A Staff Report from the Straight Dope Science Advisory Board

Why do coroner's reports take so much longer to prepare than medical test results?

April 6, 2010

Dear Straight Dope:

Why does it take a couple of days to get the medical test results that will tell you what's going to kill you, but many many weeks for the coroner to determine what actually did kill you? Also, is it my imagination or is there a direct ratio between the length of time to get the coroner's results and the fame of the deceased?

SDSTAFF Hawkeye replies:

The discrepancy you note isn't really a discrepancy — you're comparing apples and oranges. Medical test results and coroner's reports are prepared for entirely different purposes by different groups of people using different sorts of data.

Medical test results come from a hospital’s pathology lab. Some tests are fairly quick to run, such as a CBC (complete blood count), which includes counts and analysis of red and white blood cells and platelets. A test of the blood’s serum chemistry is also quite quick. Other tests, such as bacteriology, take longer due to the need to isolate and culture specific bacterial strains. In most cases, the great number of available tests can be narrowed down to a small handful based on the patient’s symptoms. But as a general rule, the work gets done as quickly as accuracy will permit, for obvious reasons: the speed with which the results are obtained can mean the difference between life and death.

After the threshold of death has been crossed, however, things slow down a bit, and not necessarily for lack of trying. The coroner's report must draw conclusions about both the cause of death (i.e., the actual physical process that caused the person to die) and the manner of death (i.e., natural, accidental, suicide, or homicide), and neither of these things is always easy to determine. For example, the death of a driver at the scene of a car crash may not need an extensive investigation. If blood samples are sent off for toxicological analysis and it's determined that there was enough alcohol in the driver's system to cause impairment, the cause of death may seem clear. But if investigators perform a mechanical analysis of the vehicle and determine that the brakes were tampered with, suddenly the case isn't so simple anymore. Now the cause of death depends on who did the tampering: was it the driver (intending to disguise suicide as an accident for insurance purposes) or someone else (intending to disguise homicide as an accident for prosecution-avoidance purposes)? The coroner’s task isn't complete until all these possibilities have been examined; it requires a total and final assessment of the case, after everyone else’s job is finished.

And speaking as a forensic biologist, I'm not at all sure it's true that the coroner typically takes longer to weigh in when the dead person was famous. Public scrutiny can complicate both forensic science and politics, and the coroner’s job often combines the two; at the same time, the famous tend to get faster service than the rest of us, even posthumously. A high-profile death creates extra pressure to get the report done right, but also extra pressure to get it done quickly. In the case of Anna Nicole Smith, for instance, her fame certainly didn't slow things down, and may well have sped them up: the work was done within a week, and the report was quickly made public because there were no criminal charges. Michael Jackson's case, on the other hand, was more complicated: the cause of his death (cardiac arrest) was known, but the manner (homicide, suicide, accidental, or natural) was not. But even here, the real delay was doubtless in getting the report made public; the work had been done for a while, I'm quite sure.

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