CORONERS IN Pennsylvania are legally charged with investigating all violent, accidental, sudden and suspicious deaths.
In that job, they might have to autopsy and photograph bodies, examine death scenes, do toxicology tests, sleuth to identify nameless or decomposing corpses, give heart-breaking news to next of kin, interview witnesses and authorities, issue death certificates, order inquests, archive unclaimed bodies and belongings, and rule whether the death was criminal or otherwise.
You would think such duties would require the most stringent of credentials.
You would be wrong.
The only prerequisite to be a county coroner in Pennsylvania is to be a registered voter. That's because in 64 of the state's 67 counties, it's an elected position. (Philadelphia, Allegheny and Delaware counties appoint medical examiners, who are board-certified forensic pathologists.)
"In Pennsylvania, the butcher, the baker and the candlestick maker can be the coroner," said Montgomery County Coroner Dr. Walter I. Hofman, whose own credentials fill nine pages of resume.
Pennsylvania does not, in fact, have coroners who are butchers, bakers or candlestick makers.
But there is a coroner who's a garbage hauler and former supermarket shelf-stocker (Huntingdon County's Ronald Morder). Another is an electrician (Juniata County's Lee Snyder). Others include a former unemployed steel worker (Cambria County's Dennis Kwiatkowski), former craft-store owner (Adams County's Patricia Felix), former machinist (Cameron County's Ted Walters) and former business-form printer (Bedford County's Sam Gordon).
To be fair, all of the above worked as emergency medical technicians or paramedics before becoming coroners.
And many logged time working in their county coroner's offices before running for the top post.
But while nearly a quarter of the 64 county coroners have experience as emergency medical responders, only 13 are doctors or nurses.
And most of those did not train in forensic pathology; rather, they are family physicians, a podiatrist, a pulmonologist, a radiologist, nurses and an HIV counselor.
Other coroners came from law enforcement or the mortuary business: Ten are retired cops, and 29 are funeral directors or employees.
Those vastly varying credentials have prompted calls for change.
The Pennsylvania Coroners Association wants the state to beef up continuing education requirements for sitting coroners.
And, in February, the National Academy of Sciences recommended that Congress increase funding so that states could replace coroners with medical examiners. Academy researchers further stated that "medicolegal" autopsies should be performed only by board-certified forensic pathologists.
The coroner is an ancient job, a hand-me-down from England dating back to 1194.
Like any creaky relic, it needs revision, critics say.
"The problem arises not in doing the autopsies," which so-called "lay coroners" can subcontract, said Hofman, the only coroner statewide who's a board-certified forensic pathologist. "It's the decision-making process. Unless you have somebody with experience, knowledge and training, you might miss something. We rely on being informed."
Coroners generally order autopsies on just a fraction of the cases they take. Deciding which cases require further study or autopsies is not always clear, Hofman and Howard said.
"You're spending taxpayer dollars, so you don't want to waste the dollars on autopsies that are not necessary," Howard said. "But you also don't want to miss the swine flu because someone says: 'Oh, that looks like a heart attack.' "
Coroners also could risk public health by failing to notice commonalities that signal preventable, treacherous trends in consumer products, traffic incidents, contagions or crime, Hofman said.
Take the Northampton County coroner, who came under fire with other authorities there for failing to notice that a serial killer was at work in several Bethlehem-area hospitals. Nurse Charles Cullen, who killed seven patients in Pennsylvania, wasn't nabbed until 2003, after he moved his murder spree to New Jersey.
And a coroner who wrongly rules the manner of death to be homicide, suicide, accident or otherwise could jeopardize justice, Howard added.
"If an incorrect assumption is made very early on by an improperly trained coroner, that gets perpetuated and gives direction to the investigation, which then either misses things or gives too much credence to things that don't exist," Howard said. "So you may have people getting away with murder - or innocent people who get charged with a crime."
Other problems may be smaller - but still traumatic to those coping with loss. In one western Pennsylvania county, a coroner took so long to issue a death certificate that the killer was tried and convicted before the victim's family received it. Such delays can imperil everything from probate, wills and insurance to surviving grief and achieving emotional closure, critics say.
And, in Pennsylvania, where funeral directors fill nearly half of coroner posts, some worry that the profession is ripe for abuse.
"It's a conflict of interest," said Huntingdon County's Morder.
Venango County Coroner H. John Greggs, a former cop, agreed: "You got funeral directors who say: 'Well, we work with dead bodies, so we know everything about it.' But that's not true."
Still, Lyell Cook, Erie County coroner and president of the Pennsylvania Coroners Association, argued that funeral directors have more experience with anatomy and medicine than most citizens and so can be competent coroners.
They shouldn't promote their businesses when responding to death scenes, he added. Still, he acknowledged, no law exists preventing them from doing so.
Cook works for several funeral homes as an embalmer, but emphasized that he keeps his two careers separate.
Other states, such as Washington, have decided that funeral directors do have a conflict of interest in serving as coroners and have banned them from the job.
In Bedford County, Coroner Sam Gordon's "office" is his house. Calls to the coroner come to his home, where records are stored in the attic and his wife acts as unofficial secretary. Business is so sparse, the 73-year-old Gordon doesn't have to wait until the weekend to go fishing.
In Cameron County, things are similarly slow. Coroner Ted L. Walters' pay is $12,000 a year. But he's not complaining; he handles only about a dozen cases a year.
"That works out to about $1,000 a case, and that's pretty good if you look at it that way," Walters said with a laugh.
The prospect of eliminating coroners in Pennsylvania - especially in its most rural counties - elicits ardent argument.
"I actually think [appointing forensic pathologists as medical examiners] is a good idea, but it would run the small counties broke," said Walters, whose county has fewer than 6,000 residents.
Becoming a board-certified forensic pathologist requires 17 years of full-time, post-high-school education, Cumberland County Coroner Mike Norris said.
That means that they're expensive to hire and few in number, Norris added.
"There are a little over 3,000 coroner positions in the United States, and less than 600 board-certified forensic pathologists working," said Norris, former chairman of the state Coroner's Education Board and a former cop and EMT. "How do you fill 3,000-plus posts with less than 600 people?"
Other states - including Delaware and New Jersey - have found a way, appointing board-certified forensic pathologists as medical examiners to oversee death investigations and regionalizing in rural areas.
Still, some coroners insist that such expertise is unnecessary.
"It doesn't take a rocket scientist to figure out if someone shoots themself in the head, that's the reason they died," Adams County Coroner Patricia Felix said.
Felix and others say that they simply hire people - such as pathologists or photographers - to perform coroner duties that they can't do.
Those who want to preserve the coroner system also worry that regionalism would remove the personal touch from such a personal profession.
"Your effectiveness comes with making relationships and knowing people," said Cook, of Erie County. "How can you do this job effectively if you don't leave the office and are directing things from a hundred miles away?"
Many coroners warn that states won't have people stampeding to fill their shoes. Coroners often run uncontested, a trend some attribute to low compensation (coroner salaries in Pennsylvania range from about $12,000 to $80,000), the unsavory prospect of being on constant call and job risks such as bloodborne pathogens.
"Nobody else wants it; somebody's got to do it," said Cameron County's Walters, 65, who will seek his seventh term in 2011.
Rookie coroners in Pennsylvania first must complete a basic education course and pass a skills test administered by the state Attorney General's Office before they can get to work.
But the course is only 32 hours of training, typically spread over six days. Coroners then must take eight hours of continuing education during each year of their four-year terms, said Nils Frederiksen, a state Attorney General's Office spokesman.
The Pennsylvania Coroners Association aims to persuade lawmakers to boost that continuing-education requirement to 12 hours a year.
Even that, critics complain, is not enough.
"I didn't go to college, medical school and all the rest to be on par with someone who has no training," Montgomery County's Hofman said.
While none of Pennsylvania's coroners are as credentialed as Hofman, some echoed his call for boosting the job's qualifications.
"You have to have some background to be able to do this job; too much could pass under the radar if you come in with no experience," said Venango's Greggs, a 21-year veteran of the coroner's office who also has worked as a cop, an EMT and county EMT coordinator.
Berks County Coroner Dennis J. Hess, a retired Reading police sergeant, agreed: "That's why the public really has to pay close attention to these elections. They have the power to make sure the right people are in these jobs."
Because most cases that coroners and medical examiners handle are natural deaths, medical training - ideally in forensic pathology - is the most crucial credential a coroner candidate could have, said Philadelphia Medical Examiner Dr. Sam Gulino, who has experience in both systems. Investigative know-how and comfort around cadavers also helps, he added.
Still, Gulino said: "If you're going to have an election, then I don't know how you restrict who can run.