ISMA e-Reports, March 10, 2008

Few physicians hold county coroner job across Indiana

Each of Indiana’s counties employs a coroner, tasked primarily with determining the cause and manner of death in unusual cases. Currently, eight of the state’s 92 coroners are physicians.

Those choosing to run for the elected position typically have a personal reason for doing so.
Vidya Kora, M.D., (pictured left) an internal medicine physician in LaPorte County, cites an interest in politics and public service as his reasons for becoming a coroner about 9 years ago.

Forensic pathologist Roland Kohr, M.D., (pictured right) coroner in Vigo County, likewise explains that the job presented an opportunity for him to “give back” to the community and utilize his special skills.

Dr. Kora is quick to note the work is not “glamorous,” as the popular “CSI” television program portrays. In fact, 90-95 percent of deaths Dr. Kora investigates arise from natural causes. And, according to the Coroners Training Board, coroners investigate about 12 percent of death cases per year.

However, Dr. Kohr does call his work a “fascinating field.” Three deputy coroners take primary call in his county, and Dr. Kohr does back-up, sometimes visiting the scene of a death in the 125 cases his department handles per year.

“About every three days, we have a case,” he explained. “Half of them require an autopsy.” Dr. Kohr performs the autopsies for his county and for 14 others in Indiana and Illinois.

LaPorte County employs two chief deputy coroners, assistants who make the elected position manageable for a practicing physician. In fact, Dr. Kora sees the coroner’s job as a good fit for a retired physician. Yet, he quickly notes there is value in having physicians as coroners because plenty of medical issues must be addressed.

“Sometimes in spite of the pathology report, I still use my medical expertise to come to the cause and manner of death,” Dr. Kora said. “And in talking with families, I can better explain to them what happened to their loved one.”

He also uses his knowledge of local deaths to improve community life. This year he helped prompt legislation to improve methadone treatment, after seeing a spike in methadone-related deaths in his county. A few years ago when suicides were on the rise, he convened mental health professionals to launch more education about depression.

Time to do the job right and a circle of knowledgeable contacts are important, said Dr. Kohr, a professor of criminology at Indiana State University. “The key is some degree of training and knowing your limitations.”

Indiana is one of a shrinking number of states allowing any duly elected citizen to become a coroner. A medical examiner system exists in 22 states. The remaining 28 states that use a coroner system do, however, employ medical examiners in major cities. Medical examiners are almost always physicians, usually pathologists and often forensic pathologists, who are appointed.

Today, an elected coroner in Indiana has one year to complete training at an approved school or program and, following that, another year to complete an externship and pass a test.

Drs. Kora and Kohr agree some sort of regional system is needed to provide physician oversight at several county coroners’ offices, in addition to having trained staff in each county to handle the day-to-day administration and details that comprise the biggest part of the job.

The National Academy of Sciences supports a medical examiner system.        

Coroner mistakes in Indianapolis prompt physicians to step up

Marion County Coroner Kenneth Ackles, a chiropractor, announced he will not run again. Since taking office in 2005, he has been the subject of headlines. Ackles failed to pass a required training course and test for coroners, but since January has continued to accept his pay. A major theft and discrimination lawsuit also were reported in his office.

However, Marion County voters will have good options on the ballot. Two physicians, both ISMA members, have entered the Marion County coroner’s race.

John Pless, M.D., (pictured left) an anatomic and forensic pathologist is the Republican candidate. “I think I can do the job fairly and efficiently,” concluded the professor emeritus from the IU School of Medicine who has been coroner in two other counties.

The coroner’s job, as currently configured in Indiana, is unattractive to physicians, said Dr. Pless. He is interested in opening a dialogue about creating a medical examiner system here, to ensure untrained, unskilled people are not elected in the future.

Frank P. Lloyd Jr., M.D., (pictured right) a general surgeon at Methodist Hospital and clinical faculty member with IU School of Medicine, is the Democratic candidate. “The coroner must work with multiple groups, including law enforcement and families,” said Dr. Lloyd. “I think better relationships can be established.” His goal is to reduce the hassles surrounding contacts with the coroner’s office. 

Dr. Lloyd’s colleagues prompted him to enter the race. They were aware of his interest in ethics surrounding tissue from the deceased and organ donation. In fact, the surgeon started the first biological repository at Methodist Hospital.