Deanne Fitzmaurice/For California Watch
In the vast majority of California counties, elected sheriffs have the final say in determining the manner of death in coroners' cases.
The political element of those jobs might be reducing the number of reported suicides, according to a new study by researchers at Temple University. The sociologists found that jurisdictions where elected officials run death investigations have “slightly lower official suicide rates” than areas served by appointed medical examiners and coroners.
“The significant, albeit small, effects of office type on official suicide rates in our results support the notion that elected coroners are more susceptible to pressure from family or friends to report the death as something other than suicide and that medical examiners’ greater professionalism shields them from such influences," the report states.
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Suicide continues to carry a stigma in society, at times compelling relatives to lobby coroners to make a change or even file lawsuits to overturn such a ruling.
Forensic pathologists, the doctors who specialize in performing autopsies, do at times make errors that merit skepticism. But more often than not, the doctors’ conclusions are sound.
However, there is more to mortality data than a medical diagnosis. For starters, “cause” of death is different from “manner” of death.
Forensic pathologists set out the causes of death based on findings from the autopsy and toxicological tests. This is often a number of conditions, from longtime illnesses to sudden traumatic injuries, listed in order of importance.
Manner of death, which is printed on death certificates, is a far more subjective conclusion. All deaths fall into one of five categories: natural, accident, homicide, suicide and undetermined.
In 48 of California’s 58 counties, the sheriff decides the manner of death. The state has only two medical examiner offices (in San Diego and San Francisco counties), though the Los Angeles County coroner's office operates under a forensic pathologist’s direction.
The combined “sheriff-coroner” setup is different from much of the country, where coroners officially are independent from law enforcement. Whether affiliated with police or not, most elected officials who oversee death investigations have little to no medical training.
The Temple University research, presented last week at the American Sociological Association’s annual meeting, examined mortality data nationwide from 1999 to 2002. It found statistically significant shifts in manner-of-death rulings that suggest elected officials chose natural or accidental when it could have been suicide.
“If office type is affecting misreporting, our results suggest that female suicides are being misclassified most often as deaths from illness, and, to a lesser extent, car accidents and possibly (although not plausibly) non-firearm homicides, while male true suicides are being misclassified most frequently as car accidents,” the report said.
Sgt. Les Garcia, head of the San Joaquin County Sheriff’s Office coroner’s division, said he doubts his office would come to a different ruling on cases than a medical examiner would.
“Our pathologist does the cause of death, the reason why the person died,” Garcia said. The office relies heavily on those findings to choose manner of death, he said.
California Watch reviewed a small sampling of 2009 manner-of-death data from around the state. The exercise produced interesting anecdotes, but nothing conclusive.
The San Diego County medical examiner listed 13.9 percent of its investigated deaths as suicide that year. At the other extreme, the Santa Clara County Sheriff’s Office deemed just 3.9 percent of cases suicide.
Suicide rates in most other California offices did not vary so widely.
The San Joaquin County Sheriff’s Office ruled 8.8 percent of its death cases as suicides. That was closely in line with the San Francisco Office of the Medical Examiner, where 8.9 percent of investigated deaths were listed as suicide. The Riverside County Sheriff’s Department had a slightly higher rate of 9.1 percent.