Missouri

Is medical death investigation system centralized, county-based, or district-based?
County-based. Mo. Ann. Stat. § 58.010.

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.

In each county of the state, except in counties of the second class which prior to January 1, 1975, have a population of more than one hundred twenty thousand and less than two hundred thousand, and counties of the first class not having a charter form of government and any other county which adopts the provisions of sections 58.700 through 58.765, there shall be an office of coroner. Mo. Ann. Stat. § 58.010.

1. Except as provided in subsection 2 and subsection 3 of this section, the governing body of all counties of the second classification which prior to January 1, 1975, have a population of more than one hundred twenty thousand and less than two hundred thousand and all counties of the first classification not having a charter form of government shall appoint a county medical examiner and set his compensation.

2. The county governing body of any county of the first classification which has a population of at least ninety thousand but less than ninety-one thousand inhabitants and the county governing body of any county of the first classification which has a population of at least sixty thousand but less than seventy thousand inhabitants which borders a county of the third classification which has a population of at least thirty-five thousand inhabitants may, within one year after becoming a county of the first classification, elect to retain the office of coroner as set forth in this chapter, or may appoint a county medical examiner within such year or at any time thereafter, except that any decision to appoint a county medical examiner after such year shall be made at least one year prior to the expiration of the term of office of the county coroner. Notwithstanding any other provisions of law to the contrary, the governing body of the county shall set the compensation of the coroner or medical examiner without regard to any schedule.

3. The county governing body of any county which becomes a county of the first classification after December 31, 1998, may, within one year after becoming a county of the first classification, adopt an order retaining the county coroner until such time as the county commission subsequently adopts an order appointing a medical examiner. Any subsequent decision to appoint a county medical examiner shall be made at least one year prior to the expiration of the term of office of the county coroner. The governing body of the county shall set the compensation of the coroner or medical examiner without regard to any schedule.

Mo. Ann. Stat. § 58.700.

[Counties may also share services. Mo. Ann. Stat. § 58.765.]

“In practice” notes
None.

Is there a state medical examiner?
No.

If so, what is the state medical examiner’s role?
Not applicable.

In what department or agency is the state medical examiner’s office located?
Not applicable.

Are there deputies?
The coroner, in all counties in this state in which a coroner is required by section 58.010 may have a deputy. In such counties which now contain or may hereafter contain a city of seventy-five thousand inhabitants and less than two hundred thousand inhabitants, may have such a number of deputies and assistants, to be recommended by the coroner and appointed by the county commission as deemed necessary for the prompt and proper discharge of the duties of his office, and such deputies and assistants shall be divided into classes as follows: Class “A”, assistants or deputies; class “B”, assistants or deputies . . . All other counties shall appoint a deputy coroner, at the request of and upon the recommendation of the coroner, who may discharge all duties and exercise all powers of the coroner, and shall receive the compensation of the coroner while serving in the coroner’s absence, be compensated as provided by the county commission or serve without compensation. Mo. Ann. Stat. § 58.160.

1. The county medical examiner may appoint, with the approval of the governing body of the county . . . assistant county medical examiners and such other professional or technical personnel, clerks and other employees as may be necessary to carry out the [duties] in that county.

2. Assistant county medical examiners shall have the same qualifications as the county medical examiner and may perform all duties of the county medical examiner during his absence.

Mo. Ann. Stat. § 58.710.

If so, what are the deputies’ roles?
[M]ay discharge all duties and exercise all powers of the coroner, and shall receive the compensation of the coroner while serving in the coroner’s absence, be compensated as provided by the county commission or serve without compensation. Mo. Ann. Stat. § 58.160.

1. The county medical examiner may appoint, with the approval of the governing body of the county . . . assistant county medical examiners and such other professional or technical personnel, clerks and other employees as may be necessary to carry out the [duties] in that county.

2. Assistant county medical examiners shall have the same qualifications as the county medical examiner and may perform all duties of the county medical examiner during his absence.

Mo. Ann. Stat. § 58.710.

What are the qualifications for deputies?
Assistant county medical examiners shall have the same qualifications as the county medical examiner . . . Mo. Ann. Stat. § 58.710.

The county medical examiner shall be a physician duly licensed to practice by the state board of the healing arts. Mo. Ann. Stat. § 58.705.

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

Mo. Ann. Stat. § 58.020; Mo. Ann. Stat. § 58.705.

If so, how many years is the term of office?
Four. Mo. Ann. Stat. § 58.020.

What are the qualifications specified by law?
No person shall be elected or appointed to the office of coroner unless he be a citizen of the United States, over the age of twenty-one years, and shall have resided within the state one whole year, and within the county for which he is elected, six months next preceding the election. Mo. Ann. Stat. § 58.030.

The county medical examiner shall be a physician duly licensed to practice by the state board of the healing arts. Mo. Ann. Stat. § 58.705.

What types of deaths are required to be investigated?
1. When any person, in any county in which a coroner is required by section 58.010, dies and there is reasonable ground to believe that such person died as a result of:

(1) Violence by homicide, suicide, or accident;

(2) Criminal abortions, including those self-induced;

(3) Some unforeseen sudden occurrence and the deceased had not been attended by a physician during the thirty-six-hour period preceding the death

(4) In any unusual or suspicious manner;

(5) Any injury or illness while in the custody of the law or while an inmate in a public institution; the police, sheriff, law enforcement officer or official, or any person having knowledge of such a death shall immediately notify the coroner of the known facts concerning the time, place, manner and circumstances of the death. Immediately upon receipt of notification, the coroner or deputy coroner shall take charge of the dead body and fully investigate the essential facts concerning the medical causes of death, including whether by the act of man, and the manner of death . . .

2. When a death occurs outside a licensed health care facility, the first licensed medical professional or law enforcement official learning of such death shall immediately contact the county coroner. Immediately upon receipt of such notification, the coroner or the coroner’s deputy shall make the determination if further investigation is necessary, based on information provided by the individual contacting the coroner, and immediately advise such individual of the coroner’s intentions. . . .

4. In any case of sudden, violent or suspicious death after which the body was buried without any investigation or autopsy, the coroner, upon being advised of such facts, may at the coroner’s own discretion request that the prosecuting attorney apply for a court order requiring the body to be exhumed . . .

Mo. Ann. Stat. § 58.451.

1. When any person dies within a county having a medical examiner as a result of:

(1) Violence by homicide, suicide, or accident;

(2) Thermal, chemical, electrical, or radiation injury;

(3) Criminal abortions, including those self-induced;

(4) Disease thought to be of a hazardous and contagious nature or which might constitute a threat to public health; or when any person dies:

(a) Suddenly when in apparent good health;

(b) When unattended by a physician, chiropractor, or an accredited Christian Science practitioner, during the period of thirty-six hours immediately preceding his death;

(c) While in the custody of the law, or while an inmate in a public institution;

(d) In any unusual or suspicious manner;

the police, sheriff, law enforcement officer or official, or any person having knowledge of such a death shall immediately notify the office of the medical examiner of the known facts concerning the time, place, manner and circumstances of the death.

Immediately upon receipt of notification, the medical examiner or his designated assistant shall take charge of the dead body and fully investigate the essential facts concerning the medical causes of death.

2. When a death occurs outside a licensed health care facility, the first licensed medical professional or law enforcement official learning of such death shall contact the county medical examiner. Immediately upon receipt of such notification, the medical examiner or the medical examiner’s deputy shall make a determination if further investigation is necessary, based on information provided by the individual contacting the medical examiner, and immediately advise such individual of the medical examiner’s intentions.

3. In any case of sudden, violent or suspicious death after which the body was buried without any investigation or autopsy, the medical examiner, upon being advised of such facts, may at his own discretion request that the prosecuting attorney apply for a court order requiring the body to be exhumed.

Mo. Ann. Stat. § 58.720.

What types of deaths are required to be autopsied?
If on view of the dead body and after personal inquiry into the cause and manner of death, the coroner determines that a further examination is necessary in the public interest, the coroner on the coroner’s own authority may make or cause to be made an autopsy on the body. The coroner may on the coroner’s own authority employ the services of a pathologist, chemist, or other expert to aid in the examination of the body or of substances supposed to have caused or contributed to death . . . Mo. Ann. Stat. § 58.451.

In cases in which, in the opinion of the medical examiner, an autopsy is necessary, the autopsy shall be performed by the medical examiner if he is a pathologist or by such competent pathologist as may be authorized and employed by the medical examiner
. . . Mo. Ann. Stat. § 58.725.

When a child under the age of eighteen years, who is eligible to receive a certificate of live birth dies, the [coroner/medical examiner] shall notify a certified child death pathologist to determine the need for an autopsy. The certified child death pathologist, in conjunction with the [coroner/medical examiner], shall determine the need for an autopsy. If there is disagreement concerning the need for the autopsy, the certified child death pathologist shall make the determination unless the child fatality review panel, within twelve hours, decides against the certified child death pathologist. Mo. Ann. Stat. § 58.452; Mo. Ann. Stat. § 58.722.

Any person who discovers the dead body of, or acquires the first knowledge of the death of, any child under the age of one year and over the age of one week, where the child died suddenly when in apparent good health, shall immediately notify the county coroner or medical examiner of the known facts concerning the time, place, manner, and circumstances of the death. All such deaths shall be autopsied by a certified child death pathologist. The coroner or medical examiner shall notify the parent or guardian of the child that an autopsy shall be performed at the expense of the state . . . Mo. Ann. Stat. § 194.117.

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