Why Might A Coroner Skip An Autopsy?

This is a frequent question from authors so I thought it would be nice to cover it a bit more in detail. The autopsy is a very important part of any death investigation but they are not always performed.  In the United States we operate under a Coroner/Medical examiner system in which jurisdiction of that office is usually by the individual counties of the state. Some states have a State Medical Examiner who has jurisdiction over all deaths in that state as well. These offices have jurisdiction over any suspicious or unattended death. An unattended death is one that occurs outside the presence of a medical professional (like inside a hospital).  Ultimately the decision to perform an autopsy resides with the Coroner or Medical Examiner unless a court order superseded that decision (which is extremely rare). Practically speaking, if there is even the slightest indication that foul play took place or there is nothing to indicate a cause of death an autopsy is going to be performed in most jurisdictions.

But there are times when an autopsy is not done. most of the time there is a reasonable explanation but as crime authors you’ve probably already guessed that not doing an autopsy can really come back to bite you. First, let me clarify that when I talk about an autopsy I mean a full blown examination. This involves removing and examining the organs and scrutinizing every inch of the body for injuries and a cause of death. This is different than an “external” examination in which the Coroner/Medical Examiner simply checks for evidence of external injury. External exams are typically performed when the death has been attended by medical professionals or when the victim has a lengthy medical history of a terminal illness (such as being in hospice care for advanced cancer). So what factors might lead a Coroner or Medical Examiner to skip the autopsy beside the above examples?

In the best of circumstances (meaning the death was medically foreseeable), when the cause and manner of death are obvious, a family may object to an autopsy on religious or cultural grounds. The Coroner ALWAYS has the authority to conduct an autopsy if they so choose but may decide not to under the above circumstances. Now for the bad news. Actually this is good news for fiction writers. Sometimes a Coroner/Medical examiner may fore go an autopsy for…shall we say…stupid reasons. I have to stress that in my experience this is very rare but it can, and does, happen so you can use conditions like these to fuel your story and add a ton of tension.

Reason #1:  As I have previously written, not all Coroners are forensic pathologists. Some don’t have any real medical training at all. In the United States it is an elected position. As such, their decision to skip an autopsy may be influenced by such things as budget constraints. many of these offices have to hire a forensic pathologist to do the autopsy which may cost upwards of $1,000.00.  So if the death doesn’t “look” suspicious they may decide to save the cost and skip the procedure.

Reason #2: These elected officials might also skip an autopsy because they feel one is not warranted. For example, if the death appears to be a suicide by intra-oral gunshot then they might say “why do an autopsy when the cause and manner of death is obvious”? or “I don’t need a forensic pathologist to tell me that this woman died in a car accident”. In my opinion this is unwise but it happens. The most obvious concern is that the scene has been staged in some way or the actual cause of death is hidden among other traumatic injuries. For example, what if a person found in a burning car following an accident actually had a gunshot wound to the head which wasn’t obvious because of severe trauma following the accident? What looks like an accident might actually be homicide from road rage or some other motive.

Reason #3: This is extremely rare but again, it happens. The elected official may have a personal interest or motivation to avoid an autopsy. As fiction writers this is the most “juicy” motive of all. On the benign end of the scale the victim may be the child of a friend, business partner, or other associate of the Coroner. Think SIDS death where the parents are known to the Coroner. There may be a motive to write the death off as SIDS rather than investigate any negligence on behalf of the young mother. The Coroner may also have an ideological aversion to certain forms of death such as auto-erotic, SIDS, shaken baby, etc and may choose to declare a death suicide or accident rather than some other cause. The manner of death, such as auto-erotic, may be very embarrassing to the victim’s family or even the community (think religious leader or politician found that way) so the Coroner may avoid an autopsy which may declare the death as such.  Under the worst of condition the Coroner or associate may actually be involved in the death (or at least a suspect). Imagine if a Coroner was carrying on an affair with a wife who kills her abusive husband staging it to look like a suicide. Once he goes down that road there may be no coming back. So while that may be rare and extreme, it makes for an engaging story!