAL EXAMINERS AND THE PRODUCTION OF "MANNER OF DEATH" STATISTICS Trudy Knicely Henson A Dissertation Submitted, to the Graduate College of Bowling Green State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY June 1978 © ,-v 1978 Trudy Knicely Henson All Rights Reserved li ABSTRACT The official statistics for manner of death (natural, accidental, suicide, and homicide) are used hy social scientists in a variety of ways. Despite their widespread use, however, the statistics are often criticized for a number of weaknesses. A review of social science literature and preliminary interviews and observations among the coroners and medical examiners who produce the statistics indicated that much of the bias in official statistics could be attributed to role conflict and role strain. Several methods were used to collect data about medicolegal officials, the role strain and/or conflict they experience, and the structural and personal mechanisms they use to resolve strain and conflict. These included: l) observation in two coroners’ offices; 2) examination of case records; 3) focused interviews with coroners and medical examiners; and M a mail survey of a national sample of medicolegal officials. The research was directed at an analysis of the coroner/medical examiner role with attention to the ways in which its various components might affect the production of manner of death statistics. To accomplish that goal the medicolegal role was examined on three levels: l) role requirements as dictated by state laws; 2) the role as defined by officials themselves; and 3) the actual role performances of coroners and medical examiners. Attention was given to those factors likely to affect the quality of official death statistics—the complexity of the official's role, the amount of role commitment, interaction with iii -f role partners such as police, legislators, and medial personnel, and the existence and resolution of role conflict and role strain. The data support the assertion that manner of death statistics are biased, but they indicate that the error is more often a result of role strain and conflict than of intentional misclassification. Officials reported that budgetary restrictions, insufficient personnel, lack of proper training and skills, and conflicting expectations from role partners are factors which interfere with their role per­ formances and contribute to inaccuracies in manner of death verdicts. Il I ?>•, "A single death is a tragedy, a million deaths is a statistic." —Joseph Stalin IV ACKNOWLEDGEMENT The completion of a study such as this is never due solely to the efforts of one person. Throughout the project a number of people provide invaluable support and assistance. I would like to thank Dr. Charles McCaghy and the other members of my committee—Drs. Del Hilyard, Steve Cernkovich, Peggy Giordano, and Don McQuarie—for their support and cooperation from the beginning of the research. To my husband, Gary, I owe a special thank you for his moral support and encouragement. A portion of the financial burden of the project was relieved by grants from the Sigma Xi Scientific Research Society of North America and the Bowling Green State University Graduate College. The Bowling Green Sociology Department also provided supportive resources during the survey phase of the study. Finally, I wish to express my deepest appreciation to all those medicolegal officials and personnel who gave so freely of their time and knowledge throughout the study. Although all of these people had crowded schedules and many responsibilities, they were very helpful. Without their cooperation the project could never have been completed. To all these people and many others who provided support, encouragement, and time, thank you. V TABLE OF CONTENTS " CHAPTER Page I INTRODUCTION..............................................1 II REVIEW OF LITERATURE..................................... .8 Weaknesses of official statistics...................... 8 Previous studies of coroners/medical examiners......... 16 Theoretical approach.................. ............... 21 Summary............................................... 27 III METHODOLOGY: SAMPLES, STRATEGIES, AND TECHNIQUES.......... 30, Terminology........................................... 30 Samples............. 33 Research methods...................................... 39 Summary............................................... 1+9 IV MEDICOLEGAL ROLE REQUIREMENTS: THE HISTORY AND STATE LAWS............................... .......... ....50 History of the medicolegal office.......................50. Laws.................................................. 57 Discussion............................................ 83 Summary............................................... 90 V THE MEDICOLEGAL ROLE AS PERCEIVED BY CORONERS AND MEDICAL EXAMINERS................... 92 The purpose of the office.............. .. ............92 Responsibilities to role partners............... ......95 vi CHAPTER Page Qualifications and selection......................... 101. Motivation........................................... Ill Summary.............. 113 VI THE MEDICOLEGAL ROLE: PERFORMANCE, CONFLICT, AND STRAIN............................................. Il6 Role conflict and role strain........................ 117 Individual characteristics and the medicolegal role...122 Performances of individual offices................... 132 Role performance in the occupation in general........ 152 Manner of death statistics and role strain/conflict...156 VII CONCLUSIONS AND SUGGESTIONS FOR USERS OF MEDICOLEGAL STATISTICS................................ 1Ô7 Legal role requirements.......... 167 Perceived role requirements........ 169 Role performances evaluated.......................... 170 Suggestions for users of official statistics......... 172 Suggestions for future research.......................173 Summary.............................................. 175 REFERENCES...................................................... 176 APPENDIX I: MAIL SURVEY QUESTIONNAIRE......................... 182 APPENDIX II.: INTERVIEW LETTER.................................. 191 APPENDIX III: INTERVIEW SCHEDULE:S AMPLE QUESTIONS...... ......... 193 APPENDIX IV: QUESTIONNAIRE COVER LETTERS....................... 195 APPENDIX V: STANDARDS FOR MODERN MEDICOLEGAL SYSTEMS AS OUTLINED BY THE NATIONAL ASSOCIATION OF MEDICAL .'EXAMINERS.................... ..199 VI1 LIST OF TABLES TABLE Page 3.1 Interview sample by type of system, population, and rural-urban character................. 37 3.2 Description of survey respondents by type of system, type of jurisdiction, and respondent’s educational background...................................... ..... 39 U.l Summary of state laws regarding the medicolegal office and officials......................... .........75 5.1 Qualifications for medicolegal office as viewed by questionnaire respondents.........................103 6.1 Age distribution of mail survey sample............... 123 6.2 Distribution of survey sample by years in office..... 12H 6.3 Other titles held by medicolegal respondents in the mail survey....................... ........... ...125 6.U Facilities and staff available to officials.......... 135 6.5 Percentage of offices routinely ordering autopsies in selected cases.......................... 137 6.6 Respondents' evaluations of their role performances in obligations to role partners...................... 1^0 6.7 Frequencies with which role partners pressure officials to change a suicide............... .........148 6.8 Respondents' evaluations of frequency of r ' mistakes at various steps in the medicolegal handling of cases.................................... 15^ Vili LIST OF FIGURES FIGURE Page 4.1 Typology of state medicolegal systems including title of office, method of selection, and quired qualifications................................. 82 7 Chapter I INTRODUCTION Death is an universal phenomenon. This fact in itself makes death an object of interest. Beyond that, however, death is significant because of its effect on individuals, groups, and society. Few people attain such a degree of fame that their individual deaths are lamented by the world, or even by one society. And few people lead lives of so little significance that their passing touches no one. Individual deaths vary in degree of impact on others, but each one has an effect on the social network in which the deceased was once an actor. Beyond the micro-level of individual social networks, death in the aggregate is significant in its impact on whole societies. It is a major factor in population trends, and because of this it affects the economy, the government, and the quality of life in a society. Considering its significance in social life, it is surprising that for most of human history few records of death have been kept. Systematic compilation of statistics on causes and rates of occurrence of death is a relatively recent phenomenon. In the United States, annual collection of death statistics did not begin until 1900. At that time ten states were included in the project. Complete coverage was not achieved until 1933. Today most developed countries maintain death registration systems, but many underdeveloped countries still have only minimal registration of deaths (Petersen, 1975; Shryock, 1976). Prior to the establishment 2 of modern registration systems, the only records of death were those kept by a family, or lists compiled for limited areas and purposes by town officials, clergymen,