More Deaths Go Unchecked as Autopsy Rate Falls to “Miserably Low” Levels


August 8, 2012
Watch Post Mortem, FRONTLINE’s exploration of America’s patchwork death investigation system, and The Real CSI, our follow-up film which investigates the science behind forensics.

Nearly 7,000 people die each day in the United States, and according to a new report, there remains a critical shortage of experts trained to determine their cause of death.

The study, conducted by a research group working under the auspices of the Department of Justice, noted a “miserably low” national autopsy rate of 8.5 percent, with only about 4.3 percent of disease-caused deaths resulting in an autopsy. Autopsies are crucial because in instances of natural death, they enhance how medical experts understand disease, and can even help family members discover whether a relative died from an undiagnosed hereditary illness. In instances of homicide, they can provide crucial clues to investigators.

But the undersupply of medical examiners is far from the only challenge. As FRONTLINE’s Lowell Bergman reported last winter in the film Post Mortem, the nation’s approach to death investigation is one plagued by widespread dysfunction. There is no federal oversight of death investigators, and accreditation is voluntary. In more than 1,300 counties across the country, elected politicians are in charge of death investigation.

Such lax standards present serious implications for the criminal justice system, Sen. Patrick Leahy (D-Vt.) said during a July hearing on the state of forensic science.

“In the past several years, we have seen a continuing stream of exonerations of people convicted of serious crimes because of … flawed forensic evidence,” Leahy said.

The new report (PDF) from the Scientific Working Group for Medicolegal Death Investigation (SWGMDI) echoed that concern. Here are highlights from the study as well as several of the group’s recommendations:

Not enough examiners

There are an estimated 500 full-time forensic pathologists conducting death investigations in the U.S. — half as many as experts believe are necessary to provide adequate coverage to the country. In fact, since 1959, the nation has produced a total of 1,400 board-certified forensic pathologists. By comparison, more than 10,000 medical residents train in internal medicine and family practice each year.

Few paths to training

While there are more than 130 medical schools in 45 states and the District of Columbia, there are just 37 accredited forensic pathology training programs across 27 states and Puerto Rico.

Examiner burnout

Only two-thirds of forensic pathology fellowship graduates practice full time, while roughly a fifth end up not practicing at all. “Continued exposure to violence, challenging cases with media exposure and confrontation in court, relatively low pay, and recent government cutbacks” were all cited as factors.

Autopsy “deserts”

Many rural areas lack either a high enough mortality rate or a large enough tax base to justify bringing on a forensic pathologist. In some parts of the nation, the report notes, “if forensic pathologists are available, there is only enough work for a part-time effort and the forensic pathologist must travel or serve multiple areas to make a living.”

Fewer hospital autopsies

The authors note that “many hospitals have basically abandoned the use of … autopsies” to gauge the quality of their medical care, a trend that worsened since 19971, after the Joint Commission on Accreditation of Healthcare Organizations dropped a requirement that hospitals maintain a minimum autopsy rate of 20 percent. Another factor: “Virtually non-existant” funding.


The report’s authors recommend medical schools raise the profile of forensic pathology and death investigation, while offering financial incentives, such as loan forgiveness programs, to attract more students. They also call for salaries, which typically range between $100,000 and $200,000, to be made more competitive with other fields of medicine.

Jason M. Breslow

Jason M. Breslow, Former Digital Editor



More Stories

Kherson After Liberation: Co-producer of ‘Putin’s Attack on Ukraine’ Documentary Describes Visit
A Ukrainian filmmaker and journalist who was on one of the first trains traveling to the newly liberated city talks to FRONTLINE about the damage he saw in Kherson after eight months of Russian occupation.
November 29, 2022
As Donald Trump Announces His 2024 Run, a Look Back at His Presidency and Impact
FRONTLINE has built a unique public record, in documentary format, of the former president’s impact on American life, politics and democracy — and his previous battles with a special counsel and the Department of Justice.
November 16, 2022
How American Politics Reached This Fraught Moment: 12 Documentaries to Watch Ahead of the Midterms
As a divided America prepares to vote and fears of political violence continue, these FRONTLINE documentaries show how U.S. politics reached this moment.
November 4, 2022
How Russian Soldiers Ran a "Cleansing" Operation in Bucha
"I’ve already killed so many civilians,” a Russian soldier told his wife from Bucha, Ukraine. The Associated Press and FRONTLINE obtained hundreds of hours of CCTV footage and intercepts of audio calls by Russian soldiers that show for the first time what a Russian "cleansing" operation looked like.
November 3, 2022