In 1976, Jack Klugman’s “Quincy, M.E.” launched a decades-long American fascination with death investigation as entertainment — a lineage running straight through “CSI” and “Forensic Files.” But the real investigators behind those fictional coroners and medical examiners are running a system that’s been quietly falling apart for decades, and only in the last several years has the federal government mounted a serious, coordinated effort to fix it.
Today, somewhere between 5,000 and 8,000 death investigators work across more than 2,000 medical examiner and coroner offices nationwide. They face chronic underfunding, a severe shortage of board-certified forensic pathologists, outdated equipment, and wildly inconsistent standards from one jurisdiction to the next. Some counties don’t own a camera or a body bag. Others rely on elected coroners with no medical training — in Alabama, roughly 30 percent of the time, that person is a funeral director. The fragmentation is structural: coroner and medical examiner offices are run locally, under a patchwork of state, county, and city authority, which makes federal reform genuinely hard to execute even when the will exists.
That effort has been building since 2013, when the National Commission on Forensic Science first flagged the need for more consistent, reliable data from medical examiners and coroners. Follow-on reports in 2016 pushed for better reporting and stronger accreditation. Then, in 2018, the National Institute of Justice (NIJ) and the Centers for Disease Control and Prevention (CDC) formalized the Medicolegal Death Investigation Working Group, pulling in partners like the National Transportation Safety Board, the DEA, and the Consumer Product Safety Commission. The roughly 30-member group synchronizes what federal agencies know and do about the crisis — from tracking emerging street drugs through NIJ-supported NPS Discovery, to launching the CDC’s Collaborating Office for Medical Examiners and Coroners (COMEC) in 2022, which helps local offices investigate everything from overdoses to sudden infant deaths.
Money remains a persistent obstacle. The Paul Coverdell Forensic Science Improvement Grants program — funded at $35 million in 2023 and still issuing competitive and formula grants through 2025 and 2026 — helps offices cover training, accreditation, and equipment. But as NIJ’s Lucas Zarwell put it, “the federal government can never just write a blank check.” Real fixes depend on workforce, infrastructure, and standards no single grant program can buy on its own.
The workforce gap is the sharpest pain point. The country needs an estimated 1,100–1,200 full-time forensic pathologists; fewer than half that number are practicing. Only about 37 new ones are certified each year, and just 21 stay in the field full time — not enough to replace those who leave, let alone close the gap.
The pressure for reform intensified this fall. On October 30, 2025, the National Academies of Sciences, Engineering, and Medicine released Strengthening the U.S. Medicolegal Death Investigation System, recommending Congress fund state infrastructure improvements, require comprehensive data on in-custody deaths, and direct HHS to set autopsy standards for those cases — while states require licensure, continuing education, and peer review of at least 10 percent of cases annually.
As committee co-chair John Rich put it, the system’s gaps “undermine the credibility” of investigations Americans depend on — for closure, for justice, and increasingly, for public health surveillance. Seven years into the federal working group’s existence, the data is clearer than ever. Whether Congress acts on it is the next chapter.