Medical examiner has replaced the Cook County coroner

SOME REFORMS come quietly, almost unnoticed by the general public. So, in early December, Cook County will no longer have a coroner; instead, murders, suicides and suspicious deaths generally will be checked out by a medical examiner:

Few people have watched that change over the years more closely than Dr. Victor Levine, 72, who served as a pathologist (later chief) under two coroners, one Republican, one Democrat. He saw, firsthand, the weaknesses in the system, tried twice to persuade the General Assembly to change the system and failed, and finally saw his battle won, at least in Cook County, by another legislative route.

The story of the Cook County change has statewide significance because in many other parts of Illinois the coroner system is under attack just as it was in the Chicago area, and for much the same reason.

First, with the aid of Dr. Levine, let's take a look at the coroner system: "It was introduced into this country during colonial times from England. Americans added one new wrinkle; they decided to elect the coroner.

"The coroner system persists in England and works reasonably well because the coroner tends to be either a lawyer or a doctor versed in medicallegal matters. Also, he's appointed by the Crown, essentially for life."

By contrast, in the United States anybody could become coroner; there were no qualifications; and there still are none under the Illinois Constitution.

In 1877 Massachusetts required the coroner be a physician. That system has come under attack since Chappaquiddick on grounds that medicine has become so specialized, the medical examiner should be limited to persons with special skills in forensic pathology — a scientific term meaning a doctor skilled in autopsy and other fields relating to medicine and the law.

One of the best known modern systems is in New York City, primarily because since the system started there in 1918, there have only been four chief medical examiners. The office has built up experience and continuity of service — an advantage of the medical examiner system in contrast to the coroner system where a new man may be elected every four years.

In theory the coroner system could use trained medical personnel — and most do — and there is at least one downstate pathologist who feels he works well with the five coroners in his district and isn't all that enthusiastic about change. But most specialists feel the office works best when it is under professional supervision from the top and under long-term direction by the same man.

Why all the concern?
One surprising statistic: One in every five deaths is investigated by a legal-medical investigator who may be a coroner or a medical examiner. Under the medical examiner, a well run office makes far fewer mistakes and what mistakes do occur are far less serious.

This underscores a second surprising statistic. A pathologist conducting an autopsy on a patient who died in his hospital knows the cause of death 95 out of 100 times when he finishes. But a forensic pathologist examining a body can be sure only 60 per cent of the time, without further investigation.

Dr. Levine points out, "This means a medical examiner has to have competent assistants to conduct extensive tests and good investigation techniques. When I was with the coroner's office, I spent about half my time on the tele- phone — talking to relatives, non- medical investigating."

Some coroners' offices (Cleveland and Cincinnati) are directed by physicians and have excellent investigation facilities, but this is unusual. The problem is particularly critical in counties outside of Cook and four or five larger areas in Illinois. There the facilities are limited and procedures can be slipshod. (For example, even many pathologists have little or no experience with gunshot wounds.)

The first effort to reform the coroner system in Illinois came in 1930 when a special commission studying ways to improve government came out flatly to abolish the office; nothing happened.

Dr. Levine and others got into the matter in 1969 as a result of the Illinois Constitutional Convention proposals. In 1973 a reform measure got 92 votes in the House, three more than a majority, but it lost when the acting speaker ruled the measure a home rule proposal needing a three-fifths majority. Two years later the proposal was sent to a hostile House committee and died. Statewide reform is still stymied.

But help for Cook County came from an unexpected source. Donald Mulack, a young attorney, was slated by Republicans to run for coroner in 1972, and he campaigned on a platform to abolish the office. The Democratic-controlled Cook County Board, to head off his appeal, agreed to put the issue on the ballot, and the public voted 4 to 1 to create the medical examiner office.

Although the office had been controlled by Democrats for most of its existence, there was no organized resistance to the referendum, and newspapers and civic groups supported the change. There was an original question whether the referendum was simply advisory, but the county board accepted it as a mandate and began planning for the changeover. 

(Next month: more on the new medical examiner system in Cook County.)

30/ December 1976/ Illinois Issues