DENVER—It’s a grisly truth in Colorado: Autopsy standards are patchwork, and some county coroners have little medical training. No statewide standard mandates which cases require a forensic autopsy.
That could change as state lawmakers near agreement on Colorado’s first regulations directing which deaths call for autopsies. But the Legislature is struggling against an Old West-style system in which local standards, not medicine, determine who gets one.
“Some folks doing this work are extremely well-trained and qualified. Some folks—well, you just hope if you have a loved one, that they die somewhere else,” said Democratic Sen. Morgan Carroll of Aurora, who sponsored a failed bill to study whether to keep Colorado’s coroner system.
Colorado’s 63 county coroners are in most cases elected, not appointed, and the posts have minimal requirements. To qualify, one must be over 18 with a high school diploma or equivalent. Medical training is required later, but it isn’t a prerequisite.
Colorado spells out which deaths call for a coroner to “investigate”—but not necessarily order a forensic autopsy. Death investigators say that in some cash-strapped counties, autopsies are rare unless a crime is suspected.
“It shouldn’t matter where a person lives—or rather, dies. They deserve the same standards,” said Sen. Linda Newell, a Littleton Democrat who sponsored the pending standards bill.
The National Academy of Sciences concluded in 2009 that coroner systems should be phased out and replaced with board-certified medical examiners. The report noted that coroners have roots in ninth-century England, where their job was to protect the crown from tax evaders. Coroners started being replaced by medically trained examiners in this country as early as the 1870s.
States still using elected county coroners tend to be Western, according to a 2010 PBS/ProPublica report. Idaho, Nebraska, Nevada and Wyoming also rely on county coroners rather than state medical examiners.
Carroll’s bill to study Colorado’s elected system was rejected in February amid complaints that the proposed study group didn’t include enough stakeholders, such as funeral directors.
The Colorado Coroners Association, which represents the state’s 63 coroners, opposed that bill but favors using national standards, set by the National Association of Medical Examiners, as a guide.
Those standards require forensic autopsies in suspected unnatural deaths, including poisonings, drug overdoses, unwitnessed drownings or when someone dies behind the wheel in a car accident. Colorado would additionally require forensic autopsies for any unnatural death in a public institution such as a county jail or state prison.
“Everybody else has standards and guidelines that they have to follow, but we’ve never had that,” said CCA president and Grand County coroner Barbara Bock.
But the elected coroner system should remain, said Bock, who isn’t a doctor but has worked in death investigations for 24 years.
“It keeps the cases local. When people pass away, their families want to know their coroner, not go down to the big urban counties and be just a number,” Bock said.
Statewide, about 13 percent of Colorado deaths received an autopsy in 2009, according to the CCA. Some counties sent nearly half of their deaths for an autopsy, while in others, autopsies were performed in fewer than one in 10 deaths.
Autopsy rates vary, the CCA reported. Rural Teller County ordered autopsies in 18 of 77 deaths in 2009, while rural Otero County autopsied just nine of 193 deaths that year.
Statewide standards have the support of county prosecutors, who already can order autopsies and would retain that authority under the bill.
“It just sets a threshold for which cases definitely demand an autopsy,” said Tom Raynes, head of the Colorado District Attorneys’ Council.
The state’s busiest coroner, Dr. Amy Martin of the city and county of Denver, said Newell’s bill is a good idea but doesn’t go far enough. Martin, one of Colorado’s few appointed coroners, said it still doesn’t require autopsies to be performed by someone certified by the American Board of Pathology.
Martin said the bill also contains no penalty for not ordering a forensic autopsy when national standards suggest one should be done. And she said it would inevitably require more autopsies without providing money to pay for them. Forensic autopsies average about $1,300 each in Denver but can run much higher in some complex cases, Martin said.
Zane Laubhan, the coroner in Gilpin County, said adopting national standards is an improvement.
“In many situations it was left to personal opinion, and sometimes opinion got in the way of good judgment,” Laubhan said.
The standards measure has passed both the House and Senate, but in slightly different forms. Once lawmakers agree to a single bill, it will go on to Gov. John Hickenlooper for his consideration. The governor hasn’t taken a position yet on the proposal.
Martin urged legislators to completely re-examine how Colorado handles autopsies.
“I think that there are better ways to fix the problem,” Martin said. “Death investigation really calls for elimination of the coroner system, or at least changes in the coroner system. There is so much more to be done.”
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Online:
House Bill 1258:
National Academy of Sciences coroner report:
