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The system used to investigate sudden or unusual deaths in Washington state is a patchwork. Only six counties rely on medical examiners — doctors who are highly trained. The rest rely on elected coroners, who come from a variety of backgrounds. And the problems that result run deep. For months, KNKX’s Kari Plog has been investigating the system in a three-part series, poring over documents and talking to people in the industry and those affected by their work. Reporting by Kari Plog

As effort to reform death investigation system begins, KNKX looks outside WA for solutions

Dr. Nicole Yarid, an associate medical examiner for King County, walks into the autopsy room dedicated to examining people who died from COVID-related complications. Yarid told KNKX that the pandemic response has detracted from other priorities.
Ted S. Warren
The Associated Press
Dr. Nicole Yarid, an associate medical examiner for King County, walks into the autopsy room dedicated to examining people who died from COVID-related complications. Yarid told KNKX that the pandemic response has detracted from other priorities.

Since its founding more than a century ago, Washington state has seen few changes to the way sudden or unusual deaths are investigated. And experts from every corner of the system acknowledge it’s far from perfect. 

Offices statewide are underfunded, even the six counties with appointed medical examiners — highly trained doctors who work in dedicated facilities with support staff. Those include King and Pierce counties.  

Elected coroners in the remaining 33 counties are left cobbling together whatever space they can find for performing exams — typically local funeral homes. 

Coroners in the state’s smallest counties are also prosecutors, who are tasked with juggling two jobs that are supposed to remain independent from one another. 

All of the autopsies in a majority of Washington’s counties fall to just a few traveling forensic pathologists. They are constantly crisscrossing the state, hauling their own equipment to substandard facilities, where the person in charge may or may not have collected enough information to put their work in context to accurately determine how someone may have died. 

And there’s no clear oversight for coroners — officials with wide-ranging experience, and sometimes no relevant experience at all.  

KNKX Public Radio recently published an in-depth series on death investigation in Washington state. The reporting, which happened over the course of many months and took us all over the region, revealed a system riddled with these and other problems. 

Now, we’re taking a closer look at how to possibly solve those problems — which affect more than many people realize. 

We don’t like to think about death, but public health officials can learn a lot from the dead to help the living. Death determinations can affect life insurance payouts and public policy decisions on important issues, such as substance abuse and suicide. 

And right now, as the world deals with COVID-19, this work is especially important. Death investigators are on the frontlines of the pandemic response, offering some of the most timely data available. And some say these professionals are on the frontlines of justice, as society continues to reckon with issues of police brutality and holding institutions accountable.


There is a real effort brewing to heavily reform the system, led by Nancy Belcher of the King County Medical Society. 

Lobbying for uniform death investigations statewide has been among the group’s top priorities since Belcher took over as CEO a few years ago. 

She didn’t know much about the system in the beginning. And as she has talked to lawmakers in Olympia, Belcher has been running into what KNKX did in reporting its three-part series: most of the people in charge don’t know much at all about the system — or its problems.

As lawmakers have learned more, their reactions have all been the same: shock and disappointment.

“So people seem ready and prepared to fix it, they just don’t really know how,” Belcher said in a recent interview with KNKX. 

All of them are coming into the system from different vantage points, as death investigations touch many issues that are at the forefront of lawmakers’ minds: missing and murdered indigenous women, the opioid epidemic and homelessness, to name a few. 

State Rep. Tina Orwall, a Democrat from Des Moines, started learning more about the industry through her work on legislation related to suicide prevention. She’s on the growing list of lawmakers who are in early talks with the King County Medical Society, as the group prepares its effort to lobby for reforms at the state Capitol in the upcoming legislative session. 

State Rep. Tina Orwall
Credit Parker Miles Blohm / KNKX
State Rep. Tina Orwall

In an earlier interview with KNKX, Orwall said one possible solution might be creating a state ombuds for death investigations, like Washington has for long-term care facilities. But that would only address issues after they’ve already happened. 

Belcher and her colleagues at the medical society want to solve problems at the source by creating a statewide medical examiner system. 

But one hurdle there is making sure any new system would be tailored to the unique needs of smaller counties. “We want it to be, regardless of where life is lost in our state, that they have the ability to investigate,” Orwall said.  


Some experts are skeptical a statewide medical examiner system can work in Washington state.

Tim Davidson is coroner in Cowlitz County, and serves as president of the Washington Association of Coroners and Medical Examiners. 

“It will never happen. Counties can’t afford it,” he told KNKX. “You’re talking hundreds of millions of dollars to switch over.”

But the system Davidson is referring to is a centralized one, based at the state level. The proposal the King County Medical Society is lobbying for is a regional system: clusters of counties that would fall under designated regional offices, each one overseen by a chief forensic pathologist with support staff. 

Only a handful of states in the country do it that way. Among the most successful examples is Florida. 

Dr. Stephen Nelson, one of the district medical examiners there, says his state has a “best practices” system that’s been in place for decades. He says it’s a system Washington state could learn from as it looks toward reforms.  

“As far as how we do it, and how it’s paid for, how it’s supported, the people that are at the table as the oversight regulatory board, I think is excellent,” said Nelson, who also serves as chair of Florida’s Medical Examiners Commission, an oversight body made up of stakeholders from across the system.  

Nelson says roughly 20 or so medical examiner offices serve Florida’s 67 counties. The regional facility he oversees is responsible for handling cases across three counties. He acknowledges that still means a little bit of driving for smaller, more remote counties. But it’s a cost-saver compared to the centralized system that’s garnered criticism from skeptics here in Washington.  

And, Nelson stressed, this kind of work can’t be done “on the cheap.” He says any investment in improving Washington’s system would be a significant improvement compared to what the state has relied on for more than 100 years. 

Listen to an extended conversation with Dr. Stephen Nelson below.

Dr. Stephen Nelson, a district medical examiner and head of the Medical Examiners Commission in Florida, says his state has a “best practices” system that’s been in place for decades. He talked with KNKX's Kari Plog about how Florida's system came to be, how it works, and what Washington state could learn as it works toward reform. (Producer: Geoffrey Redick)

Kari Plog is a former KNKX reporter who covered the people and systems in Pierce, Thurston and Kitsap counties, with an emphasis on police accountability.