Tennessee

Is medical death investigation system centralized, county-based, or district-based?
County-based. Tenn. Code Ann. § 8-9-101.

If centralized, in which department or agency is the system housed?
Not applicable.

Does the state system have a coroner, medical examiner, or coroners and medical examiners?
Coroners and medical examiners.

The county legislative body is hereby granted discretionary authority to create the office of county coroner. If such office is created, the county legislative body shall elect a coroner who shall hold office for two (2) years, and until a successor is qualified. However, in those counties that have a county medical examiner, the county legislative body may vest the duties of the county coroner in the county medical examiner and shall not be required to elect a county coroner. Tenn. Code Ann.
§ 8-9-101.

A county medical examiner shall be appointed by the county mayor, subject to confirmation by the county legislative body, based on a recommendation from a convention of physicians resident in the county. . . . If the county has an elected coroner, the coroner shall serve as the medical investigator for the county; provided, that such coroner meets the qualifications for a medical investigator set out in subdivision (f)(1) . . . The county medical investigator may conduct investigations when a death is reported, as provided in § 38-7-108, under the supervision of the county medical examiner. The county medical investigator may make pronouncements of death and may recommend to the county medical examiner that an autopsy be ordered. However, the county medical investigator shall not be empowered to sign a death certificate. The county medical examiner may delegate to the county medical investigator the authority to order an autopsy. Tenn. Code Ann. § 38-7-104.

“In practice” notes
Although it is permitted by state statute, no Tennessee counties appear to maintain the elected office of coroner.

Is there a state medical examiner?
Yes. Tenn. Code Ann. § 38-7-102.

If so, what is the state medical examiner’s role?
[C]hief medical examiner [shall] direct the [post-mortem examination] division or service . . . Tenn. Code Ann. § 38-7-102.

In addition to the chief medical examiner’s other administrative duties, the chief medical examiner’s educational duties shall include developing and providing initial training and regular continuing education to all county medical examiners and medical investigators . . . The chief medical examiner shall have investigative authority for certain types of death that are in the interests of the state, including mass fatality incidents, for the identification, examination and disposition of victims’ remains, and instances that represent a threat to the public health or safety, or both. Tenn. Code Ann. § 38-7-103.

In what department or agency is the state medical examiner’s office located?
Department of Health. Tenn. Code Ann. § 38-7-102.

Are there deputies?
(a) Coroners have the power to appoint one (1) or more deputies, and to require them to give bond, with security, to save their respective principals harmless, and for the faithful discharge of their duties.

(b) In those counties which have the office of county coroner, the office of deputy coroner or deputy coroners may be created by private act . . .

Tenn. Code Ann. § 8-9-105.

The Tennessee medical examiner advisory council shall recommend to the chief medical examiner three (3) deputy state medical examiners, one (1) from each grand division of the state. The chief medical examiner, in consultation with the advisory council and with the approval of the commissioner of health, shall appoint the three (3) deputy state medical examiners and any assistant state medical examiners needed for regional administrative, professional and technical duties. The deputy medical examiners shall be based in one (1) of the state forensic centers. Tenn. Code Ann.
§ 38-7-103.

If so, what are the deputies’ roles?
[S]uch deputy coroner or deputy coroners shall be authorized to perform all duties which can now be performed by the coroner. Tenn. Code Ann. § 8-9-105.

[As] needed for regional administrative, professional and technical duties . . . In addition to their other administrative, professional and technical duties, the deputy and assistant state medical examiners may lecture to medical and law school classes and conduct such special classes for county medical examiners and law enforcement officers and other investigators. Tenn. Code Ann. § 38-7-103.

What are the qualifications for deputies?
These state medical examiners shall have the same qualifications as the chief medical examiner. Tenn. Code Ann. § 38-7-103.

Is the coroner or medical examiner position elected?
Coroner: elected
Medical examiner: appointed

Tenn. Code Ann. § 38-7-104.

If so, how many years is the term of office?
Two. Tenn. Code Ann. § 8-9-101.

What are the qualifications specified by law?
The chief medical examiner shall be a physician with an unlimited license to practice medicine and surgery in the state of Tennessee, or who is qualified and eligible for such license, and shall be required to obtain a license within the six-month period after employment. The chief medical examiner shall be a pathologist who is certified by the American Board of Pathology and who holds a certificate of competency in forensic pathology. Tenn. Code Ann. § 38-7-103.

A county medical examiner shall be a physician who is either a graduate of an accredited medical school authorized to confer upon graduates the degree of doctor of medicine (M.D.) and who is duly licensed in Tennessee, or is a graduate of a recognized osteopathic college authorized to confer the degree of doctor of osteopathy (D.O.) and who is licensed to practice osteopathic medicine in Tennessee . . .

(f)(1) A medical investigator shall be a licensed emergency medical technician (EMT), paramedic, registered nurse, physician’s assistant or a person registered by or a diplomat of the American Board of Medicolegal Death Investigators and approved by the county medical examiner as qualified to serve as medical investigator.

(2) If the county has an elected coroner, the coroner shall serve as the medical investigator for the county; provided, that such coroner meets the qualifications for a medical investigator set out in subdivision (f)(1). If the coroner is not qualified to serve as medical investigator, then the county legislative body shall, by resolution, either authorize the county medical examiner to appoint a medical investigator subject to confirmation by the county legislative body, or provide for this function through a contract for service approved by the county medical examiner and the county legislative body; provided, however, that, if the county has an elected coroner who has served in that capacity for ten (10) years or more, such coroner shall serve as the medical investigator for the county, regardless of whether the coroner meets the qualifications set out in subdivision (f)(1) . . . County medical examiners and medical investigators shall be required to receive initial training and regular continuing education through the chief medical examiner and to operate according to the death investigation guidelines adopted by the department of health. Tenn. Code Ann.
§ 38-7-104.

What types of deaths are required to be investigated?
Any physician, undertaker, law enforcement officer, or other person having knowledge of the death of any person from violence or trauma of any type, suddenly when in apparent health, sudden unexpected death of infants and children, deaths of prisoners or persons in state custody, deaths on the job or related to employment, deaths believed to represent a threat to public health, deaths where neglect or abuse of extended care residents are suspected or confirmed, deaths where the identity of the person is unknown or unclear, deaths in any suspicious/unusual/unnatural manner, found dead, or where the body is to be cremated, shall immediately notify the county medical examiner or the district attorney general, the local police or the county sheriff, who in turn shall notify the county medical examiner. The notification shall be directed to the county medical examiner in the county in which the death occurred. Tenn. Code Ann. § 38-7-108.

When a death is reported as provided in § 38-7-108, it is the duty of the county medical examiner in the county in which the death occurred to immediately make an investigation of the circumstances of the death. Tenn. Code Ann. § 38-7-109.

What types of deaths are required to be autopsied?
A county medical examiner may perform or order an autopsy on the body of any person in a case involving a homicide, suspected homicide, a suicide, a violent, unnatural or suspicious death, an unexpected apparent natural death in an adult, sudden unexpected infant and child deaths, deaths believed to represent a threat to public health or safety, and executed prisoners. When the county medical examiner decides to order an autopsy, the county medical examiner shall notify the district attorney general and the chief medical examiner. The chief medical examiner or the district attorney general may order an autopsy in such cases on the body of a person in the absence of the county medical examiner or if the county medical examiner has not ordered an autopsy. The district attorney general may order an autopsy in such cases on the body of a person in the absence of the county medical examiner or the failure of the county medical examiner to act. Tenn. Code Ann. § 38-7-106.

When an autopsy is ordered by the district attorney general, the county medical examiner shall notify the chief medical examiner and the county medical examiner may perform the autopsy or shall designate and authorize a pathologist to perform the autopsy as provided in § 38-7-105. Tenn. Code Ann. § 38-7-109.

Does the state require that pathologists perform the autopsies?
No.