Fixing Garden State’s Broken Medical Examiner System

Raft of changes proposed for structure that critics have slammed as mismanaged, underfunded, overworked, and fragmented

New Jersey’s medical examiner system would get a top to bottom overhaul under a proposal designed to create a more coordinated, independent, and professional program to investigate mysterious and suspicious deaths.

Legislation introduced last month by Sen. Joseph Vitale (D-Middlesex), to reform the state’s medical examiner infrastructure is scheduled for consideration today by the Senate health committee, which Vitale chairs. Among other things, the measure would put health officials in charge, create a unified statewide system, and specify when autopsies are required.

Critics have blasted the Garden State’s system as fragmented, mismanaged, under-resourced and overworked; the situation is exacerbated by the current opioid epidemic, which killed some 2,100 residents in 2017.

At a Senate health committee hearing in January, witnesses described how in some medical examiner facilities, procedures aren’t standardized, bodies become backlogged, there is no heat, the staff is underpaid, and families are forced to wait for answers about the death of a loved one. Medical examiners reviewed 21,000 deaths last year and conducted 5,000 autopsies, officials said.

No set standards

New Jersey’s system is hampered by its design, experts note, as suspicious deaths are investigated by one of 10 regional offices that don’t operate under a unified set of standards. The state medical examiner has direct control over only two of these facilities; the rest are controlled by individual counties or groups of counties.

The entire network falls under the jurisdiction of the state’s attorney general’s office, which also oversees law enforcement in New Jersey. That creates a potential conflict of interest that makes it harder for medical examiners to remain independent from prosecutors who must use their results in trials, observers note.

These problems were the focus of an in-depth report published in December by that called it a system “marred by neglect and dysfunction.” Several former medical examiners resigned in protest over the lack of funding or control and efforts by governors and lawmakers over the past four decades have failed to spark reform, it noted.

The issue has been on Vitale’s radar for years. In 2010, he first introduced legislation, along with Sen. Christopher “Kip” Bateman (R-Somerset), to shift the system from the attorney general to the Department of Health; the measure got several hearings, but not a full vote. Bills introduced each session since failed to advance.

Drastic changes

The latest proposal (S-976) — sponsored by Vitale alone — would drastically change the 1967 law now governing the state’s medical examiner system. It would require each county to create a medical examiner office, or join with other counties to do so; the entire process would be structurally overseen by, but not directly controlled by, officials at the state health department.

“The bill specifies that the office is to be independent of any supervision or control by the department or by any board or officer of the department,” the draft notes.

It would also call for the governor to appoint a chief medical examiner, with Senate approval, to a five-year term; the individual must be a licensed physician and a qualified forensic pathologist. The chief would be responsible for ensuring all county offices were properly staffed and equipped, establishing training requirements for key staff, and crafting uniform protocols for all facilities.

In addition, the bill spells out exactly when an autopsy should be performed, something that now depends in part on the discretion of the local medical examiner. This would include cases involving violent death and accident, suicide, public health threats or unknown disease, when abuse is suspected, and for those who die under age 18 of any cause. Autopsies would also be mandatory when someone died within 24 hours of entering a hospital or nursing home, or because of an occupational injury.

New testing and timelines

The proposal calls for the creation of a state laboratory to assist the medical examiners, and for all related samples to be tested at this facility. It would establish a process and timeline for appealing decisions and create a review team, with state officials and public members, to investigate disputes or protocol violations.

The state medical examiner would be required to issue an annual public report under the plan, which would take effect just over a month after being signed into law.