Hatton’s quick appraisal was typical of forensic pathologists in 1920s
Chicago. He was one of only six covering all of Cook County, which had a
population of over 3 million in 1920. Their extreme workload often meant
short, hasty autopsies. It’s a situation that may be repeating in coroner’s
offices across the United States, made worse in some regions by
skyrocketing overdose deaths.
In the late 1920s, Hatton, perhaps out of guilt, went public on the
failures of the Cook County coroner’s office. He wrote articles in medical
journals and spoke at conferences, divulging how the office valued speed
over accuracy. Years went by without a completed autopsy, he said. The
physicians typically guessed at the cause of death, and when they cut into
a corpse, they were quick and sloppy.
The doctors weren’t incompetent or indifferent; they were busy. Along with
the demand of performing autopsies for a populous county, several were also
employed as professors at local universities. Hatton was a professor of
pathology at Northwestern University’s dental school. Adding to the
workload, the county coroner — leader of the office — insisted the doctors
publish in medical journals to raise the office’s prestige.
An Archaic System
Reforms to the coroner system seemed imminent, at least for a while. When
Hatton went public, the newly formed Illinois Association for Criminal
Justice was already recommending significant changes to county coroner’s
offices throughout the state. For example, counties should not force urban
doctors to trek to suburban crime scenes. And more support staff was needed
to handle administrative tasks.
The association also joined a nationwide movement pushing for the end of
what was considered an archaic coroner system. Even though the county
coroner signed death certificates and determined whether a crime occurred,
the coroner was not required to be a doctor. Reformers wanted an M.D. at
the helm, and they argued for replacing the elected coroner with an
appointed physician, called a medical examiner.
The reforms and physician-in-charge structure never fully caught on,
however. Although some offices adopted the new system, many others did not.
In Chicago’s Cook County, a voter referendum in 1972 established the
medical examiner’s office. It remains the only county in Illinois to make
the switch.
A Modern Dilemma
But does it matter if an elected official or a physician leads a forensic
pathology office? Doctors within either management structure today are
overworked, just like their counterparts in 1920s Chicago.
“There are 500 [forensic pathologists] in the country,” says Brian
Peterson, former president of the National Association of Medical Examiners
and chief medical examiner at the Milwaukee County Medical Examiner’s
Office. “The need is triple and growing.”
A state audit in Massachusetts from 2013 to 2016 revealed that forensic
pathologists struggle to keep up with demand. Their job spills into
administrative tasks, such as obtaining police and medical records, and
they are expected to address five outstanding cases each month that require
additional testing or investigation. During the audit, 28 percent of cases
requiring a toxicology report were not completed within a 90-day time
frame. After the report was finished, finalizing the autopsy report
averaged 164 days.