In the fall of 2018, I conducted an internship with the Travis County Medical Examiner’s Office (TCMEO), in the department of Death Investigation. This report will describe the organization, the tasks of death investigators in my role as an intern, and it will detail how American views of death affect the process of death investigation.
The Travis County Medical Examiner’s Office (TCMEO) is in charge of medicolegal death investigation for Travis County as well as 42 surrounding counties. The TCMEO was established in 1977, and within the past few years moved to a three-story building that includes rooms for the medical examiner, death investigation department, forensic anthropology, toxicology, and administration. According to the 2016 TCME Annual Report, there are 42 employees at the TCMEO within the following departments: Forensic Pathology, Investigation, Morgue, Forensic Toxicology, and Administration. There are twelve positions within Death Investigation, including the Chief Investigator, a Deputy Chief Investigator, as well as Investigator I and II personnel. Forensic anthropologists are not directly employed by TCMEO; instead, university professors or other consultants are brought in to help with anthropological cases. The office is accredited by the National Association of Medical Examiners (NAME). Additionally, TCME was accredited for a one-year forensic pathology fellowship training as of July 1, 2016 by the Accreditation Council for Graduate Medical Education (ACGME). Currently, the office accepts two fellowship students a year.
The TCMEO is responsible for the investigation and certification for cause and manner of death for sudden, unexpected, violent, suspicious, or unnatural deaths that occur in Travis County and surrounding counties. “Cause of death” is defined as the factor, such as injury, toxicity, disease, or other combinations of factors that brought on the physiologic change leading to death. By contrast, “manner of death” is defined as the circumstances surrounding what brought on the death, and is split into five different categories: natural, accident, suicide, homicide, and undetermined. Investigations include assessments of where the death occurred, and in the case of homicide or deaths with ambiguous circumstances, an autopsy is performed. In addition, the TCMEO performs autopsy and laboratory services for surrounding smaller counties for a fee.
In order to assure that cases are properly investigated, deaths occurring in Travis County are reported using a databased called VAST. All cases called in are split into one of five categories: Sign-Off (SO), Not Reportable (NR), Death Certification (CT), Medical Examiner (ME), or Private Autopsy (PA). Cases categorized as a SO or NR will not require an autopsy nor certification from the TCMEO. SO and NR cases are typically from individuals in hospice care, with NR cases referring to those who had stayed in a 24-hour care facility for greater than twenty-four hours. CT cases typically will not require an autopsy, but the medical examiner may have some examination of the decedent’s body before certifying the death certificate. PA cases refer to cases requested by the Justice of the Peace for smaller counties; these are considered private autopsies, and cost money for the Justice’s county. ME cases typically involve a preliminary investigation and the medical examiner will later conduct an autopsy on the decedent in order to determine cause and manner of death.
As an intern, my primary role was answering phone calls for the death investigation department. I was involved in all calls from hospice care and would record contact information or pass along calls to my supervising investigator when a call was received from a hospital or police department.
When a case required the department to complete an investigation, I accompanied my supervising investigator and either observe the investigation or assist with photography; this often depended on what investigator I was working with. I was allowed to accompany the death investigator on natural, accidental, or suicidal deaths, but couldn’t accompany them on neonatal or homicide cases.
During my internship at TCMEO, we were expected to maintain professionalism and maintain an objective view of the death we encounter during fieldwork. As a result, at times it can seem like the investigators have a relatively disconnected view of how families may choose to mourn. While the investigators never outright said anything about how I wouldn’t be allowed to cry or show any particular emotion, none of the investigators showed any sort of emotion beyond saying that they’re sorry for the loss the family has experienced. In addition, most of the investigators seemed hesitant to allow any sort of religious ceremony for decedents when their body has to be transported by TCME. As an example, the decedent’s family are not always allowed to view the body if they have to be transported, and even if a viewing is allowed, they aren’t allowed to touch the body in any way. While not touching the body may be to avoid any issues during later investigation, it seems like there may be a benefit for the family if they are given a more substantial chance to see their loved one before they have to be transported away.
Before the eighteenth century, death and mourning were integrated into the daily lives of Americans. The mourning process was a routine part of life for families affected by childhood or infant deaths. Close family and friends were often in charge of preparation of the decedent’s body and for arranging internment of the decedent. However, starting in the nineteenth century, Puritan influence helped lessen the dichotomy between body and soul, and families began to delegate all duties surrounding preparation of the decedent and funerals to individuals referred to as “Layers Out of the Dead”. (Price, 1999) Later, around and during the Civil War, Americans began to take a more scientific approach to how they viewed the corpse. In addition, with the advent of battlefield photography, corpses began to be seen in a more objectified light, contributing to an American apathy towards the dead. (Price, 1999)
In general, Americans have a fear of death. This fear appears to come from a multitude of factors, including fear of the unknown and religious belief, such as the fear of going to Christian Hell rather than Heaven based on your deeds. (Foust, 2013) This sort of fear helps contribute to what can be called a death-shaming society. In this context, a death-shaming society refers to a society that has an antagonistic view of death. This can be seen in how the American beauty industry so heavily relies on, especially for women, undoing signs of aging.
In general, there is still debate over whether or not a medical examiner or coroner system is most beneficial for our country. In general, the medical examiner system is considered to give higher quality of death investigation, an increased sense of uniformity in how death investigation is approached, Additionally, the ME system is believed to have a better centralization of administration, which can help in situations such as mass disasters. However, an ideal centralized medical examiner system requires strong leadership, attention to budget priorities and competition with other public health/criminal justice programs, and requires good human-resource management to help recruit and retain multiple types of professionals. (Marcella Fierro, 2003)
While I did enjoy my time with the TCMEO, I still felt as if I hadn’t experienced as much as I had wanted to. Because I worked day shift- which in general is considered a relatively quiet shift- I didn’t get as many opportunities as I had wanted to do investigations. For any future individuals interested in a death investigation internship, I would advise taking a shift later in the day.
- Medicolegal death investigation system : workshop summary. (2003). Washington, D.C. : National Academies Press, ©2003. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK221913/
- Price, J. L. (1999). The sacred remains: American attitudes toward death, 1799-1883. Journal of the American Academy of Religion, 67(3), 683–686. Retrieved from http://libproxy.txstate.edu/login?url=http://search.ebscohost.com.libproxy.txstate.edu/login.aspx?direct=true&db=rfh&AN=ATLA0000351407&site=eds-live&scope=site
- Foust, M. A. (2013). Experience as a prelude to disaster: American philosophy and the fear of death. Mortality, 18(1), 1–16. https://doi-org.libproxy.txstate.edu/10.1080/13576275.2012.753871
- Travis County Medical Examiner’s Office. (2016). TCME Annual Report- 2016(Rep.). doi: https://www.traviscountytx.gov/images/medical_examiner/docs/annual_report2016.pdf