CMEC Attachments

CMEC2018 OMB Package Attachments.pdf

Census of Medical Examiner and Coroner Offices

CMEC Attachments

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CMEC 2018 Attachments
Attachment 1. 34 U.S.C. §10131–10132
Attachment 2. CMEC Questionnaire: Formatted paper instrument
Attachment 3. 2018 CMEC questionnaire: Example screen shots of web instruments
Attachment 4. 60-day Federal Register Notice
Attachment 5. 30-day Federal Register Notice
Attachment 6. Pre-notification letter
Attachment 7. Survey invitation cover letter
Attachment 8. Survey invitation email
Attachment 9. 1st reminder – letter
Attachment 10. 1st reminder – email
Attachment 11. 2nd reminder – postcard
Attachment 12. 3rd reminder – email
Attachment 13. 3rd reminder – letter
Attachment 14. 4th reminder – letter
Attachment 15: 5th reminder – postcard
Attachment 16. Data quality follow-up telephone script
Attachment 17. Sample call script for telephone prompting calls
Attachment 18. Sample call script for nonresponse telephone calls
Attachment 19. End-of-Study letter
Attachment 20. End-of-Study email
Attachment 21. Thank you letter
Attachment 22. Letter of Support: National Association of Medical Examiners
Attachment 23. Letter of Support: International Association of Coroners & Medical Examiners
Attachment 24. Data quality assessment of 2004 CMEC
Attachment 25. Cognitive Testing Report

Attachment 1. 34 U.S.C. §10131–10132
§10131. Statement of purpose
It is the purpose of this subchapter to provide for and encourage the collection and analysis of
statistical information concerning crime, juvenile delinquency, and the operation of the criminal
justice system and related aspects of the civil justice system and to support the development of
information and statistical systems at the Federal, State, and local levels to improve the efforts of
these levels of government to measure and understand the levels of crime, juvenile delinquency,
and the operation of the criminal justice system and related aspects of the civil justice system.
The Bureau shall utilize to the maximum extent feasible State governmental organizations and
facilities responsible for the collection and analysis of criminal justice data and statistics. In
carrying out the provisions of this subchapter, the Bureau shall give primary emphasis to the
problems of State and local justice systems.
(Pub. L. 90–351, title I, §301, as added Pub. L. 96–157, §2, Dec. 27, 1979, 93 Stat. 1176;
amended Pub. L. 98–473, title II, §605(a), Oct. 12, 1984, 98 Stat. 2079.)
§10132. Bureau of Justice Statistics
(a) Establishment
There is established within the Department of Justice, under the general authority of the Attorney
General, a Bureau of Justice Statistics (hereinafter referred to in this subchapter as "Bureau").
(b) Appointment of Director; experience; authority; restrictions
The Bureau shall be headed by a Directorappointed by the President. The Director shall have had
experience in statistical programs. The Director shall have final authority for all grants,
cooperative agreements, and contracts awarded by the Bureau. The Director shall be responsible
for the integrity of data and statistics and shall protect against improper or illegal use or
disclosure. The Director shall report to the Attorney General through the Assistant Attorney
General. The Director shall not engage in any other employment than that of serving as Director;
nor shall the Director hold any office in, or act in any capacity for, any organization, agency, or
institution with which the Bureau makes any contract or other arrangement under this Act.
(c) Duties and functions of Bureau
The Bureau is authorized to—
(1) make grants to, or enter into cooperative agreements or contracts with public agencies,
institutions of higher education, private organizations, or private individuals for purposes related
to this subchapter; grants shall be made subject to continuing compliance with standards for
gathering justice statistics set forth in rules and regulations promulgated by the Director;

(2) collect and analyze information concerning criminal victimization, including crimes against
the elderly, and civil disputes;
(3) collect and analyze data that will serve as a continuous and comparable national social
indication of the prevalence, incidence, rates, extent, distribution, and attributes of crime,
juvenile delinquency, civil disputes, and other statistical factors related to crime, civil disputes,
and juvenile delinquency, in support of national, State, tribal, and local justice policy and
decisionmaking;
(4) collect and analyze statistical information, concerning the operations of the criminal justice
system at the Federal, State, tribal, and local levels;
(5) collect and analyze statistical information concerning the prevalence, incidence, rates, extent,
distribution, and attributes of crime, and juvenile delinquency, at the Federal, State, tribal, and
local levels;
(6) analyze the correlates of crime, civil disputes and juvenile delinquency, by the use of
statistical information, about criminal and civil justice systems at the Federal, State, tribal, and
local levels, and about the extent, distribution and attributes of crime, and juvenile delinquency,
in the Nation and at the Federal, State, tribal, and local levels;
(7) compile, collate, analyze, publish, and disseminate uniform national statistics concerning all
aspects of criminal justice and related aspects of civil justice, crime, including crimes against the
elderly, juvenile delinquency, criminal offenders, juvenile delinquents, and civil disputes in the
various States and in Indian country;
(8) recommend national standards for justice statistics and for insuring the reliability and validity
of justice statistics supplied pursuant to this chapter;
(9) maintain liaison with the judicial branches of the Federal Government and State and tribal
governments in matters relating to justice statistics, and cooperate with the judicial branch in
assuring as much uniformity as feasible in statistical systems of the executive and judicial
branches;
(10) provide information to the President, the Congress, the judiciary, State, tribal, and local
governments, and the general public on justice statistics;
(11) establish or assist in the establishment of a system to provide State, tribal, and local
governments with access to Federal informational resources useful in the planning,
implementation, and evaluation of programs under this Act;
(12) conduct or support research relating to methods of gathering or analyzing justice statistics;
(13) provide for the development of justice information systems programs and assistance to the
States, Indian tribes, and units of local government relating to collection, analysis, or
dissemination of justice statistics;

(14) develop and maintain a data processing capability to support the collection, aggregation,
analysis and dissemination of information on the incidence of crime and the operation of the
criminal justice system;
(15) collect, analyze and disseminate comprehensive Federal justice transaction statistics
(including statistics on issues of Federal justice interest such as public fraud and high technology
crime) and to provide technical assistance to and work jointly with other Federal agencies to
improve the availability and quality of Federal justice data;
(16) provide for the collection, compilation, analysis, publication and dissemination of
information and statistics about the prevalence, incidence, rates, extent, distribution and
attributes of drug offenses, drug related offenses and drug dependent offenders and further
provide for the establishment of a national clearinghouse to maintain and update a
comprehensive and timely data base on all criminal justice aspects of the drug crisis and to
disseminate such information;
(17) provide for the collection, analysis, dissemination and publication of statistics on the
condition and progress of drug control activities at the Federal, State, tribal, and local levels with
particular attention to programs and intervention efforts demonstrated to be of value in the
overall national anti-drug strategy and to provide for the establishment of a national
clearinghouse for the gathering of data generated by Federal, State, tribal, and local criminal
justice agencies on their drug enforcement activities;
(18) provide for the development and enhancement of State, tribal, and local criminal justice
information systems, and the standardization of data reporting relating to the collection, analysis
or dissemination of data and statistics about drug offenses, drug related offenses, or drug
dependent offenders;
(19) provide for improvements in the accuracy, quality, timeliness, immediate accessibility, and
integration of State and tribal criminal history and related records, support the development and
enhancement of national systems of criminal history and related records including the National
Instant Criminal Background Check System, the National Incident-Based Reporting System, and
the records of the National Crime Information Center, facilitate State and tribal participation in
national records and information systems, and support statistical research for critical analysis of
the improvement and utilization of criminal history records;
(20) maintain liaison with State, tribal, and local governments and governments of other nations
concerning justice statistics;
(21) cooperate in and participate with national and international organizations in the
development of uniform justice statistics;
(22) ensure conformance with security and privacy requirement of section 10231 of this title and
identify, analyze, and participate in the development and implementation of privacy, security and
information policies which impact on Federal, tribal, and State criminal justice operations and
related statistical activities; and

(23) exercise the powers and functions set out in subchapter VII.
(d) Justice statistical collection, analysis, and dissemination
(1) In general
To ensure that all justice statistical collection, analysis, and dissemination is carried out in a
coordinated manner, the Director is authorized to—
(A) utilize, with their consent, the services, equipment, records, personnel, information, and
facilities of other Federal, State, local, and private agencies and instrumentalities with or without
reimbursement therefor, and to enter into agreements with such agencies and instrumentalities
for purposes of data collection and analysis;
(B) confer and cooperate with State, municipal, and other local agencies;
(C) request such information, data, and reports from any Federal agency as may be required to
carry out the purposes of this chapter;
(D) seek the cooperation of the judicial branch of the Federal Government in gathering data from
criminal justice records;
(E) encourage replication, coordination and sharing among justice agencies regarding
information systems, information policy, and data; and
(F) confer and cooperate with Federal statistical agencies as needed to carry out the purposes of
this subchapter, including by entering into cooperative data sharing agreements in conformity
with all laws and regulations applicable to the disclosure and use of data.
(2) Consultation with Indian tribes
The Director, acting jointly with the Assistant Secretary for Indian Affairs (acting through the
Office of Justice Services) and the Director of the Federal Bureau of Investigation, shall work
with Indian tribes and tribal law enforcement agencies to establish and implement such tribal
data collection systems as the Director determines to be necessary to achieve the purposes of this
section.
(e) Furnishing of information, data, or reports by Federal agencies
Federal agencies requested to furnish information, data, or reports pursuant to subsection
(d)(1)(C) shall provide such information to the Bureau as is required to carry out the purposes of
this section.
(f) Consultation with representatives of State, tribal, and local government and judiciary

In recommending standards for gathering justice statistics under this section, the Director shall
consult with representatives of State, tribal, and local government, including, where appropriate,
representatives of the judiciary.
(g) Reports
Not later than 1 year after July 29, 2010, and annually thereafter, the Director shall submit to
Congress a report describing the data collected and analyzed under this section relating to crimes
in Indian country.
(Pub. L. 90–351, title I, §302, as added Pub. L. 96–157, §2, Dec. 27, 1979, 93 Stat. 1176;
amended Pub. L. 98–473, title II, §605(b), Oct. 12, 1984, 98 Stat. 2079; Pub. L. 100–690, title
VI, §6092(a), Nov. 18, 1988, 102 Stat. 4339; Pub. L. 103–322, title XXXIII, §330001(h)(2),
Sept. 13, 1994, 108 Stat. 2139; Pub. L. 109–162, title XI, §1115(a), Jan. 5, 2006, 119 Stat. 3103;
Pub. L. 111–211, title II, §251(b), July 29, 2010, 124 Stat. 2297; Pub. L. 112–166, §2(h)(1),
Aug. 10, 2012, 126 Stat. 1285.)

Attachment 2. CMEC Questionnaire: Formatted paper instrument

Form CJ-XX

OMB No. XXXX-XXXX: Approval Expires DD/MM/YYYY

2018 CENSUS OF
MEDICAL EXAMINER AND CORONER OFFICES
U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics
Acting as collection agent: RTI International
Please use this form to provide information on behalf of the following agency:
[FILL AGENCY NAME HERE]
If the agency name printed above is incorrect, please call us at 1-XXX-XXX-XXXX.

Survey Instructions:
• Submit this form using one of the following four methods:
o Online: https://www.bjscmec.org

Agency ID:
Password:
o E-mail: xxxxxxx@rti.org
•
•
•
•

o Fax: 1-XXX-XXX-XXXX (toll-free)
o Mail: Use the enclosed postage-paid envelope
Please do not leave any items blank.
If the answer to a question is none or zero, write “0” in the space provided. When exact numeric answers are not available,
please provide estimates and mark the estimate check box where appropriate.
Use blue or black ink and print as neatly as possible.
Use an X when marking an answer in a box.

Please indicate the primary person who completed this form:
Name:
Last Name

First Name

Title:

—

Phone:
Area Code

Number

Extension

—

Fax:
Area Code

Number

E-mail:
Agency
Website:
If you have any questions, call RTI toll-free at 1-XXX-XXX-XXXX, or send an e-mail to xxxxxx@rti.org. If you have general projectrelated questions, please contact Connor Brooks of BJS at (202) 307-0765 or AskBJS@usdoj.gov.
Burden Statement
Federal agencies may not conduct or sponsor an information collection, and a person is not required to respond to a collection of information, unless it displays a currently valid
OMB Control Number. Public reporting burden for this collection of information is estimated to average 90 minutes per response, including time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden
estimate, or any other aspects of this collection of information, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street,
NW, Washington, DC 20531. The Omnibus Crime Control and Safe Streets Act of 1968, as amended (34 USC 10132), authorizes this information collection. Although this survey is
voluntary, we urgently need your cooperation to make the results comprehensive, accurate, and timely. We greatly appreciate your assistance.

This page is intentionally left blank.

SECTION A: ADMINISTRATIVE
A1. What is the title of the chief position in your medical examiner or coroner office (e.g., Chief
Medical Examiner, Coroner) and who holds that title?
Title:
Name:
A2. Which of the following best describes your death investigation office?
Coroner office
Medical examiner office
Sheriff-coroner office
Justice of the peace
SKIP to the end of the survey and
My office does not
return in the enclosed envelope
investigate deaths
Other medicolegal death investigation office (please specify)

A3. What level of government best describes your office?
City office
County office
District/regional office
State office
A4. Which of the following best describes the agency your office reports to?
Public health agency (e.g., department or division of public health)
Law enforcement agency (e.g., department or division of public safety)
Government attorney’s office (e.g., district attorney)
Department or division of forensic science
My office does not report to another agency
Other (please specify)

A5. What jurisdictions does your office serve (e.g., Illinois State, Los Angeles County, New York
City, First Judicial District)? If you serve multiple jurisdictions, enter a comma (,) between each
jurisdiction.

A6. Is your office accredited by the International Association of Coroners & Medical Examiners
(IAC&ME)?
Yes
No
I expect that my office will be accredited by IAC&ME by December 31, 2019.
3

A7. Is your office accredited by the National Association of Medical Examiners (NAME)?
Yes
No
I expect that my office will be accredited by NAME by December 31, 2019.

A8. Enter the number of employees during the pay period including December 31, 2018. Report
each employee in only one category. If an employee fills more than one role, please put them in
their primary role. If none, enter 0.
• Full time employees are those who work on average 35 or more hours per week.
• Part-time employees are those who work on average 34 or fewer hours per week.
• Consultants/Contractors are those who work under another company or as a consultant and
are hired to work for your office.
• On-Call employees are those who do not have regularly scheduled hours and only work
when they are needed.
During the pay period including December 31, 2018
Full-Time
Employees

Role

Part-time Consultants/
On-Call
Employees Contractors Employees

a. Autopsy pathologists
b. Coroners/non-physicians
c. Death investigators (or coroner
investigators)
d. Forensic toxicologists (i.e., performs case
interpretation)
e. Forensic analysts or chemists (i.e., does not
perform case interpretation)
f. Other scientific investigative support staff
(e.g., anthropologists, histologists)
g. Administrative staff (e.g., secretary,
accountant)
h. Ancillary staff (e.g., drivers, photographers)

Total (sum of rows a-h):

Column 1
Total

Column 2
Total

Column 3
Total

Column 4
Total

A9. Enter the starting annual salary range for full-time staff for each position in your office as of
December 31, 2018. Exclude benefits and overtime when reporting annual salaries. If the position
does not exist on a full-time basis, mark N/A. In cases where there is not a range in salary, please
write the same salary twice.
Starting Salary
Starting Salary
Minimum
Maximum
N/A
a. Autopsy pathologists
b. Coroners/non-physicians
c. Death investigators (or
coroner investigators)
d. Forensic toxicologists (i.e.,
performs case
interpretation)

$
$
$

,
,

A10. How many of your internal autopsy pathologists (i.e., medical examiners) are certified by the
American Board of Pathology (ABP)? Do not count any contractors, consultants, or volunteers.
All autopsy pathologists are ABP certified
Some autopsy pathologists are ABP certified
No autopsy pathologists are ABP certified
We do not employ any internal autopsy pathologists
A11. How many of your internal coroners or death investigators are certified by the American
Board of Medicolegal Death Investigators (ABMDI)? Do not count any contractors, consultants, or
volunteers.
All death investigators are ABMDI certified
Some death investigators are ABMDI certified
No death investigators are ABMDI certified
We do not employ any internal death investigators
A12. How many of your internal forensic toxicologists are certified by the American Board of
Forensic Toxicology (ABFT)? Do not count any contractors, consultants, or volunteers.
All forensic toxicologists are ABFT certified
Some forensic toxicologists are ABFT certified
No forensic toxicologists are ABFT certified
We do not employ any internal forensic toxicologists
A13. How many of your internal forensic analysts or chemists are certified by the American Board
of Forensic Toxicology (ABFT)? Do not count any contractors, consultants, or volunteers.
All forensic analysts or chemists are ABFT certified
Some forensic analysts or chemists are ABFT certified
No forensic analysts or chemists are ABFT certified
We do not employ any internal forensic analysts or chemists

SECTION B: BUDGET AND CAPITAL RESOURCES
B1. For the most recently completed fiscal year, what was your total budget?

.00

If estimate, check here:

B2. What was the last day of your most recently completed fiscal year (e.g., 06/30/2018, 09/30/2018,
12/31/2018)?

MM /DD/ Y Y YY
B3. Does your office have a specific personnel budget for items such as wages, salaries and
benefits?
Yes
No → SKIP to B5
B4. What was the total budget allocated for personnel costs?

.00

If estimate, check here:

B5. Does your office receive money from any of the following?
Revenue Source

Yes No

a. Consultant fees
b. Cremation waiver/authorization or permit fees
c. Private autopsy fees
d. Report/record fees
e. Teaching/speaking honorarium fees
f. Testimony fees
g. Transportation fees
h. Grants
i. Other (please specify)

Don’t
Know

SECTION C: WORKLOAD
C1. In 2018, did your office receive any reported cases? Include all cases in which your office
documented or investigated the report of a case to your office.
Yes
No → SKIP to C11 on page 8

C2. In 2018, what was the total number of cases reported to your office?
We did not track reported cases

Reported Cases

If estimate, check here:

C3. “Accepted cases” are cases for which the office completes the death certificate or otherwise
determines the cause and manner of death. In 2018, did you have any accepted cases? Do not
include cremation approval cases or cases in which jurisdiction was declined.
Yes
No → SKIP to C5

C4. In 2018, what was the total number of cases accepted by your office? Do not include
cremation approval cases or cases in which jurisdiction was declined.
We did not track accepted cases

Accepted Cases

If estimate, check here:

Please Check Your Numbers!
The number of your “accepted cases” in C4 should be LESS THAN or EQUAL TO the number of
“reported cases” in C2.
C5. In 2018, did your office receive any reported cases from tribal lands? The term ‘tribal lands’
includes areas labeled Indian Country, federal or state recognized reservations, trust lands, Alaska
Native villages, and tribal communities.
Yes
No → SKIP to C11 on page 8

C6. In 2018, how many of the total cases reported to your office were from tribal land(s)?
We did not track reported cases from tribal lands separately

Reported Cases

If estimate, check here:

C7. Did you include cases reported from tribal lands (C6) in the total number of reported
cases (C2) you indicated?
Yes
No

C8. In 2018, did your office accept any cases from tribal lands?
Yes
No → SKIP to C11

C9. In 2018, how many of the total cases accepted by your office were from tribal
land(s)?
We did not track accepted cases from tribal lands separately

Accepted Cases

If estimate, check here:

Please Check Your Numbers!
The number of your “accepted cases” from tribal lands in C9 should be LESS THAN or
EQUAL TO the number of “reported cases” from tribal lands in C6.

C10. Did you include cases accepted from tribal lands (C9) in the total number of
accepted cases (C4) you indicated?
Yes
No

C11. In 2018, how many complete autopsies did your office conduct? A complete autopsy is defined
as an examination and dissection of a dead body by a physician for the purpose of determining the
cause, mechanism, or manner of death, or the seat of disease, confirming the clinical diagnosis,
obtaining specimens for specialized testing, retrieving physical evidence, identifying the deceased or
educating medical professionals and students.

Complete autopsies

If estimate, check here:

C12. Some functions of a medical examiner or coroner’s office are done within one’s own office
(internally). Other functions may be done by using an outside organization or independent
facility, such as a health department or commercial laboratory (externally).
Below, please indicate if your office primarily provides these functions internally, externally, if
your office does not have access to this function, or if the function is not necessary for your
office.
My office
My office
My office
primarily
primarily
does not
This function
provides this provides this have access
is not
function
function
to this
necessary for
Function
internally
externally
function
my office
a. Death scene investigation
b. Death scene photography
c. Medical record review
d. External examinations
e. Partial autopsy
(Minimal dissection, less than a
complete autopsy)
f. Complete autopsy
(Remove and examine the brain,
thoracic, and abdominal organs)
g. Characterization of skeletal
remains
h. Autopsy photography
i.

Forensic toxicology testing

Imaging (X-ray, CT)

k. Metabolic screen
l.

Cremation waivers/authorization

m. Death certificate distribution
C13. Below, please indicate if your office primarily provides these functions internally, externally, if
the function or service is not available to your office, or if the function or service is not
necessary for your office.
My office
My office
My office
primarily
primarily
does not
This function
provides this provides this have access
is not
function
function
to this
necessary for
Function
internally
externally
function
my office
a. Anthropology
b. Cardiac pathology
c. Histology
d. Microbiology
e. Neuropathology
f. Odontology
9

C14. For those functions that are conducted internally at your office, who are the people that
perform those duties? Please mark all that apply.

Duty

Autopsy
Pathologists

Coroner/
NonPhysician

Not
Performed
Death
Other
by My
Investigators Internal Staff
Office

a. Death scene
investigations
b. Determination of which
cases are accepted/
declined
c. External examinations
d. Determination of which
cases are autopsied
e. Determination of which
cases receive forensic
toxicology testing
C15. For your office, who of the following is responsible for notifying the next of kin about the
individual’s death? Please mark all that apply.
Medical examiner/coroner personnel
Family services personnel (either internal or external)
Law enforcement personnel
Someone else (please specify)

C16. For your office, who of the following is responsible for follow-up communication with the next
of kin, such as cultural preferences, returning belongings, and other policies and procedures?
Please mark all that apply.
Medical examiner/coroner personnel
Family services personnel (either internal or external)
Law enforcement personnel
Someone else (please specify)

SECTION D: SPECIALIZED DEATH INVESTIGATIONS
D1. Does your office have a written policy for final disposition (e.g., burial, cremation) of
unidentified remains after a specified period?
Yes
No
Don’t Know

D2. Did your office have possession of any unidentified remains that were not identified by the end
of 2018?
Yes
No → SKIP to D6
D3. In your office, how many total cases of unidentified remains …
a. Were on record as of December 31, 2018?

Cases

If estimate, check here:

Don’t Know
b. Were on record as of December 31, 2018 and have had DNA evidence collected from
them? Please count DNA that has been collected, even if it has not yet been tested.

Cases

If estimate, check here:

Don’t Know
Please Check Your Numbers!
Make sure the number of unidentified remains that have had DNA evidence collected in D3b is
LESS THAN or EQUAL TO those presently on record in D3a.

D4. In what year was the oldest case of unidentified remains currently on record reported to
your office?
If estimate, check here:

Don’t Know
D5. In 2018, how many unidentified remains were classified as unidentified in their final
disposition?

Cases

If estimate, check here:

Don’t Know

D6. Are the following procedures standard parts of your office’s death investigations for sudden
unexpected infant deaths?
Procedure

Yes

Don’t Know

a. Scene investigation
b. Scene or doll re-enactment
c. Comprehensive forensic toxicology (e.g.,
multiple toxin screens)
d. Complete autopsy
e. Child or infant death review
f. Genetic testing (e.g., sudden cardiac deaths)
g. Metabolic screening (e.g., pediatric inborn errors
of metabolism)
h. Microbiologic testing
i. Pediatric skeletal survey (e.g., radiology)
D7. Does your office use the Sudden Infant Death Syndrome, or SIDS, diagnosis?
Yes
No
D8. Does your office use the Sudden Unexpected Infant Death, or SUID, diagnosis?
Yes
No
D9. Has the increase in drug-related deaths and the opioid epidemic changed your strategy for
forensic toxicology testing?
Yes
No
D10. At the death scene, external examination, or at autopsy, does your office perform drug
screening tests?
Yes
No → SKIP to E1 on page 13
D11. After performing these drug screening tests, does your office routinely confirm results
with toxicology testing in a laboratory?
Yes
No

SECTION E: RECORDS AND EVIDENCE RETENTION
E1. Does your office have a computerized system used to manage, compile, or track cases or
evidence? Such a system is also known as a computerized information management system or
CMS. This does not include the use of Excel or other spreadsheet software to manage case
information.
Yes
No → SKIP to E3
E2. Is your computerized information management system or CMS networked so that
information on all cases is available to all authorized users?
Yes
No
E3. Does your office have a written retention schedule for the following sources?
Source

Yes

Don’t Know

a. Case records
b. Forensic toxicology specimens
c. Physical evidence
d. Unidentified remains
e. Records pertaining to unidentified remains
(including x-rays, fingerprints, DNA)
E4. Are case records maintained for storage as hard copies, electronically, or both?
Hard copies
Electronically
Both
E5. Does your office archive hard copies of your official investigative records and reports?
Yes
No → SKIP to F1 on page 14
E6. Are hard copies of your official investigative records and reports archived at any of the
following places?
Location

Yes

a. On site
b. A government-owned or government-paid storage
facility
c. A regulated third-party storage facility (e.g., Iron
Mountain)

d. Some other location

SECTION F: RESOURCES AND OPERATIONS
F1.

Does your office currently have access to the Internet separate from a personal device?
Yes
No

F2.

Does your office currently have access to the following resources, either directly or through a
partner agency?
Yes,
Yes, through a
Resource
directly
partner agency
No access
a. Criminal history databases
b. Fingerprint databases
c. Prescription drug monitoring programs

F3.

Does your office currently have access to the following trainings or resources, either directly
or through a partner agency?
Yes,
Yes, through a
Training or Resource
directly
partner agency
No access
a. Mass fatality investigation
b. Disaster planning (e.g., National
Incident Management System [NIMS])
c. Bloodborne pathogens
d. Proper lifting procedures
e. Stress management

F4.

Does your office participate in county/statewide emergency response drills?
Yes
No

F5.

Does your office have access to a computerized axial tomography (CAT or CT) scan, either
directly or through a partner agency?
Yes, directly
Yes, through a partner agency
No

F6.

Does your office have access to magnetic resonance imaging (MRI), either directly or through
a partner agency?
Yes, directly
Yes, through a partner agency
No

F7.

Does your office currently have access to the following specialized investigation teams, either
directly or through a partner agency?
Yes,
Yes, through a
Specialty Area
directly
partner agency
No access
a. Child fatality
b. Drowning investigative team
c. Drug case review/surveillance
d. Elderly investigative team
e. Infectious disease investigative team
f. Maternal death investigative team
g. Poison investigative team
h. Suicide investigative team
i. Vulnerable adult fatality review

F8.

Does your office currently participate in any of these data collection efforts?
Data Collection
a. Combined DNA Index System (CODIS)
Sponsor: Federal Bureau of Investigation (FBI)
b. Fatality Analysis Reporting System (FARS)
Sponsor: National Highway Traffic Safety Administration (NHTSA)
c. National Crime Information Center (NCIC)
Sponsor: Federal Bureau of Investigation (FBI)
d. National Missing and Unidentified Persons System (NamUs)
Sponsor: Department of Justice (DOJ)
e. National Violent Death Reporting System (NVDRS)
Sponsor: Centers for Disease Control and Prevention (CDC)
f. State Unintentional Drug Overdose Reporting System (SUDORS)
Sponsor: Centers for Disease Control and Prevention (CDC)
g. State or local data collections
h. Other data collection

Yes

Don’t
Know

F9.

Does your office currently have access to the following support services, either directly or
through a partner agency?
Yes,
Yes, through a
Support Service
directly
partner agency
No access
a. Advocates for families of victims
b. Grief and bereavement services for
survivors (e.g. counseling or therapy,
homicide survivor groups)
c. On-scene support or advocacy for
bystanders or other family and friends
of the deceased

F10. Is your office located within another business, such as a funeral home?
Yes
No

F11. Does your office have a Department Originating Agency Identifier Number or, ORI number?
Yes
No
SKIP to the end
Don’t know of the survey

F12. What is your Department Originating Agency Identifier Number or ORI number?

Thank you for your participation in the 2018 Census of Medical Examiner
and Coroner Offices (CMEC).
Your feedback is very important to us!

Please return your survey in the enclosed envelope
or send to:
Census of Medical Examiner and Coroner Offices
Address Line 1
Address Line 2
Raleigh, NC XXXXX

Attachment 3. 2018 CMEC questionnaire: Example screen shots of web instruments

Attachment 4. 60-day Federal Register Notice

Federal Register / Vol. 83, No. 238 / Wednesday, December 12, 2018 / Notices
DEPARTMENT OF JUSTICE
[OMB Number 1121–0296]

Agency Information Collection
Activities: Proposed Collection;
Comments Requested; Reinstatement,
With Change, of a Previously
Approved Collection for Which
Approval Has Expired: 2018 Census of
Medical Examiner and Coroner Offices
(CMEC)
Bureau of Justice Statistics,
Department of Justice.
ACTION: 60-day notice.
AGENCY:

The Department of Justice
(DOJ), Office of Justice Programs,
Bureau of Justice Statistics, will be
submitting the following information
collection request to the Office of
Management and Budget (OMB) for
review and approval in accordance with
the Paperwork Reduction Act of 1995.
DATES: Comments are encouraged and
will be accepted for 60 days until
February 11, 2019.
FOR FURTHER INFORMATION CONTACT: If
you have additional comments
especially on the estimated public
burden or associated response time,
suggestions, or need a copy of the
proposed information collection
instrument with instructions or
additional information, please contact
Connor Brooks, Statistician, Law
Enforcement Statistics Unit, Bureau of
Justice Statistics, 810 Seventh Street
NW, Washington, DC 20531 (email:
Connor.Brooks@usdoj.gov; phone: 202–
514–8633).
SUPPLEMENTARY INFORMATION: Written
comments and suggestions from the
public and affected agencies concerning
the proposed collection of information
are encouraged. Your comments should
address one or more of the following
four points:
—Evaluate whether the proposed
collection of information is necessary
for the proper performance of the
functions of the Bureau of Justice
Statistics, including whether the
information will have practical utility;
—Evaluate the accuracy of the agency’s
estimate of the burden of the
proposed collection of information,
including the validity of the
methodology and assumptions used;
—Evaluate whether and if so how the
quality, utility, and clarity of the
information to be collected can be
enhanced; and
—Minimize the burden of the collection
of information on those who are to
respond, including through the use of
appropriate automated, electronic,
mechanical, or other technological

amozie on DSK3GDR082PROD with NOTICES1

SUMMARY:

VerDate Sep<11>2014

18:39 Dec 11, 2018

Jkt 247001

collection techniques or other forms
of information technology, e.g.,
permitting electronic submission of
responses.
Overview of This Information
Collection
(1) Type of Information Collection:
Reinstatement of the Census of Medical
Examiner and Coroner Offices, with
changes, of a previously approved
collection for which approval has
expired.
(2) The Title of the Form/Collection:
2018 Census of Medical Examiner and
Coroner Offices.
(3) The agency form number, if any,
and the applicable component of the
Department sponsoring the collection:
The form number is CMEC–1. The
applicable component within the
Department of Justice is the Bureau of
Justice Statistics, Office of Justice
Programs.
(4) Affected public who will be asked
or required to respond, as well as a brief
abstract:
This information collection is a
census of medical examiner and coroner
offices. The 2018 survey is revised from
the data collection referencing 2004. BJS
plans to field the 2018 CMEC from May
through November 2019. Respondents
will be the medical examiners and
coroners (or members of their staff)
working in medicolegal death
investigation offices.
Abstract: The 2018 CMEC will focus
on the same topics as the 2004: The
number and type of medical examiner
and coroner offices operating in the
U.S., staff at these offices, budget and
capital resources, workload, policies
and procedures regarding casework,
specialized death investigations, records
and evidence retention, resources, and
operations. The survey was assessed by
a panel of practitioners and subject
matter experts. Results from these
efforts were used to revise the survey to
ensure content was up-to-date and
relevant to the medicolegal death
investigation system today. The survey
was also revised to improve clarity and
ease of answering questions.
Suggestions resulting from this review
were incorporated into the survey and
then cognitively tested with 14 medical
examiner and coroner offices.
(5) An estimate of the total number of
respondents and the amount of time
estimated for an average respondent to
respond: A projected 2,400 respondents
will take an average of 1.5 hours each
to complete form CMEC–1, including
time to research or find information not
readily available. In addition, an
estimated 1,100 respondents will be

PO 00000

Frm 00085

Fmt 4703

Sfmt 4703

63909

contacted for data quality follow-up by
phone at 15 minutes per call.
(6) An estimate of the total public
burden (in hours) associated with the
collection: There are an estimated 3,875
total burden hours associated with this
information collection.
If additional information is required
contact: Melody Braswell, Department
Clearance Officer, United States
Department of Justice, Justice
Management Division, Policy and
Planning Staff, Two Constitution
Square, 145 N Street NE, 3E.405A,
Washington, DC 20530.
Dated: December 7, 2018.
Melody Braswell,
Department Clearance Officer for PRA, U.S.
Department of Justice.
[FR Doc. 2018–26881 Filed 12–11–18; 8:45 am]
BILLING CODE 4410–18–P

DEPARTMENT OF JUSTICE
[OMB Number 1121–0147]

Agency Information Collection
Activities; Proposed eCollection
eComments Requested;
Reinstatement, With Change, of a
Previously Approved Collection for
Which Approval Has Expired: Census
of State and Federal Adult Correctional
Facilities
Bureau of Justice Statistics,
Department of Justice.
ACTION: 60-Day notice.
AGENCY:

E:\FR\FM\12DEN1.SGM

12DEN1

Attachment 5. 30-day Federal Register Notice

DEPARTMENT OF JUSTICE
Bureau of Justice Statistics
[OMB Number 1121-0296]
Agency Information Collection Activities: Proposed Collection; Comments Requested;
Reinstatement, with change, of a previously approved collection for which approval has
expired: 2018 Census of Medical Examiner and Coroner Offices (CMEC)
AGENCY: Bureau of Justice Statistics, Department of Justice.
ACTION: 30-Day Notice.
SUMMARY: The Department of Justice (DOJ), Office of Justice Programs, Bureau of Justice
Statistics, will be submitting the following information collection request to the Office of
Management and Budget (OMB) for review and approval in accordance with the Paperwork
Reduction Act of 1995. The proposed information collection was previously published in the
Federal Register, Volume 83, Number 238, page 63909 on Wednesday, December 12, 2018.
DATES: Comments are encouraged and will be accepted for 30 days until [INSERT DATE 60
DAYS AFTER DATE OF PUBLICATION IN THE FEDERAL REGISTER].

FOR FURTHER INFORMATION CONTACT:
If you have additional comments especially on the estimated public burden or associated
response time, suggestions, or need a copy of the proposed information collection instrument
with instructions or additional information, please contact Connor Brooks, Statistician, Law
Enforcement Statistics Unit, Bureau of Justice Statistics, 810 Seventh Street NW, Washington,
DC 20531 (email: Connor.Brooks@usdoj.gov ; phone: 202-514-8633).

SUPPLEMENTARY INFORMATION: Written comments and suggestions from the public
and affected agencies concerning the proposed collection of information are encouraged. Your
comments should address one or more of the following four points:

Evaluate whether the proposed collection of information is necessary for the proper
performance of the functions of the Bureau of Justice Statistics, including whether the
information will have practical utility;

Evaluate the accuracy of the agency’s estimate of the burden of the proposed
collection of information, including the validity of the methodology and assumptions
used;

Evaluate whether and if so how the quality, utility, and clarity of the information to
be collected can be enhanced; and

Minimize the burden of the collection of information on those who are to respond,
including through the use of appropriate automated, electronic, mechanical, or other
technological collection techniques or other forms of information technology, e.g.,
permitting electronic submission of responses.

Overview of this information collection:
1) Type of Information Collection: Reinstatement of the Census of Medical Examiner
and Coroner Offices, with changes, of a previously approved collection for which
approval has expired.

2) The Title of the Form/Collection: 2018 Census of Medical Examiner and Coroner
Offices.

3) The agency form number, if any, and the applicable component of the Department
sponsoring the collection: The form number is CMEC-1. The applicable component
within the Department of Justice is the Bureau of Justice Statistics, Office of Justice
Programs.

4) Affected public who will be asked or required to respond, as well as a brief abstract:
This information collection is a census of medical examiner and coroner offices. The
2018 survey is revised from the data collection referencing 2004. BJS plans to field
the 2018 CMEC from May through November 2019. Respondents will be the medical
examiners and coroners (or members of their staff) working in medicolegal death
investigation offices.
Abstract:
The 2018 CMEC will focus on the same topics as the 2004: the number and type of
medical examiner and coroner offices operating in the U.S., staff at these offices,
budget and capital resources, workload, policies and procedures regarding casework,
specialized death investigations, records and evidence retention, resources, and
operations. The survey was assessed by a panel of practitioners and subject matter
experts. Results from these efforts were used to revise the survey to ensure content was
up-to-date and relevant to the medicolegal death investigation system today. The
survey was also revised to improve clarity and ease of answering questions.

Suggestions resulting from this review were incorporated into the survey and then
cognitively tested with 14 medical examiner and coroner offices.

5) An estimate of the total number of respondents and the amount of time estimated for
an average respondent to respond: A projected 2,200 respondents will take an
average of 1.5 hours each to complete form CMEC-1, including time to research or
find information not readily available. In addition, an estimated 1,100 respondents
will be contacted for data quality follow-up by phone at 15 minutes per call.

6) An estimate of the total public burden (in hours) associated with the collection: There
are an estimated 3,575 total burden hours associated with this information collection.

If additional information is required contact: Melody Braswell, Department Clearance Officer,
United States Department of Justice, Justice Management Division, Policy and Planning Staff,
Two Constitution Square, 145 N Street NE, 3E.405A, Washington, DC 20530.
Dated:

Melody Braswell,
Department Clearance Officer for PRA,
U.S. Department of Justice.
Billing Code: 4410-18

Attachment 6. Pre-notification letter

«Date»
«Salutation» «ContactFirstName» «ContactLastName»
«MEC»
«ContactAddress1» «ContactAddress2»
«ContactCity», «ContactState» «ContactZip»
Dear «Salutation» «ContactLastName»:
I am pleased to announce that the Bureau of Justice Statistics (BJS) is preparing to conduct the second
Census of Medical Examiner and Coroner Offices (CMEC) in 2019. This survey was last conducted in
2004, and we are aware that the work in your office has likely changed over the past 15 years. By
conducting the 2018 CMEC, BJS will be able to understand how the current work of medical examiners
and coroners has changed since the previous survey. The information you provide is critical to providing
accurate and reliable information to policy makers and other medical examiners and coroners.
In the next few weeks, BJS will invite <> to participate in the 2018 CMEC; specifically, your
office will be asked to complete an online survey focusing on administrative issues, budget and resources,
workload, specialized death investigations, records and evidence retention, training, and more.
I appreciate that you may receive a number of data requests throughout the year and I thank you for your
support for CMEC. If you have questions about CMEC, please contact BJS’s data collection agent, RTI
International, via phone or e-mail at ###-###-#### or cmec@rti.org. If you have any general comments
about this data collection, please contact the Bureau of Justice Statistics Program Manager Connor
Brooks at 202-514-8633 or connor.brooks@usdoj.gov.
Sincerely,
Jeffrey H. Anderson, Director
Bureau of Justice Statistics

Attachment 7. Survey invitation cover letter

«TITLE» «POC NAME»
OR CURRENT CHIEF EXECUTIVE
«MEC»
«ADDRESS1», «ADDRESS2»
«CITY», «STATE» «ZIP»
Dear «TITLE» «NAME»:
I am writing to ask for your participation in the 2018 Census of Medical Examiner and Coroner Offices
(CMEC). This survey was last conducted in 2004, and we are aware that the work of your office has
likely changed over the past 15 years. Your response to the 2018 CMEC is critical to the Bureau of
Justice Statistics’ effort to produce national estimates of personnel, resources, policies, and practices of
the facilities who conduct this important work.
To complete your survey, please access the questionnaire online at [WEB ADDRESS]. You may start and
stop as needed. Your individualized log-in information is:
User name: «WebUsername»
Password: «PIN»
Please complete this questionnaire online by [DATE].
The questionnaire takes approximately 1.5 hours to complete including time to research or find
information you may not have readily available. You may download a PDF copy of the survey from the
website to assist you in gathering the necessary data. You may share it with others at your office who can
assist you in providing the requested information.
If you need to change the point of contact for your office or update your contact information (including
email address), go to [WEB ADDRESS] using the user name and password shown above and follow the
instructions provided on the website. If you have questions about CMEC, please contact the CMEC data
collection team via phone or e-mail at [RTI NUMBER] or cmec@rti.org. If you have any general
comments about this data collection, please contact me at ###-###-#### or connor.brooks@usdoj.gov.

BJS uses the data collected in CMEC only for research and statistical purposes, as described in Title 34,
USC §10134. RTI International, BJS’s CMEC data collection agent, is required to adhere to BJS Data
Protection Guidelines, which summarize the many federal statutes, regulations, and other authorities that
govern all BJS data and data collected and maintained under BJS’s authority. The Guidelines may be
found at http://www.bjs.gov/content/pub/pdf/BJS_Data_Protection_Guidelines.pdf.
Thank you in advance for your office’s participation in CMEC. I appreciate your consideration, time, and
effort.
Sincerely,
Connor Brooks
Program Manager
Bureau of Justice Statistics
Enclosures: Endorsement Letters

Case ID: «caseid»

Attachment 8. Survey invitation email

TO: «TITLE» «POC NAME»
OR CURRENT CHIEF EXECUTIVE
«MEC»
SUBJECT: Census of Medical Examiner and Coroner Offices
Dear «TITLE» «NAME»:
Last week, we sent you the 2018 Census of Medical Examiner and Coroner Offices (CMEC).
This email message requests confirmation that you successfully received your invitation. I
encourage you to contact BJS’ data collection agent for CMEC, RTI International, if you have
any questions related to the data collection or did not receive the materials.
Please reply to this message to indicate that you received the 2018 CMEC invitation.
In the event you did not receive the packet, the information contained in the mailed materials is
provided below.
Thank you,
Connor Brooks
Program Manager
Bureau of Justice Statistics
«TITLE» «POC NAME»
OR CURRENT CHIEF EXECUTIVE
«MEC»
«ADDRESS1», «ADDRESS2»
«CITY», «STATE» «ZIP»
Dear «TITLE» «NAME»:
I am writing to ask for your participation in the 2018 Census of Medical Examiner and Coroner
Offices (CMEC). This survey was last conducted in 2004, and we are aware that the work of
your office has likely changed over the past 15 years. Your response to the 2018 CMEC is
critical to the Bureau of Justice Statistics effort to produce national estimates of personnel,
resources, policies, and practices of the offices who conduct this important work.
To complete your survey, please access the questionnaire online at [WEB ADDRESS]. You may
start and stop as needed. Your individualized log-in information is:
User name:
Password:

«WebUsername»
«PIN»

Please complete this questionnaire online by [DATE].

The questionnaire takes approximately 1.5 hours to complete including time to research or find
information you may not have readily available. You may download a copy of the survey from
the website to assist you in gathering the necessary data. You may share it with others at your
office who can assist you in providing the requested information.
If you need to change the point of contact for your office or update your contact information
(including email address), go to [WEB ADDRESS] using the user name and password shown
above and follow the instruction provided on the website. If you have questions about CMEC,
please contact the CMEC data collection team via phone or e-mail at [ RTI NUMBER] or
cmec@rti.org. If you have any general comments about this data collection, please contact me at
###-###-#### or connor.brooks@usdoj.gov.
BJS uses the data collected in CMEC only for research and statistical purposes, as described in
Title 34, USC §10134. RTI International, the CMEC data collection agent, is required to adhere
to BJS Data Protection Guidelines, which summarize the many federal statutes, regulations, and
other authorities that govern all BJS data and data collected and maintained under BJS’s
authority. The Guidelines may be found at
http://www.bjs.gov/content/pub/pdf/BJS_Data_Protection_Guidelines.pdf.
Thank you in advance for your office’s participation in CMEC. I appreciate your time and effort.
Sincerely,
Connor Brooks
Program Manager
Bureau of Justice Statistics
Enclosures: Endorsement Letters

Case ID: «caseid»

Attachment 9. 1st reminder – letter

«TITLE» «POC NAME»
«MEC»
«ADDRESS1», «ADDRESS2»
«CITY», «STATE» «ZIP»
Dear «TITLE» «NAME»:
On behalf of the Bureau of Justice Statistics (BJS), RTI International is conducting the 2018 Census of
Medical Examiner and Coroner Offices (CMEC). RTI reached out to <> on [INITIAL DATE].
We hope to receive your survey soon so that the census data reflect the variety of responsibilities and
resources of medical examiners’ and coroners’ offices of all types and sizes. Information from your
office is needed to ensure the quality of the study.
We hope that you can complete the CMEC questionnaire as soon as possible. I understand that you
receive a number of survey requests, and I genuinely appreciate your attention to this effort.
You may access the questionnaire online at [WEB ADDRESS] and entering the following
information:
User Name: <>
Password: <>
If you have questions about CMEC, need to change the point of contact for your office, or need to update
your contact information, please contact the RTI team via phone or e-mail at [RTI NUMBER] or
cmec@rti.org. If you have any general comments about this data collection, please contact me at ######-#### or connor.brooks@usdoj.gov.
Thank you for your time and consideration.
Sincerely,
Connor Brooks
Program Manager
Bureau of Justice Statistics
«caseID»

Attachment 10. 1st reminder – email

TO: «TITLE» «POC NAME»
OR CURRENT CHIEF EXECUTIVE
«MEC»
SUBJECT: Census of Medical Examiner and Coroner Offices
Dear «TITLE» «NAME»:
On behalf of the Bureau of Justice Statistics (BJS), RTI International is conducting the 2018
Census of Medical Examiner and Coroner Offices (CMEC). RTI reached out to <> on
[INITIAL DATE]. We hope to receive your survey soon so that the census data reflect the
variety of responsibilities and resources of medical examiners’ and coroners’ offices of all types
and sizes. Information from your office is needed to ensure the quality of the study.
We hope that you can complete the CMEC questionnaire as soon as possible. I understand that
you receive a number of survey requests, and I genuinely appreciate your attention to this effort.
You may access the questionnaire online at [WEB ADDRESS] and entering the following
information:
User Name: <>
Password: <>
If you have questions about CMEC, need to change the point of contact for your office, or need
to update your contact information, please contact the RTI team via phone or e-mail at [RTI
NUMBER] or cmec@rti.org. If you have any general comments about this data collection,
please contact me at ###-###-#### or connor.brooks@usdoj.gov.
Thank you for your time and consideration.
Sincerely,
Connor Brooks
Program Manager
Bureau of Justice Statistics
«caseID»

Attachment 11. 2nd reminder – postcard
Front

Back

Attachment 12. 3rd reminder – email

TO: «TITLE» «POC NAME»
OR CURRENT CHIEF EXECUTIVE
«MEC»
SUBJECT: Census of Medical Examiner and Coroner Offices
Dear «TITLE» «NAME»:
Recently, materials related to the 2018 Census of Medical Examiner and Coroner Offices
(CMEC) were sent to you by mail. This email message is to request confirmation that we have
successfully reached you and encourage you to contact us if you have any questions related to
the data collection.
Please reply to this message to confirm that we have reached <>.
The information contained in the letter that we mailed most recently (on <>) is
provided below.
Thank you,
Connor Brooks
Program Manager
Bureau of Justice Statistics
Dear «TITLE» «NAME»:
On behalf of the Bureau of Justice Statistics (BJS), RTI International is conducting the 2018
Census of Medical Examiner and Coroner Offices (CMEC). RTI has been reaching out to
<> since May. We hope to receive your survey soon so that the census data reflect the
variety of responsibilities and resources of medical examiners’ and coroners’ offices of all types
and sizes. Information from your office is needed to ensure the quality of the study.
The due date is [DUE DATE]. Please complete the CMEC questionnaire as soon as possible. I
understand that you receive a number of survey requests and I genuinely appreciate your
attention to this request.
You may access the questionnaire online at [WEB ADDRESS] and entering the following
information:
User Name: <>
Password: <>
If you have questions about CMEC, need to change the point of contact at your training
academy, or need to update your contact information, please contact the RTI team via phone or

e-mail at [RTI NUMBER] or cmec@rti.org. If you have any general comments about this data
collection, please contact me at ###-###-#### or connor.brooks@usdoj.gov.
Thank you for your time and consideration.
Sincerely,
Connor Brooks
Program Manager
Bureau of Justice Statistics
«caseID»

Attachment 13. 3rd reminder – letter

«TITLE» «POC NAME»
«MEC»
«ADDRESS1», «ADDRESS2»
«CITY», «STATE» «ZIP»
Dear «TITLE» «NAME»:
On behalf of the Bureau of Justice Statistics (BJS), RTI International is conducting the 2018 Census of
Medical Examiner and Coroner Offices (CMEC). RTI has been reaching out to <> since May.
We hope to receive your survey soon so that the census data reflect the variety of responsibilities and
resources of medical examiners’ and coroners’ offices of all types and sizes. Information from your
office is needed to ensure the quality of the study.
The due date is [DUE DATE]. Please complete the CMEC questionnaire as soon as possible. I
understand that you receive a number of survey requests and I genuinely appreciate your attention to this
request.
You may access the questionnaire online at [WEB ADDRESS] and entering the following
information:
User Name: <>
Password: <>
If you have questions about CMEC, need to change the point of contact for your office, or need to update
your contact information, please contact the RTI team via phone or e-mail at [RTI NUMBER] or
CMEC@rti.org. If you have any general comments about this data collection, please contact me at ######-#### or connor.brooks@usdoj.gov.
Thank you for your time and consideration.
Sincerely,
Connor Brooks
Program Manager
Bureau of Justice Statistics
«caseID»

Attachment 14. 4th reminder – letter

«TITLE» «POC NAME»
«MEC»
«ADDRESS1», «ADDRESS2»
«CITY», «STATE» «ZIP»
Dear «TITLE» «NAME»:
«MEC» has been asked to participate in the Bureau of Justice Statistics’ (BJS) Census of Medical
Examiner and Coroner Offices (CMEC). CMEC data will be used by policy makers and researchers to
better understand and respond to the challenges facing medical examiners and coroners such as yourself.
No other national data collection can provide comprehensive data on administrative issues, budget and
resources, workload, specialized death investigations, records and evidence retention, and training. Since
CMEC is a census, your responses cannot be replaced.
I recognize that you may not have received the previous correspondence or that you may not have
responded because of time constraints. I appreciate that your time is limited; however, the reliability of
the study directly depends on your participation. The questionnaire includes items that are relevant to all
medical examiners’ and coroners’ offices, and your responses are essential to our ability to provide the
information needed by practitioners, policy makers, researchers, and other stakeholders.
Please complete the questionnaire by using this link [WEB ADDRESS] and entering the following
information:
User Name: <>
Password: <>
Alternatively, you can submit your data by mail using the enclosed hardcopy questionnaire and business
reply envelope.
The questionnaire due date was [DUE DATE]. Please submit your questionnaire as soon as possible. If
you have questions about the CMEC survey or having difficulty accessing the website, please contact the
CMEC data collection team via phone or e-mail at [RTI NUMBER] or cmec@rti.org. If you have any
general comments about this data collection, please contact me at ###-###-#### or
connor.brooks@usdoj.gov.
Sincerely,
Connor Brooks
Program Manager
Bureau of Justice Statistics
Enclosures: CMEC questionnaire; Business reply envelope

«caseID»

Attachment 15: 5th reminder – postcard
Front

Back

Attachment 16. Data quality follow-up telephone script

Sample Call Script for Data Quality Follow-up Calls
[IF CALL RINGS TO A GATEKEEPER]
Hello, this is <> calling on behalf of the Bureau of Justice Statistics in the
U.S. Department of Justice regarding the 2018 Census of Medical Examiner and Coroner Offices
(CMEC). I am following up on a survey invitation that we sent addressed to <>.
May I speak with <>?
[IF CALL RINGS TO POC]
Hello, this is <> calling on behalf of the Bureau of Justice Statistics in the
U.S. Department of Justice regarding the 2018 Census of Medical Examiner and Coroner
Offices. It is important that we obtain complete data from all law enforcement training
academies. I’m calling now to confirm that we have everything recorded correctly and
completely for your office. This should only take a few minutes of your time.

BEGIN READING QUESTION(s) THAT IS (ARE) MISSING INFORMATION OR
HAVE INCONSISTENT RESPONSES.
Thank you for your time.

Attachment 17. Sample call script for telephone prompting calls

Phone Prompting Specifications
CMEC Incomplete Response Follow-Up CATI Script
NT00.
PROGRAMMER, DISPLAY:
STATUS, DATE OF LAST CALL, NUMBER OF ATTEMPTS
QINT1. Hello, this is <>, calling on behalf of the Bureau of Justice Statistics in the
U.S. Department of Justice regarding the 2018 Census of Medical Examiner and Coroner Offices,
also known as CMEC.
To ensure I’ve contacted the correct medical examiner or coroner, I would like to ask a few brief
questions about your office. I have the name as…
[PROGRAMMER: FILL MEC.]
Is that correct?
1 YES [GO TO QINT3]
2 NO [GO TO QINT2]
QINT2. What is the office’s/agency’s name?
______________________
QINT3. What is the office’s/agency’s address?
[PROGRAMMER: FILL ADDRESS]
1 YES – MATCH TO RECORDS [GO TO QINT5]
2 NO – DOES NOT MATCH RECORDS [GO TO NEW_ADDR1]
NEW_ADDR1. INTERVIEWER: RECORD ADDRESS, ASKING RESPONDENT TO REPEAT IF NECESSARY.
ADDRESS 1:
ADDRESS 2:
CITY:
STATE:
ZIP:
QINT5. Let me just check to see if the information we have on record is up-to-date.
[PROGRAMMER: DISPLAY MEC, ADDRESS, NEW INFORMATION JUST PROVIDED AND VICINITY
LIST.]
INTERVIEWER: USE LOOKUP TABLE TO IDENTIFY ANY AGENCIES WITH NAMES THAT ARE
SIMILAR TO THE NAME OF THE AGENCY TI IS TALKING TO. IF ANY SIMILAR, DISCUSS WITH
RESPONDENT. ONCE MEC IS CONFIRMED SELECT FROM LIST AND CONTINUE.
QINT7. I’m following up on a survey invitation that we sent to <>.
Have I reached <>-<>?
1 CORRECT NUMBER [GO TO QINT10]
2 NOT CORRECT [GO TO QINT8]
3 WOULD LIKE TO BE CALLED ON A NEW NUMBER [GO TO TEL06]

QINT8. What phone number have I reached?
________________________
[PROGRAMMER: APPEND THE PHONE NUMBER TO THIS CASE.]
[GO TO QINT10]
TEL06. What is the number you would like to be contacted at?
________________________
(ENTER NUMBER WITH NO DASHES, SPACES OR OTHER PUNCTION)
INTERVIEWER: RECORD THE NUMBER, THEN CALL THE RESPONDENT BACK ON THE NEW
NUMBER.
[PROGRAMMER: APPEND THE PHONE NUMBER TO THIS CASE.]
[GO TO QINT10]
QINT10. Which one of the following best describes your agency?
1
County or state coroner
2
County or state medical examiner
3
Sheriff-coroner
4
Justice of the peace
5
My office does not investigate deaths
6
Other medicolegal death investigation office _____________

QINT11. May I speak with <> <<name>>?
1 TRANSFER TO POC (LIVE) [GO TO QINT14]
2 GATEKEEPER IS POC [GO TO QINT14]
3 TRANSFER TO VM FOR POC [GO TO ANSPROMPT1]
4 NO/NOT AVAILABLE – SCHEDULE CALLBACK [GO TO INT06]
5 POC NO LONGER IN MEC [GO TO QINT12]
-2 REFUSED [GO TO QINT18]
QINT12.

What is the new (medical examiner’s/coroner’s) name?

_______________________
9 REFUSED
[GO TO QINT13]
QINT13. May I speak with the (medical examiner/coroner)?
1 TRANSFER TO POC (LIVE) [GO TO QINT14]
2 GATEKEEPER IS POC [GO TO QINT14]
3 TRANSFER TO VM FOR POC [GO TO ANSPROMPT1]

NO/NOT AVAILABLE – SCHEDULE CALLBACK [GO TO INT06]
REFUSED [GO TO QINT18]

4
5

QINT14.
[IF Q11=1 OR Q13=1, FILL: Hello, this is <<INTERVIEWER NAME>> calling on behalf of the
Bureau of Justice Statistics in the U.S. Department of Justice regarding the 2018 Census of Medical
Examiner and Coroner Offices, also known as CMEC.]
I’m following up on our invitation that asked your office to participate in the CMEC survey.
Since we did not hear back from your office, I wanted to call to see if you received the
invitation.
1
2
3
4
-2

YES [GO TO QINT18]
NO [GO TO QINT19]
NO ANSWER [END CALL]
WENT TO VOICEMAIL [GO TO ANSPROMPT1]
REFUSED [GO TO QINT17]

ANSPROMPT1. [DISPLAY FOR CALLING ROUNDS 1 AND 2] Hello, this is _____________, calling on behalf
of the Bureau of Justice Statistics in the U.S. Department of Justice regarding the Census of
Medical Examiner and Coroner Offices, also known as CMEC. This message is for <<POC
name>>. Our records show that we have not yet received your completed survey. We hope
that you can complete the survey within the next week. If you have any questions about the
survey, please call our toll-free number, ###-###-####.
[DISPLAY FOR CALLING ROUND 3] Hello, this is _____________, calling on behalf of the Bureau
of Justice Statistics in the U.S. Department of Justice regarding the 2018 the Census of Medical
Examiner and Coroner Offices, also known as CMEC. This message is for <<POC name>>. Our
records show that we have not yet received your completed survey. Your participation helps to
ensure the accuracy of the study results and we cannot substitute another agency for yours.
We hope that you can complete the survey by [DATE]. If you like, please call our toll-free
number ###-###-#### and a member of the research team can assist you.
1
2
3

LEFT MESSAGE. END CALL.
SOMEONE PICKED UP. [GO TO QINT11]
UNABLE TO LEAVE MESSAGE. END CALL.

INT06. When would be a better time to call back?
INTERVIEWER: IF RESPONDENT INDICATES THAT THEY ARE WILLING TO TALK NOW BUT THEY
ARE DRIVING, SAY: I’m sorry, but for your safety we’re not able to continue while you’re
driving (or doing something else that requires your full attention)
IS THIS CALLBACK SET BY THE RESPONDENT OR SOMEONE ELSE?
(INTERVIEWER NOTES: CALLBACK SHOULD ONLY BE SET IF THE RESPONDENT REQUESTED OR
AGREED TO BE CALLED BACK.
CALLBACK DEFINITION:
CALLBACK BY SUBJECT: THE RESPONDENT SELECTED TO COMPLETE THE INTERVIEW
PROVIDED A SPECIFIC TIME AND DATE FOR THE APPOINTMENT.
CALLBACK BY OTHER: SOMEONE OTHER THAN THE SELECTED RESPONDENT ASKED FOR US TO
CALLBACK, OR THE SELECTED RESPONDENT DID NOT PROVIDE A SPECIFIC DATE AND TIME TO
BE CALLED BACK.
1
2
3

APPOINTMENT BY SUBJECT [GO TO APPOINTMENT SCHEDULE SCREENS AND THEN QINT28]
APPOINTMENT BY OTHER [GO TO APPOINTMENT SCHEDULE SCREENS AND THEN QINT28]
REFUSED. I will just try again later. [GO TO QINT28]

QINT17.
[PROGRAMMER: IF AGENCY HAS NOT RECEIVED COMMUNICATIONS (Q14=2), DO NOT
ASK. ELSE, ASK OF EACH AGENCY THAT HAS NOT REFUSED.]
Your agency’s participation helps to ensure our study accurately represents law enforcement
agencies across the country. We cannot substitute another agency for yours. Would you
please tell me more about your agency’s reasons for not participating?
INTERVIEWER: ENTER VERBATIM IN OPEN ENDED BOX FOR CODE 00, THEN CODE THE
RESPONSE
___________________________________________
SELECT ALL THAT APPLY:
0 ENTER VERBATIM
1 COMPLETE — AGENCY CLAIMS THAT SURVEY HAS BEEN SUBMITTED/SENT
2 DUE DATE — CANNOT RESPOND BY DUE DATE
3 LIMITED TIME/RESOURCES — NOT RELATED TO DUE DATE
4 APPLICABILITY — AGENCY THOUGHT SURVEY DID NOT APPLY TO THEM
5 NO INTEREST – AGENCY STAFF ARE UNINTERESTED IN THE SURVEY TOPIC OR GOALS
6 NO BENEFIT – AGENCY RECEIVES NO BENEFIT FROM PARTICIPATION/SURVEY
7 VOLUNTARY – PARTICIPATION IS NOT MANDATED BY LAW
8 SURVEY FATIGUE — AGENCY RECEIVES TOO MANY SURVEY REQUESTS
9 LACK OF DATA — DATA NOT AVAILABLE DURING SURVEY PERIOD
10 LACK OF DATA — DATA DO NOT EXIST OR ARE NOT MAINTAINED
11 INACCESSIBLE DATA – DATA EXIST, BUT ARE NOT EASILY ACCESSIBLE
12 POOR QUALITY DATA – DATA EXIST, BUT ARE OF QUESTIONABLE/POOR QUALITY
13 CONFIDENTIALITY – DATA ARE NOT TO BE SHARED OUTSIDE OF AGENCY/AUTHORITY
14 FEDERAL ROLE – FEDERAL GOVERNMENT SHOULD NOT BE INVOLVED IN LOCAL ISSUES
15 JURISDICTION RULE – JURISDICTION DOES NOT PARTICIPATE IN RESEARCH
16 OTHER
17 REFUSED TO GIVE REASON FOR DELAY/REFUSAL
QINT18. INTERVIEWER: IF REFUSAL, DO NOT ASK; CODE 05 [NO, will not complete survey]
ELSE: How would you prefer to complete the survey? You have the option to complete it
online or by hard copy.
1 POC has completed web survey or sent hard copy [GO TO QINT28]
2 YES, will complete survey online [GO TO QINT21]
3 YES, will complete a hard copy [GO TO QINT23]
4 YES, will complete a hard copy already received [GO TO QINT27]
5 NO, will not complete survey [GO TO QINT28]
QINT19.
1
2
3

IF QINT14=2: Let me send you the survey again. You have the option to complete it online or
by hard copy. Which do you prefer?
YES, will complete survey online [GO TO QINT21]
YES, will complete a hard copy [GO TO QINT23]
NO, will not complete survey [GO TO QINT18]

QINT20. Do you need me to send the survey link and login information to you again?
1 Yes [GO TO QINT22]
2 No [GO TO QINT28]
QINT21. What is your email address?
________________________________
[GO TO QINT26]
QINT22. Do you need me to mail you another copy of the survey?
1 Yes [GO TO QINT23]
2 No [GO TO QINT28]
QINT23. Should I use the address we have on file for you or another address?
1 Address on file [GO TO QINT27]
2 Another address [GO TO QINT24]
QINT24. What is that address?
________________________________
[GO TO QINT27]
QINT25.

We will send a link to the survey and the access code by email. We look forward to receiving
the completed survey. I appreciate you taking the time to speak with me today. Have a nice
day.
INTERVIEWER: END CALL.

QINT26.

We will mail the questionnaire in the next day or two. We look forward to having you compete
the survey. I appreciate you taking the time to speak with me today. Have a nice day.
INTERVIEWER: END CALL.

QINT27.

We look forward to receiving the completed survey. I appreciate you taking the time to speak
with me today. Have a nice day.
INTERVIEWER: END CALL.

QINT28.

I appreciate you taking the time to speak with me today. Have a nice day.
INTERVIEWER: END CALL.

Attachment 18. Sample call script for nonresponse telephone calls

Sample Call Script for Nonresponse Telephone Calls
[IF CALL RINGS TO A GATEKEEPER]
Hello, this is <<INSERT NAME>> calling on behalf of the Bureau of Justice Statistics in the
U.S. Department of Justice regarding the 2018 Census of Medical Examiner and Coroner
Offices. I am following up on a survey invitation that we sent addressed to <<POC NAME>>.
May I speak with <<POC NAME>>?
[IF CALL RINGS TO POC]
Hello, this is <<INSERT NAME>> calling on behalf of the Bureau of Justice Statistics in the
U.S. Department of Justice regarding the 2018 Census of Medical Examiner and Coroner
Offices. A few months ago, we sent you a letter and an email message inviting your agency to
participate in the survey. We did not hear back from your office and I wanted to follow up with
you to confirm that you received the request.
Have you received our communications?
[IF YES]
[IF QUESTIONS ABOUT THE SURVEY]
- The Census of Medical Examiner and Coroner Offices (CMEC) has not been
conducted since 2004.
- The CMEC collects information on administrative issues, budget and resources,
workload, specialized death investigations, records and evidence retention, and
training.
- BJS will use the data collected through this survey only for research and statistical
purposes. Results—at the national level, not at the individual level—will be
shared with other medical examiners and coroners, policy makers, and other
stakeholders.
- The survey will take approximately 1.5 hours to complete, including gathering
some of the information and numbers you might need to compile.
[OFFER ASSISTANCE TO COMPLETE]
- Is there anything I can do to assist you in completing the survey? A paper version
is available if you would prefer to submit the information by mail.
[IF PROMPTING AGENCY TO COMPLETE ONLY CRITICAL ITEMS]
- BJS considers the following questions to be most critical: <<INSERT ITEMS>>.
Would you be able to provide responses to just those questions? I can record your
answers now or schedule a time to call you that would be most convenient.
[IF AGENCY SAYS THEY DO NOT INTEND TO RESPOND]
- Thank you for letting us know. Would you be able to provide responses to just
those questions? I can record your answers now or schedule a time to call you
that would be most convenient. Would you be willing to share with us why you
have chosen not to participate?
[IF NO]
- Let me review the information we have on file for your agency. [REVIEW EMAIL ADDRESS AND MAILING ADDRESS.]
- What is the POC’s preferred method of contact and offer so I can re-send the
information?

Attachment 19. End-of-Study letter

«TITLE» «POC NAME»
OR CURRENT CHIEF EXECUTIVE
«MEC»
«ADDRESS1», «ADDRESS2»
«CITY», «STATE» «ZIP»
Dear «TITLE» «NAME»:
We have made several attempts to contact you over the past few months regarding the participation of
<<MEC>> in the Bureau of Justice Statistics’ (BJS) Census of Medical Examiner and Coroner Offices
(CMEC). Your responses are vital to informing the Department of Justice of the needs of the medicolegal
death investigation community and representing your jurisdiction.
I am writing today to notify you that there are only a couple of weeks remaining to complete the
questionnaire. We must receive your response soon to ensure that the study results accurately reflect the
characteristics and activities of your office. The reliability of the study’s results directly depends on the
participation of all medical examiners and coroners. Since CMEC is a census, your responses cannot
be replaced.
Please complete the questionnaire by using the following link: [WEB ADDRESS] and entering the
following information:
User Name: «WebUsername»
Password: «PIN»
Alternatively, if you would prefer to complete the questionnaire on paper, we are happy to send you a
hard copy or you may download and print a paper version upon entering your questionnaire access code
on the CMEC questionnaire website.
If you have questions about CMEC or need to update your contact information (including e-mail address),
please contact the CMEC data collection team via phone or e-mail at ###-###-#### or cmec@rti.org. If
you have any general comments about this data collection, please contact me at ###-###-#### or
connor.brooks@usdoj.gov.
I greatly appreciate your consideration.
Sincerely,
Connor Brooks
Program Manager, Bureau of Justice Statistics

Attachment 20. End-of-Study email

TO: «TITLE» «POC NAME»
OR CURRENT CHIEF EXECUTIVE
«MEC»
SUBJECT: End of Study - Census of Medical Examiner and Coroner Offices
Dear «TITLE» «NAME»:
Recently, materials related to the 2018 Census of Medical Examiner and Coroner Offices
(CMEC) were sent to you by mail. This email message is to relay this message to you via email
as well and encourage you to contact us if you have any questions related to the data collection.
Please reply to this message to confirm that we have reached <<MEC>>.
The information contained in the letter that we mailed most recently (on <<DATE>>) is
provided below.
Thank you,
Connor Brooks
Program Manager
Bureau of Justice Statistics

«TITLE» «POC NAME»
OR CURRENT CHIEF EXECUTIVE
«MEC»
«ADDRESS1», «ADDRESS2»
«CITY», «STATE» «ZIP»
Dear «TITLE» «NAME»:
We have made several attempts to contact you over the past few months regarding the
participation of <<MEC>> in the Bureau of Justice Statistics’ (BJS) Census of Medical
Examiner and Coroner Offices (CMEC). Your responses are vital to informing the Department
of Justice of the needs of the medicolegal death investigation community and representing your
jurisdiction.
I am writing today to notify you that there are only a couple of weeks remaining to complete the
questionnaire. We must receive your response soon to ensure that the study results accurately
reflect the characteristics and activities of your office. The reliability of the study’s results
directly depends on the participation of all medical examiners and coroners. Since CMEC is a
census, your responses cannot be replaced.
Please complete the questionnaire by using the following link: [WEB ADDRESS] and
entering the following information:
User Name: «WebUsername»
Password: «PIN»
Alternatively, if you would prefer to complete the questionnaire on paper, we are happy to send
you a hard copy or you may download and print a paper version upon entering your
questionnaire access code on the CMEC questionnaire website.
If you have questions about CMEC or need to update your contact information (including e-mail
address), please contact the CMEC data collection team via phone or e-mail at ###-###-#### or
cmec@rti.org. If you have any general comments about this data collection, please contact me at
###-###-#### or connor.brooks@usdoj.gov.
I greatly appreciate your consideration.
Sincerely,
Connor Brooks
Program Manager
Bureau of Justice Statistics

Attachment 21. Thank you letter

«TITLE» «POC NAME»
OR CURRENT CHIEF EXECUTIVE
«MEC»
«ADDRESS1», «ADDRESS2»
«CITY», «STATE» «ZIP»
Dear «TITLE» «NAME»:
On behalf of the Bureau of Justice Statistics (BJS) and RTI International, I would like to thank
you for your participation in the 2018 Census of Medical Examiner and Coroner Offices
(CMEC). I truly appreciate your support in completing this survey. Your participation ensures
that we are a step closer to providing a complete enumeration of the nation’s medical examiner
and coroner offices and that your jurisdiction is represented as the Department of Justice
assesses the needs of the medicolegal death investigation community.
This letter confirms that we have received your survey and are currently processing the data.
RTI will contact you if there are any questions about the answers your agency has submitted.
We anticipate all survey responses will be collected by the end of October 2019. A copy of the
report will be available through BJS and the CMEC website in 2020.
If you have any general comments or questions, please feel free to contact me at 202-616-1706
or connor.brooks@usdoj.gov. If you have questions about CMEC or need to update your
contact information (including email address), please contact RTI’s CMEC support team at
###-###-#### or cmec@rti.org.
Sincerely,
Connor Brooks
Program Manager
Bureau of Justice Statistics

Attachment 22. Letter of Support: National Association of Medical Examiners

The National Association of Medical Examiners®
660-734-1891

362 Bristol Rd, Walnut Shade, MO 65771
Fax: 888-370-4839 Email: name@thename.org Website: www.thename.org

OFFICERS 2018
*President
Kim A. Collins, M.D.

Executive Vice President
Mary Ann Sens, M.D., Ph.D.

Executive Director
Denise D. McNally

*Vice-President
Jonathan L. Arden, M.D.

December 21, 2018

*Secretary-Treasurer
J. Scott Denton, M.D.

Dear Fellow Medical Examiner or Coroner:

BOARD OF DIRECTORS 2018

The National Association of Medical Examiners encourages you to participate in the attached 2018
Census of Medical Examiner and Coroner Offices (CMEC). The Bureau of Justice Statistics (BJS),
working with RTI International (RTI), is sending the CMEC to every medical examiner and coroner
office in the United States with the goal of generating statistics that will develop a detailed
understanding of the U.S. medicolegal death investigation system and gather information that will
help address training, staffing, and jurisdictional coverage needs. NAME and the BJS team are
hoping that you will participate in this important survey effort.

* Brian L. Peterson, M.D.
Chairman
*Sally S. Aiken, M.D. (2018)
Christopher Boden, BS (2018)
Tracey S. Corey, M.D. (2020)
Joyce deJong, D.O. (2019)
Daniel W. Dye, M.D. (2020)
*Louis N. Finelli, D.O. (2018)
Kent E. Harshbarger, M.D. (2019)
Thomas Hensley, F-ABMDI (2019)
Laura D. Knight, M.D. (2020)
Dianne Little, MBBS (2020)
Judy Melinek, M.D. (2019)
Owen L. Middleton, M.D. (2019)
Christopher M. Milroy, M.D. (2018)
William R. Oliver, M.D. (2019)
Maneesha Pandey, M.D. (2020)
*Kathryn Pinneri, M.D. (2020)

The information produced by the CMEC, which has been informed, reviewed, and vetted by an expert
panel of medical examiners and coroners, will provide valuable data regarding staffing, budget, and
caseload information that will be comparable to the only previous CMEC administration, which
referenced 2004. The previous CMEC found, for example, that the estimated total annual budget
across all MEC offices in the U.S. was $718.5M, the average budget per office was $387K, and the
median budget per office was $37K. The previous CMEC also determined that the average workload in
2004 was 131 reported cases and 67 average accepted cases per fulltime employee. For more
information about the previous CMEC’s survey results that referenced 2004, please see:
https://www.bjs.gov/content/pub/pdf/meco04.pdf.
Your response to the 2018 CMEC is critical to obtain national estimates of personnel,
resources, policies, and infrastructure of our community. Since it is a census, your responses
cannot be replaced. The CMEC is the only systematic survey effort of its kind to focus on our
community and directly supports the NAME mission of promoting excellence in the day to day
investigation of individual cases as well as improving the interaction of death investigation systems
with other agencies and political entities that interact with death investigation efforts.
We know that you and your staff have many responsibilities and limited time, but we hope that you
will provide the requested information and contribute to this effort. Your participation will help
ensure that the 2018 CMEC is a success and that the results can be used with confidence by the federal
government and by our community.

Joseph Prahlow, M.D. (Ex-Officio)
Reade A. Quinton, M.D. (2019)
Michele T. Stauffenberg, M.D. (2020)

Thank you in advance for your cooperation with this important effort.
Sincerely,

Robert Stoppacher, M.D. (2019)
Lindsey C. Thomas, M.D. (2018)
Suzanne R. Utley, M.D. (2020)
Samantha L. Wetzler, M.D. (2018)

Kim A. Collins, MD
2018 NAME President

Barbara C. Wolf, M.D. (2019)
*Indicates Member of Executive Committee

Brian L. Peterson, MD
2018 NAME Chairman of the Board

Jonathan L. Arden, MD
2018 NAME Vice President

Attachment 23. Letter of Support: International Association of Coroners & Medical
Examiners

International Association of Coroners & Medical Examiners
Collaboration · Education · Accreditation

Dedicated to the promotion of excellence in medicolegal death investigation through
collaboration, education and accreditation.

December 11, 2018
Dear Fellow Coroner or Medical Examiner:
On behalf of the International Association of Medical Examiners & Coroners (IAC&ME), I write to encourage you to
participate in the attached 2018 Census of Medical Examiner and Coroner Offices (CMEC), which is sponsored by the
Bureau of Justice Statistics (BJS) and administered by RTI International. BJS’s goals for this survey include
developing a detailed understanding of the U.S. medicolegal death investigation system and gathering information that
will help address training, staffing, and jurisdictional coverage needs. IAC&ME and the BJS team are hoping that
you will participate in this important survey effort.
The CMEC, which was last conducted in 2005 referencing 2004, is the only national data collection that provides a
complete enumeration of coroners and medical examiner offices in the U.S. As such, the CMEC provides key
information about the infrastructure (e.g., staffing and budget) in place to handle our Nation’s death investigations. For
example, the 2004 survey documented that:

•
•
•

County coroners’ offices accounted for 80% of coroner or medical examiner offices nationwide, and
most offices served populations of less than 50,000 persons.
Offices serving large jurisdictions had an average of over 20 fulltime personnel, while those serving
medium to small jurisdictions averaged 1 to 2 fulltime positions.
The average number of cases reported to coroners and medical examiners ranged from 40 to 70 in
offices serving small jurisdictions to over 3,500 among offices serving large jurisdictions.

More information about the findings from the previous CMEC survey may be found on BJS’s website
(https://www.bjs.gov/content/pub/pdf/meco04.pdf). Given the opioid epidemic and other pressures that have been
shouldered by our community in recent years, the 2018 CMEC has been revised to emphasize assessing “access” to
resources (investigative teams, technology, and services) so that we will have a national gauge of our community’s
needs. These new questions were added at the request of a panel of coroners and medical examiners who informed the
survey team of the most important issues facing coroners and medical examiners. The 2018 questions were then tested
by a pool of coroners and medical examiners this past fall.
Since the CMEC is a census, your responses cannot be replaced or replicated. We know that coroners and medical
examiners are overburdened and time is limited. However, IAC&ME leadership would like to emphasize that this is
our chance to provide key information about the state of the death investigation community and our needs. We thank
you in advance for your participation in this important study.
Sincerely,

John Fudenberg, D-AMBDI
Secretary, Past President

1704 PINTO LANE  LAS VEGAS, NEVADA 89106  (702) 455-3385

Attachment 24. Data quality assessment of 2004 CMEC

April 3, 2018

2018 Census of Medical Examiners
and Coroners’ Offices

Expert Panel Pre-Meeting Materials

Connor Brooks
Bureau of Justice Statistics
810 Seventh Street, NW
Washington, DC 20531

Prepared by
Hope Smiley-McDonald
Jeri Ropero-Miller
Stirling Cummings
Crystal Daye
Caitlin Dean
RTI International
3040 E. Cornwallis Road
Research Triangle Park, NC 27709

RTI Project Number 0216093

Table of Contents
1.

Introduction ......................................................................................................................................................1

Identifying Topical Areas and Data Elements for the 2018 CMEC....................................................................1
2.1 Administrative Information ........................................................................................................................2
2004 CMEC Item Response Summary.........................................................................................................3
2.2 Policies and Procedures ..............................................................................................................................3
2004 CMEC Item Response Summary.........................................................................................................6
Infant Deaths......................................................................................................................................6
Criminal Deaths ..................................................................................................................................6
Unidentified/Unclaimed Decedents ..................................................................................................6
Information Sharing/Database Use ...................................................................................................6
Data and Records ...............................................................................................................................6
Completion of Death Certificate Practices.........................................................................................7
2.3 Budget and Fiscal Expenditures ..................................................................................................................7
2004 CMEC Item Response Summary.........................................................................................................7
2.4 Workload/Caseload ....................................................................................................................................7
2004 CMEC Item Response Summary.........................................................................................................8
2.5 Training .......................................................................................................................................................8
2004 CMEC Item Response Summary.........................................................................................................9
2.6 Resource Needs ..........................................................................................................................................9
2004 CMEC Item Response Summary...................................................................................................... 10
2.7 Examination Capabilities and Capacity .................................................................................................... 10
2004 CMEC Item Response Summary...................................................................................................... 11
2.8 Communication and Coordination........................................................................................................... 11

2004 CMEC Item Response Summary...................................................................................................... 12
Special Topics................................................................................................................................................. 12

References ............................................................................................................................................................... 14
Appendix: 2004 Census of Medical Examiner and Coroner Offices (CMEC) ........................................................... 18

Introduction

In 2005, the Bureau of Justice Statistics (BJS) funded RTI International to conduct the 2004 Census of
Medical Examiner and Coroners’ Offices (CMEC; see Appendix), which was the last time the CMEC was
fielded. The 2004 CMEC achieved an 86% response rate across 1,998 MECs. BJS/RTI’s final report for
the 2004 CMEC (Hickman et al., 2007) remains the only comprehensive source of basic data about the
U.S. medicolegal death investigation (MDI) systems. The 2007 landmark report made clear that the
MDI systems varied widely across all measures (e.g., jurisdiction size and type, caseload, staffing,
procedures performed, record retention, use of national databases, operation, budget). Given MECs’
critical role, it is time to update our understanding of the funding, infrastructure, staffing, resources,
and operations that make up the Nation’s MDI community.
BJS’s goals for the 2018 CMEC include the following (BJS, 2017):
1. Generate statistics that will help develop a detailed understanding of the U.S. MDI system.
2. Gather information that will help address training, staffing, or jurisdictional coverage needs in
the MDI system.
3. Further develop the understanding of the relationship between law enforcement agencies and
MECs.
To that end, in 2017, BJS funded RTI to conduct the 2018 CMEC. This document integrates preliminary
information from a literature review and assesses the data quality from the 2004 CMEC to better
inform efforts of RTI, BJS, and subject matter experts to develop a robust, timely, logical, and relevant
survey instrument for the 2018 CMEC.

Identifying Topical Areas and Data Elements for the 2018 CMEC

Only two other census-scale surveys exist that matched BJS’s 2004 CMEC in terms of breadth of topics,
scope of effort, or response. The first was the 2003 Survey of Medical Examiners and Coroners funded
by the U.S. Department of Veterans Affairs (VA) (n=3,104), which was designed to gather information
on the number of annual unclaimed decedents throughout the Nation and what steps are taken to
determine decedent veteran status (Schulman, Ronca, & Bucuvalas, Inc., 2003). Although it is not clear
how many questions were included on the VA survey, we believe that the “brief” survey included
about 12 questions based on the methodology and findings sections in the report. The VA survey
achieved a 78% response rate. The second large-scale MEC survey is the Drug Enforcement
Administration’s (DEA’s) recent National Forensic Laboratory Information System (NFLIS) 2017 MEC
Office Survey (n=2,157) (DEA, 2018). This 30-item survey included questions related to administrative
information, caseload and drug testing policies, information management systems (IMS), and
resources needed to participate in a national drug surveillance system. The 2017 NFLIS MEC Office
Survey achieved a 61% response rate.
1

Given the small number of census MEC surveys, BJS’s 2014 Census of Publicly Funded Forensic Crime
Laboratories (CPFFCL) survey included data elements that are relevant and complementary to the data
that could be collected from the 2018 CMEC (Durose, Burch, Walsh, & Tiry, 2016a, 2016b). The CPFFCL
survey achieved an 88% response rate across 409 federal, state, and local crime laboratories. This
survey is especially relevant given BJS’s third goal for the 2018 CMEC to “further develop the
understanding of the relationship between law enforcement agencies and MEC offices” (BJS, 2017).
Similarly, Drake and Nolte’s (2011) work adapts an instrument based on the Centers for Disease
Control and Prevention’s (CDC’s) 10 Essential Public Health Services by translating the terminology to
that of essential MDI services.
Taken together, these five efforts (i.e., the 2004 CMEC, the 2003 VA report, the 2017 NFLIS MEC Office
Survey, BJS’s 2016 CPFFCL survey, and Drake and Nolte’s 2011 development work) provide a starting
point for identifying data elements for inclusion into the 2018 CMEC. This review contains information
on the knowledge gaps and proposed new topic areas and data elements identified in the literature
and gathered from recent meetings of the MDI community leaders (e.g., the recent February 5–6
National Institute of Justice MDI Stakeholder’s Meeting in Washington, DC). The themes are divided
into eight categories (i.e., report sections): administrative information, policies and procedures, budget
and fiscal expenditures, workload/caseload, training, resource needs, examination capabilities and
capacity, and communication and coordination. Across each of these themes, we summarize the data
elements common across these five survey efforts, include relevant literature, and summarize the
2004 CMEC item responses where pertinent.
For the 2004 CMEC item response rates, we highlight differences in medical examiner versus coroner
response rates where percentage points were greater than 5. Where data items overlapped across
the eight categories, the percentages were not repeated in latter sections.

2.1

Administrative Information

As Table 1 shows, type of office and jurisdiction served were common across the BJS and the DEA
surveys, which makes sense given the wide variation in MEC organizational structures within and
across states and the importance of being able to contextualize the size of the caseload by population
size. Full-time staff and contracted staffing—which are included on the 2004 CMEC and the CPFFCL
surveys—are timely given concerns about pathologist and MDI staffing shortages nationwide,
especially in light of increases in MEC caseloads nationwide. Accreditation of facilities has become
increasingly salient given recent federal goals to have all MECs accredited by 2020 (National
Commission on Forensic Science [NCFS], 2016a). Providing national data that can speak to the extent
to which these goals are being met nationally will be critical for policy makers and budget directors.

Table 1. Administrative Items Common Across Five Survey Efforts Relevant to the 2018 CMEC

Data Element

2004 CMEC

Administrative Information

2017 NFLIS MEC
Office Survey

2016 CPFFCL
Survey

Instrument Question Number

2003 VA Report

2011 Drake &
Nolte MDI
Services

Addressed (Indicated by an “X”)

Type of Office

---

Jurisdiction Served

---

Population Served

---

A6, A7, A8

---

A8, C4

---

FTE and Contracted Staffing
Staff Duties
Accreditation

2004 CMEC Item Response Summary1
•

The largest number of CMEC respondents were county coroners (n=1,366), followed by county
medical examiners (n=266). Regional medical examiners (n=33), state medical examiners (n=24),
regional coroners (n=29), and city medical examiners (n=3) were respondents in the remaining
surveys.
The response rates across the administrative questions were fairly high, ranging from 72% (e.g., the
full-time equivalent [FTE] detail) to 100% (across type of office [Question A3] and jurisdiction
population [Question A4]).
Overall response to general questions (e.g., total number of FTE employees) was often very high
(100% overall; Question A6). However, detail responses on the same subjects (e.g., the number of
FTEs and contractor detail questions) were often much lower, ranging from 69% to 87%. In fact, as
a general rule, coroners had lower response rates compared with medical examiners across many
areas in the survey instrument. For example, coroners were less likely than medical examiners to
answer questions such as the following:

•

○ The number of consultant/contractor positions (86% vs. 90%; Question A7)
○ FTE detail questions (69% vs. 85%; Question A8)
○ Contractor detail questions (78% vs. 87%; Question A8)

2.2

Policies and Procedures

Policies and procedures surrounding types of death and investigative procedures cover a wide range of
issues and topics. Summarized as follows are the major topical areas that were included on the 2004
1

For some questions, it was unclear whether a missing value was a result of declining to answer a question, for which there
could be several reasons, or was a “No” or numeric “0” response. According to the codebook that accompanied the
data, there were supposed to be such “informative missing” codes for the data. However, these codes did not appear in
the final public release dataset.

CMEC and verified in the literature as important for consideration for the 2018 administration given a
large or growing literature (e.g., sudden infant deaths) or persistent issues that merit consideration for
the 2018 CMEC (e.g., cold cases). As Table 2 shows, the topics related to criminal deaths, information
sharing, data and records, and completion of death certificates were common across the five major
survey efforts. Unless specifically stated, there were no differences in a given item response.
Child/infant death investigation policies and procedures: Wide variations exist in standard practices
and policies for investigating sudden unexpected infant deaths (e.g., Covington, 2011; Moissiy, 2016),
which in turn affects the interpretation and death certification of these cases.
•

•

One survey of MECs provided hypothetical scenarios depicting infant deaths with negative autopsy
findings and safe or unsafe sleeping conditions with potential airway obstruction. Practitioners’
classification of infant deaths varied by scenario (Shapiro-Mendoza et al., 2017).
In their survey of MECs serving large jurisdictions (population greater than 300,000; n=154;
response rate: 29%), Brooks and Gill (2015) found significant interoffice variability regarding testing
for infectious diseases (histology, viral studies, blood culture, etc.) in sudden infant death cases.
Variability in testing was due to the perceived lack of utility of such testing, rather than lack of test
availability.
A sample of National Child Death Review Case Reporting System cases found that nearly all cases
included a death scene investigation (98%) and witness interviews (88%) (Erck Lambert et al.,
2016). All sampled cases included an autopsy. The most frequently reported autopsy components
conducted were histology, microbiology, and toxicology.

Criminal deaths: New methods are being developed, validated, and used in criminal investigations
using DNA, whereas the validity and accuracy of older methods (e.g., latent printing) are being
challenged (e.g., Butler, 2015).
Unidentified and unclaimed decedents: This topic covers cold cases (i.e., unresolved homicides and
deaths), record-keeping practices for these cases, and disposition policies and practices.
•

•

Stein, Kimmerle, Adcock, and Martin (2017) recently identified more than 230,355 unresolved
homicides (i.e., cold cases) for the period between 1980 and 2014. Previous national estimates had
estimated the national cold case docket at 185,000.
Schulman, Ronca, & Bucuvalas, Inc. (2003) reported that more than half of all jurisdictions surveyed
(54%) reported that they kept records on identified, unclaimed decedents. Of those that kept
records on identified, unclaimed decedents, 69% kept those records indefinitely.

Information sharing: Several federal databases are available for use to MECs (e.g., National Crime
Information Center [NCIC], Combined DNA Index System [CODIS], National Violent Death Reporting
System [NVDRS], National Missing and Unidentified Persons System [NamUs]), and MECs are
increasingly getting access to state-specific resources (e.g., prescription monitoring program data).

Data records: Surveys conducted by the National Association of Medical Examiners (NAME) in 2007
and 2011 suggested that using an IMS increased between survey years, but the 2011 survey showed
that 18% of death investigation systems lacked an IMS (Levy, 2013). Moreover, the percentage of
offices with home-developed systems increased between 2007 and 2011, whereas users’ satisfaction
with these systems decreased during the same period (Levy, 2013).
Coding standards: Coding standards, death certificate completion conventions, and policies governing
how causes of death are rendered and coded vary. Examples are provided as follows:
•

•

Work-related fatal injuries versus non-work-related deaths: One survey of coroners’ offices looking
at work-related fatal injuries found that respondents were internally consistent (i.e., each
participant consistently endorsed his or her vignettes based on his or her own method), but
respondents varied in their determination of whether the vignettes portrayed work-related fatal
injuries (Peek-Asa, McArthur, & Kraus, 1997).
Classifications for drug-related deaths: The NAME suggests that the best classification for manner
of death in deaths due to opioid abuse (without intent of self-harm) is “accident.” “Undetermined”
should be used for cases in which evidence supports more than one possible determination, and
“suicide” should be used for cases in which fatal injury is self-inflicted with indication of intended
self-harm (Davis & NAME, 2014).

Table 2. Policies and Procedures Items Common Across Five Survey Efforts Relevant to the 2018
CMEC

Data Element
Policies and Procedures
Infant Deaths

2004 CMEC

2017 NFLIS
MEC Office
Survey

2016
CPFFCL
Survey

Instrument Question Number

2003 VA
Report

2011 Drake &
Nolte MDI
Services

Addressed (Indicated by an “X”)

D8, D9, D10

---

C5, D9

---

Unidentified and Unclaimed
Decedents

D2, D3, D4, F2

---

Disposition of Remains

---

D5, D6, D7

---

D5, D6, D7, F3,
F4

---

C6, E6

---

E5, E6, E7

---

16, 17

---

Criminal Deaths

Information Sharing
Criminal Database Use (e.g.,
CODIS, NamUs)
Data and Records
Evidence Retention and Storage
Coding Standards
Completion of Death Certificate

2004 CMEC Item Response Summary
Infant Deaths
•
•

Of MECs, 82% provided the total number of infant deaths (Question D8), and 90% of MECs
provided the total number of infant death cases by diagnosis numbers (Question D9).
Of MECs, 66% responded to the question about the types of procedures used for investigating
sudden infant deaths (Question D10).

Criminal Deaths
•

Of MECs, 66% provided responses to the question about the average turnaround time in days
across the six manners of death (Questions C5a–C5f).

Unidentified/Unclaimed Decedents
•
•
•
•
•

Of MECs, 99% entered a total number of cases of unidentified human decedents (Question D3).
Of MECs, 95% provided a response to the question about policies for retaining records of
unidentified human remains (Question D2).
Of respondents, 80% reported what would be needed to reduce their inventory of unidentified
human decedents (Question F3).
Of MECs, 67% responded to the question about whether their office used an unidentified persons
database (Question D4).
Slightly fewer coroners than medical examiners responded to the question about whether they had
a policy for the final disposition of unidentified human remains (93% vs. 97%; Question D1).

Information Sharing/Database Use
•
•
•
•

Of MECs, 96% inputted their frequency for using NCIC (Question D5).
Of MECs, 92% reported data on how their office used NCIC (Question D6).
Of MECs, 88% provided insights about how often they used CODIS (Question D7).
When asked about additional data collection efforts (Questions F3 and F4), about two-thirds of
coroner and medical examiner respondents provided responses (65% for Question F3; 66% for
Question F4), and their responses were comparable.

Data and Records
•
•

Of MECs, 68% provided information about whether their death certificates were completed after
receiving the results of all investigations and reports (Question C6).
Of respondents, 65% reported on how they maintained their case records (Question E6).

The series of questions about how long records, evidence, and specimens were retained in months
(Question E5) yielded response rates that ranged from 79% for toxicology specimens (Question E5c) to
93% for case records (Question E5a).

Completion of Death Certificate Practices
•

Of MECs, 68% answered the question about whether there is a standard practice for completing
the death certificate after completing all investigations and reports (Question C6).

2.3

Budget and Fiscal Expenditures

Budget information was a critical item on the 2004 CMEC and part of the 2016 CPFFCL survey (Table 3)
but was not included on the non-BJS survey efforts. Budget is likely to be a key variable of interest
given recent pushes at the federal level to modernize the MDI infrastructure, increase certification and
accreditation, and improve recruitment and retention of forensic pathologists (NCFS, 2016a). The 2016
CPFFLC survey findings showed that 4 out of 10 crime laboratories charge fees for completing forensic
services to generate revenue to fund trainings and autopsies (Durose et al., 2016a).
Table 3. Budget and Fiscal Items Common Across Five Survey Efforts Relevant to the 2018 CMEC

Data Element

2004 CMEC

Budget and Fiscal Expenditures
Annual Budget

2017 NFLIS MEC
Office Survey

2016 CPFFCL
Survey

Instrument Question Number

2003 VA
Report

2011 Drake &
Nolte MDI
Services

Addressed (Indicated by an “X”)

B1, B2

---

Budget Categories (e.g., personnel,
travel, training)

---

Funding Source

---

Grant Funds

---

Agency Fees (i.e., revenue)

---

Salaries

---

C3, C4

---

2004 CMEC Item Response Summary
•
•
•
•

2.4

Of MECs, 99% provided the total operating budget (Question B1).
Of MECs, 63% provided input about whether their budget was by fiscal or calendar year period
(Questions B1-1 and B1-2).
Of MECs, 62% filled out the line item budget details (Questions B3a–B3j).
Of MECs, 57% provided a response to grant funding (Question B5) and revenue from services
(Question B6).

Workload/Caseload

Table 4 presents the caseload and the characteristics associated with workload that were included on
all the surveys except for the 2003 VA report. The most common data elements were accepted cases,
types of cases, and turnaround time for case processing.

Table 4. Workload/Caseload Items Common Across Five Survey Efforts Relevant to the 2018 CMEC

Data Element

2004 CMEC

Workload/Caseload

2017 NFLIS MEC
Office Survey

2016 CPFFCL
Survey

Instrument Question Number

2003 VA Report

2011 Drake &
Nolte MDI
Services

Addressed (Indicated by an “X”)

Number of Referrals

---

Accepted Cases

---

Types of Cases

13, 14

---

Autopsied Cases

C3, C4, C7

---

Turnaround Time

---

2004 CMEC Item Response Summary
•
•
•
•
•

2.5

Of MECs, 100% provided responses for the number of referred cases (Question C1) and the number
of accepted cases (Question C2).
Of MECs, 96% indicated the extent to which they performed functions routinely or by special
request (e.g., certificate of death, physical inspection of a decedent; Questions C7a–C7g).
Of MECs, 68% inputted a response for the type of investigations, exams, and autopsies (Questions
C3a–C3j).
Of MECs, 66% provided responses regarding case completion turnaround time (Question C5).
Of MECs, 65% responded to types of cases for which the office performs a procedure (e.g., death
scene investigation, complete autopsy, toxicology, radiology; Question C4).

Training

As Table 5 demonstrates, only training as a resource need was included on the 2004 CMEC, and
certification status was included on BJS’s most recent CPFFCL survey (Durose et al., 2016b). Federal
reports consistently recommended professional certification be sought to “support improvements in
the practice of MDI and professionalization of MDI personnel” (National Science and Technology
Council [NSTC], 2016b). This topic continues to be a persistent part of the national dialogue about the
state of the MDI, in part because the qualifications and training vary across coroners and medical
examiners. All MEC surveys largely did not address the status of certification, qualifications, continuing
education, or resource needs. Examples of this variation are exemplified in the following research:
•

A survey of pathology residency program directors found that some programs (6%) do not require a
forensic pathology rotation, and those that do are brief (4 weeks), conducted at a medical
examiner’s office, and require set prerequisites (Spencer, Ross, & Domen, 2017). More than 1 in 5
programs have residents who are not receiving documented evaluations for their forensic rotation,
and although most (40%) programs have a defined forensics curriculum, up to 15% do not (Spencer
et al., 2017).
8

•

Some states mandate 16 to 40 hours per year of in-service training for coroners, whereas others do
not provide training or provide funding for investigators to attend other forms of training.
Colorado, Wyoming, and Iowa provide death investigation training through the law enforcement
academy, the state board, and/or the state advisory council (Pirsch, 2009).
One state survey found that 64% of Ohio coroner respondents have received continuing education
related to drug overdose death investigation in the past 2 years (Wymyslo & Beeghly, 2013; Ohio
Department of Health, 2013).

Table 5. Training Items Common Across Five Survey Efforts Relevant to the 2018 CMEC

Data Element

2004 CMEC

Training

2017 NFLIS MEC
Office Survey

2016 CPFFCL
Survey

Instrument Question Number

2003 VA Report

2011 Drake &
Nolte MDI
Services

Addressed (Indicated by an “X”)

Status of Certification

---

Qualifications

---

Continuing Education

---

Resource Needs

---

2004 CMEC Item Response Summary
•
•

2.6

Of MECs, 77% overall provided responses regarding training to improve case completion
turnaround time (Question F1).
Of medical examiners, 68%, and 67% of coroners, provided inputs on what types of resources could
improve their turnaround time (Question F1).

Resource Needs

As Table 6 shows, computing, IMS, and evidence tracking systems were the most common resources
specified across the five major survey efforts. As noted earlier, computing and IMS remain relevant
data items for medical examiner/coroner surveys given the fairly large proportion of noncomputerized
MECs that rely on paper or manual record-keeping (e.g., NSTC, 2016c; Levy, 2013).
Resource needs can also encompass access to staffing, particularly given the national shortage of MDI
professionals, especially trained forensic pathologists (National Research Council, 2009, p. 257),
equipment, and other services like toxicology testing. Radiographic equipment, for example, is needed
for investigating homicides, suicides, decomposed bodies, infant deaths, penetrating traumas, burn
victims, and unidentified bodies, but not all MECs have access to such equipment (American Society of
Radiologic Technologists [ASRT], 2008; Jones et al., 2017).

Table 6. Resource Need Items Common Across Five Survey Efforts Relevant to the 2018 CMEC

Data Element

2004 CMEC

Resource Needs
Computing (IT, Internet)

2017 NFLIS MEC
Office Survey

2016 CPFFCL
Survey

Instrument Question Number

2003 VA Report

2011 Drake &
Nolte MDI
Services

Addressed (Indicated by an “X”)

D4, E1, E2, E3, E4

---

Information Management
Systems

19, 20, 21,
22, 24

A6, A7

---

Evidence Tracking Systems

20, 24

A6, A7

---

F1, F2

20, 25

---

Backlog Cases

---

D2, A7

---

Staff

---

Needs

2004 CMEC Item Response Summary
•
•
•
•
•
•
•

2.7

Of MECs, 98% answered the question about whether their office had an IMS (Question E3).
Of MECs, 80% gave a response to the question about additional resources needed to eliminate
inventory of unidentified human decedents (Question F2).
Of medical examiners, 68%, and 67% of coroners, provided inputs on what types of resources could
improve their turnaround time (Question F1).
Of MECs, 68% gave a response about offices being equipped with Internet access (Question E1) and
frequency of Internet use while performing the job (Question E2).
Of MECs, 67% provided responses regarding training to improve case completion turnaround time
(Question F1).
Of MECs, 66% inputted information about potential barriers for participating in federal data
collection efforts (Question F4).
Of MECs, 60% provided responses regarding whether their office had a networked IMS (Question
E4).

Examination Capabilities and Capacity

The most common items related to capabilities and capacity across the five major survey efforts relate
to toxicology, specialized laboratories and testing practices, and reference laboratory testing.
Toxicology capabilities and toxicology service access will continue to be important constructs because
in-house toxicology laboratories are not widespread because they are expensive to staff and run.
The most recent CPFFCL survey included items related to special technologies. In terms of the general
“needs” variable, a national survey of MECs conducted by the NAME highlighted a few areas that may
be germane to the 2018 instrument, including inadequate use of personal protective equipment, lack

of negative pressure ventilation in autopsy suites, and inadequate required vaccination for pathologists
(Blau, Clark, Nolte, & NAME, 2013).
Table 7. Examination Capability and Capacity Items Common Across Five Survey Efforts Relevant to
the 2018 CMEC

Data Element

2004 CMEC

Examination Capabilities and
Capacity

2017 NFLIS MEC
Office Survey

2016 CPFFCL
Survey

Instrument Question Number

2003 VA
Report

2011 Drake &
Nolte MDI
Services

Addressed (Indicated by an “X”)

Toxicology

C3, C7

A8, D4

---

Specialized Laboratories/
Testing

C3, C7

A8, A9, D3–
D12, D13, D14

---

Specialized Technologies

---

A8, A9

---

Reference Testing

E1, E2, E3

---

Additional Needs

F1, F2

---

2004 CMEC Item Response Summary
•
•

2.8

Of MECs, 57% inputted a response for toxicology analysis (Question C3f).
Of MECs, 71% indicated the extent to which they performed toxicology analyses (Question C7f).

Communication and Coordination

During the 2004 CMEC, MECs were asked if they participated in two federal data collection efforts—
the NVDRS and the Drug Abuse Warning Network, which ceased in 2010. Recently, other efforts by
CDC and DEA have focused on drugs. Specifically, in 2016, CDC started a program to collect
unintentional opioid-related deaths, which will include collecting data on the route of exposure,
presence of witnesses, naloxone use, history of substance abuse, and history of prescription opioids
(CDC, 2017). In 2018, DEA launched the NFLIS-MEC program, which will begin recruitment for a
continuous surveillance system that will collect cases from MECs in which a drug has been identified.
DEA’s recent MEC Office Survey asked respondents about their participation in region-specific data
collection efforts given state (e.g., Georgia and OverdoseFreePA in Pennsylvania) and local efforts
(RxStat in New York City) targeting the opioid epidemic. The CPFFCL survey, the VA report, and Drake
and Nolte’s development work largely did not address communication and coordination efforts.

Table 8. Communication and Coordination Items Common Across Five Survey Efforts Relevant to
the 2018 CMEC

Data Element

2004 CMEC

Communication and Coordination
Federal (e.g., data collection efforts)

2017 NFLIS
MEC Office
Survey

2016
CPFFCL
Survey

Instrument Question Number

2003 VA Report

2011 Drake &
Nolte MDI
Services

Addressed (Indicated by an “X”)

D5, D6, D7,
F3, F4

---

Agencies of Shared Jurisdiction (e.g.,
law enforcement, public health)

---

International and Borders

---

Barriers to Collection Efforts

---

25, 26, 28

---

Emergency and National Disasters

---

2004 CMEC Item Response Summary
•
•

Of MECs, 66% inputted a response for barriers to participating in federal data collection efforts
(Question F4).
Of MECs, 65% provided a response for whether their office participated in federal data collection
efforts (Question F3).

Special Topics

Given our experience with the 2004 CMEC, findings from recent NFLIS MEC work, RTI’s ongoing
leadership on the National Institute of Justice’s Forensic Technology Center of Excellence project,
recent presentations from the International Association of Coroners & Medical Examiners, the NAME,
American Academy of Forensic Sciences meetings, and the MEC and forensic literature, we have
identified the following emerging topics that could be considered for inclusion on the 2018 CMEC.
These topics include the following:
1. Using outsourcing autopsies for selected cases (McCleskey, Reilly, & Atherton, 2017), particularly
because some private laboratories offer such services (e.g., http://www.forensicdx.com/).
2. Toxicology testing practices given the opioid epidemic and emergence of novel psychoactive
substances (Logan et al., 2017), including cannabinoids (Labay et al., 2016), cathinones, and
synthetic fentanyls or fentanyl products.
3. Toxicology outsourcing given known backlogs in forensic crime laboratories (Durose et al., 2016a).
4. Developing and participating in drug-related deaths databases given local, state, and national
efforts to centralize these data.
5. Testing practices for novel psychoactive substances given their popularity, patterns of use, and
reports of adverse events associated with them; their true prevalence in drug mortality is lacking

and delayed because of analytical testing barriers such as absence of reference standards,
validated methods, and nationally linked databases (Logan et al., 2017).
6. Infectious disease surveillance infrastructure to use staffing, testing, and national database use,
and the use of models such as Med-X (Blau et al., 2013).
7. Mass fatality preparedness given scant comprehensive research in that area (Gershon et al., 2014),
including data surveillance for bioterrorism (Nolte et al., 2007, 2010) and emergency and national
disasters (NSTC, 2016a).
8. New technologies have emerged since the 2004 CMEC, such as advanced imaging techniques (e.g.,
computed tomography, magnetic resonance) in forensic radiology to identify injury and disease
before autopsy (ASRT, 2008; Jones et al., 2017), and high-resolution mass spectrometry to identify
newer psychoactive substances (e.g., synthetic opioids and cathinones) (Logan et al., 2017).
9. Practices for identifying and repatriating the remains of undocumented migrants. Our Nation’s
reliance on undocumented workers and the subsequent migration patterns from South and Central
America have resulted in increased attention in the forensic community regarding how to identify
the remains of the undocumented.
10. Policies for notifying next of kin and other family members. Many MECs lack policies and
procedures for communications and interactions with decedents’ next of kin and other family
members during death investigations (NCFS, 2016b). Accreditation standards do not address this
deficit, and inconsistencies affect the family and the investigation (NCFS, 2016a).
11. Others? What are we missing?
Question for Panelists: If you had to identify three new or emerging topics from the above list—
including any other topics that you would add—to integrate into the 2018 CMEC, which ones would
you choose, and how would you rank them in terms of importance?

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for Bioterrorism and Infectious Diseases. (2013). Infectious disease surveillance by medical examiners
and coroners. Emerging Infectious Diseases, 19, 821. https://doi.org/10.3201/eid1905.121661
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Justice Programs. Retrieved from https://www.bjs.gov/content/pub/pdf/pffclrs14.pdf

Durose, M. R., Burch, A. M., Walsh, K., & Tiry, E. (2016b). Publicly funded forensic crime laboratories:
Quality assurance practices, 2014 (NCJ 250152). Washington, DC: U.S. Department of Justice, Office of
Justice Programs. Retrieved from https://www.bjs.gov/content/pub/pdf/pffclqap14.pdf
Erck Lambert, A. B., Parks, S. E., Camperlengo, L., Cottengim, C., & Shapiro-Mendoza, C. K. (2016).
Death scene investigation and autopsy practices in sudden unexpected infant deaths. Journal of
Pediatrics, 174, 84–90.e1. https://doi.org/10.1016/j.jpeds.2016.03.057
Gershon, R. R. M., Orr, M. G., Zhi, Q., Merrill, J. A., Chen, D. Y., Riley, H. E. M., & Sherman, M. F. (2014).
Mass fatality preparedness among medical examiners/coroners in the United States: A cross-sectional
study. BMC Public Health, 14, 1275. https://doi.org/10.1186/1471-2458-14-1275
Hickman, M. J., Hughes, K. A., Strom, K. J., & Ropero-Miller, J. D. (2007, June). Medical examiners and
coroners' offices, 2004 (NCJ 216756). Washington, DC: U.S. Department of Justice, Office of Justice
Programs. Retrieved from https://www.bjs.gov/content/pub/pdf/meco04.pdf
Jones, N., Ropero Miller, J., Waltke, H., McLeod-Henning, D., Weiss, D., & Barcus, H. (Eds.) (2017).
Proceedings of the International Forensic Radiology Research Summit, May 10–11, 2016, Amsterdam,
The Netherlands (RTI Press Publication No. CP-0005-1709). Research Triangle Park, NC.
https://doi.org/10.3768/rtipress.2017.cp.0005.1709
Labay, L. M., Caruso, J. L., Gilson, T. P., Phipps, R. J., Knight, L. D., Lemos, N. P., … Logan, B. K. (2016).
Synthetic cannabinoid drug use as a cause or contributory cause of death. Forensic Science
International, 260, 31–39. https://doi.org/10.1016/j.forsciint.2015.12.046
Levy, B. P. (2013). Implementation and user satisfaction with forensic laboratory information systems
in death investigation offices. American Journal of Forensic Medicine and Pathology, 34(1), 63–67.
https://doi.org/10.1097/paf.0b013e31827ab5c6
Logan, B. K., Mohr, A. L. A., Friscia, M., Krotulski, A. J., Papsun, D. M., Kacinko, S. L., Ropero-Miller, J. D.,
& Huestis, M. A. (2017). Reports of adverse events associated with use of novel psychoactive
substances, 2013–2016: A review. Journal of Analytical Toxicology,41, 573–610.
https://doi.org/10.1093/jat/bkx031
McCleskey, B. C., Reilly, S. D., & Atherton, D. (2017). The value of outsourcing selected cases in a
medical examiner population: A 10-year experience. Journal of Forensic Sciences, 62, 99–102.
https://doi.org/10.1111/1556-4029.13269
Moissiy, L. (2016, December). Assessing medical examiners’ current practices in utilizing genetic testing
for autopsy-negative sudden unexpected death in the young (SUDY). Master's thesis. Retrieved from
http://scholarworks.csustan.edu/handle/011235813/1077
National Commission on Forensic Science. (2016a). View of the Commission: Certification of
medicolegal death investigators. Washington, DC: National Commission on Forensic Science,

Department of Justice, and National Institute of Standards and Technology, Department of Commerce.
Retrieved from https://www.justice.gov/ncfs/file/880271/download
National Commission on Forensic Science. (2016b). View of the Commission: Communication with next
of kin and other family members. Washington, DC: National Commission on Forensic Science,
Department of Justice, and National Institute of Standards and Technology, Department of Commerce.
Retrieved from https://www.justice.gov/ncfs/page/file/905546/download
National Research Council. (2009). Strengthening forensic science in the United States: A path forward.
Retrieved from http://www.nap.edu/catalog/12589.html
National Science and Technology Council. (2016a). Recommendation to the Attorney General: National
Disaster Call Center. Washington, DC: National Commission on Forensic Science, Department of Justice,
and National Institute of Standards and Technology, Department of Commerce. Retrieved from
https://www.justice.gov/archives/ncfs/page/file/831601/download
National Science and Technology Council. (2016b). Strengthening the medicolegal-death-investigation
system: Accreditation and certification—A path forward. Washington, DC: Office of the President of the
United States. Retrieved from
https://obamawhitehouse.archives.gov/sites/default/files/microsites/ostp/NSTC/strengthening_the_
medicolegal_death_investigation_system_final.pdf
National Science and Technology Council. (2016c). Strengthening the medicolegal death investigation
system: Improving data systems. Washington, DC: Office of the President of the United States.
Retrieved from
https://obamawhitehouse.archives.gov/sites/default/files/microsites/ostp/NSTC/strengthening_the_
medicolegal_death_investigation_system_final.pdf
Nolte, K. B., Fischer, M., Reagan, S. & Lynfield, R. (2010). Guidelines to Implement Medical
Examiner/Coroner-Based Surveillance for Fatal Infectious Diseases and Bioterrorism ("Med-X").
American Journal of Forensic Medicine and Pathology, 31, 308-312.
https://doi.org/10.1097/paf.0b013e3181c187b5
Nolte, K. B., Lathrop, S. L., Nashelsky, M. B., Nine, J. S., Gallaher, M. M., Umland, E. T., McLemore, J. J.,
Reichard, R. R., Irvine, R. A., McFeeley, P. J., & Zumwalt, R. E. (2007). "Med-X": A medical examiner
surveillance model for bioterrorism and infectious disease mortality. Human Pathology, 38, 718-725.
https://doi.org/10.1016/j.humpath.2007.02.003
Ohio Department of Health. (2013). Overdose death investigations: Ohio coroner information.
Retrieved from https://www.odh.ohio.gov/health/vipp/drug/coronerinfo.aspx
Peek-Asa, C., McArthur, D. L., & Kraus, J. E. (1997). Determining injury at work on the California death
certificate. American Journal of Public Health, 87, 998–1002. https://doi.org/10.2105/ajph.87.6.998

Pirsch, P. (2009). Interim study report on standards and oversight of death investigations in Nebraska
(LR 276). Retrieved from
https://nebraskalegislature.gov/pdf/reports/committee/judiciary/LR276_2008.pdf
Schulman, Ronca, & Bucuvalas, Inc. (2003). 2003 VBA survey of medical examiners’ and coroners’
process in identification of unclaimed remains for veteran status. Washington, DC: Department of
Veterans Affairs, Veterans Benefits Administration Compensation and Pension Service. Retrieved from
https://www.miap.us/Announcements/ann20080222_c%20Complete%20Medical%20Examiners%20an
d%20Coroners%20Report.pdf
Shapiro-Mendoza, C. K., Parks, S. E., Brustrom, J., Andrew, T., Camperlengo, L., Fudenberg, J., Payn, B.,
& Rhoda, D. (2017). Variations in cause-of-death determination for sudden unexpected infant deaths.
Pediatrics, 140(1), e20170087. https://doi.org/10.1542/peds.2017-0087
Spencer, A., Ross, W. K., & Domen, R. E. (2017). Forensic pathology education in pathology residency:
A survey of current practices, a novel curriculum, and recommendations for the future. Academic
Pathology, 4, 1–10. https://doi.org/10.1177/2374289517719503
Stein, S. L., Kimmerle, E., Adcock, J. M., & Martin, S. (2017). Cold cases: An exploratory study into the
status of unresolved homicides in the USA. Investigative Sciences Journal, 9(2), 1–19. Retrieved from
http://www.investigativesciencesjournal.org/article/view/17644
U.S. Drug Enforcement Administration. (2018). National Forensic Laboratory Information System
(NFLIS) Medical Examiner/Coroner Office Survey. Unpublished Survey.
Wymyslo, T. E., & Beeghly, C. (2013, May). Response to Ohio’s prescription drug overdose epidemic:
Data update and overview of 2013 coroner survey results. Presented at 2013 Ohio State Coroners’
Association Meeting. Retrieved from https://www.odh.ohio.gov//media/ODH/ASSETS/Files/health/injury-prevention/final_2013-coroner-meeting-Presentation-Dr-W(2).pdf?la=en

Appendix:
2004 Census of Medical Examiner and Coroner Offices (CMEC)

OMB No. 1121-0296: Approval Expires 06/30/2008

RETURN
TO

}

RTI International
2005 Census of Medical Examiner
and Coroner Offices
Data Receipt
P.O. Box 12194
Research Triangle Park, NC 27709
FAX: 1-800-262-4292

2005 CENSUS OF MEDICAL EXAMINER AND
CORONER OFFICES
U.S. Department of Justice, Bureau of Justice Statistics

Questionnaire Sent In Care Of:
Name

Case ID <CaseID>

Title <Title>

Information Supplied By:
Name

Title

Office/agency name
Number and street or P.O. box/route number

City

State

ZIP code

E-mail address
Telephone (area code and number)

Extension

Fax number (area code and number)

Instructions for Completing the 2005 Census of Medical Examiner and Coroner Offices
1. The label on the front cover contains identifying information about your medical examiner or coroner office. Please answer
all questions for the jurisdictions that your office serves. If your office district includes more than one county, respond for all
counties.
2. Please answer each question in sequence by marking the appropriate box and/or by printing the requested information in
the space provided. In some cases you will be requested to skip certain questions based on your response.
3. If you need to give an explanation for an answer, please use the space provided.
4. Please complete the survey as soon as possible and return it using one of the following methods: (1) Internet: The survey
can be completed online at http://cmec.rti.org. Your logon ID is <WebAccessCode>. The website's "save" feature allows
you to complete the questionnaire in multiple sessions. Since some questions may require you to look up information, we
suggest filling in the answers on the mail survey before accessing the Internet version. Please keep the mail version for
your records. (2) Mail: You can return the completed survey by mail in the enclosed envelope. (3) Fax: You can fax the
completed survey to 1-800-262-4292. Make sure to fax both sides of the completed questionnaire pages.
5. If you need assistance to answer any question, please e-mail RTI at CMEC@rti.org or call RTI at 1-800-344-1386.
Although you are not required to respond, your participation is needed for the success of the survey.

Burden Statement
An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection of
information, unless it displays a currently valid OMB Control Number. Public reporting burden for this collection of information
is estimated to average 90 minutes per response, including time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collections of information. Send comments
regarding this burden estimate, or any other aspects of this collection of information, including suggestions for reducing this
burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street N.W., Washington, D.C. 20531.

SECTION A

ADMINISTRATIVE INFORMATION

A1. Enter the name and title of the chief position in your medical examiner or coroner office (e.g., Chief Medical
Examiner, Coroner).
Name

Title

A2. Enter the name and title of the chief position in your toxicology laboratory (e.g., Chief Toxicologist), or enter the
name and location of the off-site (e.g., state/local crime or health lab) or reference toxicology laboratory (e.g.,
commercial, academic) utilized by your office.
Name

Title

Off-site or reference laboratory

Location

A3. Which of the following best describes your office? Mark only one.
State medical examiner office......................

District/regional medical examiner office .....

County medical examiner office...................

City medical examiner office........................

District/regional coroner office .....................

County coroner office ..................................

Other ...........................................................

→ Please specify: ________________________________________

A4. What jurisdiction(s) does your office serve (e.g., Illinois State, Los Angeles County, New York City, First Judicial
District)?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
A5. Enter the aggregate population of the jurisdiction(s) your office serves.

A6. Enter the total number of full-time equivalent (FTE) salaried positions employed by your office in 2004. Count
part-time positions as 0.5, and do not include contractors or consultants.

A7. Enter the total number of consultant or contractor positions for your office in 2004. Count part-time positions as
0.5.

A7a. If the answer to A7 is 0.5 or higher, please specify the type of consultant or contractor position(s):
_____________________________________________________________________________________________
_____________________________________________________________________________________________

A8. Enter the number of FTE and consultant/contractor positions for your office in 2004 (as entered in A6 and A7)
that fall into the following categories.
Consultant/
If a position performs multiple duties, count it in the category that requires the
FTE
Contractor
largest amount of time. Part-time positions count as 0.5.
▼

▼

a. Forensic pathologists (i.e., medical examiners, coroners, coroner’s physicians) ................
b. Other medical examiners and/or coroners (e.g., deputy medical examiners or
coroners, nonforensic pathologists or physicians) ..............................................................
c. Ancillary death investigation personnel (e.g., medical death investigators,
autopsy technicians, photographers) ..................................................................................
d. Forensic specialists (e.g., specialists in odontology, entomology, anthropology)................
e. Laboratory support (e.g., lab technicians/analysts, lab support personnel, toxicologists) ...
f. Computer specialists and IT support...................................................................................
g. Administrative (i.e., clerical support and all other administrative positions) ........................
h. Other → Please specify: __________________________________...............................
SECTION B

EXPENDITURES FOR 2004

B1. The next few questions ask about your office’s budget and funding. Please answer these questions thinking
about the 2004 calendar or 2004 fiscal year, whichever is easier for you. Please select one format.
2004 calendar year...............

2004 fiscal year ....................

→ Provide dates of 2004 fiscal year:

(mm-dd-yyyy)

B2. Enter your office’s total operating budget for the 2004 calendar or fiscal year. Include personnel, equipment,
supplies, training, accreditation, travel, contractual services, and any other operating costs. Do not include
utilities or facilities costs. If exact figures are unavailable, please give your best estimate.

B3. Enter approximate budgetary amounts dedicated to each of the following areas during the 2004 calendar or fiscal
year. Include capital purchase and maintenance costs. The budget amounts should sum to the total provided in
question B2.
a. Personnel (including gross salaries, wages, benefits, and other personnel costs)......
b. Computer hardware, software, and IT support …………………………………………..
c. Other equipment (e.g., analytical, pathological) ..........................................................
d. Supplies (i.e., consumables) .......................................................................................
e. Contracted services (e.g., DNA analysis, autopsies) ..................................................
f. Travel and training ......................................................................................................
g. Quality assurance programs .......................................................................................
h. Toxicology and microbiology .......................................................................................
i. Transportation (e.g., vehicles, body transport fees) ....................................................
j. Other operating costs ..................................................................................................
TOTAL ....................................................................................................................... Figure from B2
3

B4. Based on the operating budget reported in B2, indicate the percentage of your office’s annual operating budget
that came from the following sources. The total should equal 100%. Enter -0- if your office received no funding
from a source.
a. Federal (excluding grants)......................................

b. State (excluding grants)..........................................

c. Local (city/county) (excluding grants) .....................

d. Other ......................................................................

% → Please specify: ________________________

TOTAL ...................................................................

100

B5. Enter the total dollar amount your office received from grant funds.
B6. Enter the total dollar amount your office generated through fees for reports, legal testimony, use of facilities,
→ Please specify type(s) of fee(s): _____________________________

provision of data, etc.
SECTION C

WORKLOAD (DEATH INVESTIGATIONS)

C1. Enter the total number of cases referred to your office during calendar year 2004, including all cases in which
your office conducted an investigation or documented referral of the case to your office. If referred cases are not
documented, please check the square box below.

Referred cases are not documented ......
C2. “Accepted cases” are cases in which the office completes the death certificate or otherwise determines the
cause and manner of death. For calendar year 2004, enter the total number of human death cases accepted by
your office. Do not include cremation approval cases or cases in which jurisdiction was declined.

C3. Of the total cases accepted (as entered in C2), enter the number of cases that included any of the following
procedures performed by your office. If data are not available, please provide an estimate and mark the square
box to the right.
Estimated?
▼
a. Death scene investigation ............................................................................
b. Review of medical records from a health care provider ...............................
c. Complete autopsy (defined as removal and examination
of the brain, thoracic, and abdominal organs) ..............................................
d. Partial autopsy (defined as minimal dissection, less than complete)............
e. Characterization of skeletal remains ............................................................
f. Toxicology analysis ......................................................................................
g. Radiology (one or more x-rays)....................................................................
h. Metabolic screen ..........................................................................................
i. Microbiology .................................................................................................
j. Crime scene processing (e.g., DNA analysis, latent prints, trace evidence)
4

C4. Please indicate who performs the following duties for your office. Mark all that apply.
Death Scene
Medical
Forensic
Hospital
Investigator
Coroner Examiner Pathologist
Pathologist
Other
▼
▼
▼
▼
▼
▼
a. Death scene investigations ............................
1 .............
2 ..........
3 .............
4 ................
5 ...........
6
b. External examinations....................................

1 .............

2 ..........

3 .............

4 ................

5 ...........

c. Determination of which cases are autopsied .

1 .............

2 ..........

3 .............

4 ................

5 ...........

d. Autopsies ......................................................

1 .............

2 ..........

3 .............

4 ................

5 ...........

C5. What is the average turnaround time, in days, for case completion (defined here as completion of death
certificate) for each of the following manners of death investigated by your office?
a. Natural ...............................

days

b. Homicide............................

days

c. Suicide ...............................

days

d. Non-traffic accidents ..........

days

e. Traffic accidents.................

days

f. Undetermined ....................

days

C6. Does your office routinely wait to complete the death certificate until all investigations, autopsy reports, and lab
results are completed?
Yes .......................................

No.........................................

C7. Please indicate whether your office performs the following functions routinely or occasionally/by special request.
Please also indicate whether the majority of functions are performed internally (i.e., within your office) or
externally (i.e., outsourced to an independent facility such as a health department or commercial laboratory).
Routinely
▼

Occasionally or by
Special Request
▼

Internal
▼

External
▼

a. Certificate of death........................................

1 ...................

................................

1 ...........

b. Physical inspection of decedent....................

1 ...................

................................

1 ...........

c. Autopsy of decedent ......................................

1 ...................

................................

1 ...........

d. Crime scene evidence collection
(DNA, latent print, trace evidence) .................

1 ...................

................................

1 ...........

e. Crime scene evidence analysis
(DNA, latent print, trace evidence) .................

1 ...................

................................

1 ...........

f. Toxicology analysis........................................

1 ...................

................................

1 ...........

g. In-house X-rays .............................................

1 ...................

................................

1 ...........

SECTION D

SPECIALIZED DEATH INVESTIGATIONS

D1. Does your office have a policy of final disposition (e.g., burial, cremation, long-term storage) for unidentified
human remains after a specified period?
Yes .......
No.........

→ Please specify the length of time:_____________________

D2. Does your office have a policy of retaining records for unidentified human remains (including x-rays, fingerprints,
DNA) for a specified period?
Yes ...........

No.............

→ Please specify the length of time and archival location:____________________________________

D3. In your office, how many total cases of unidentified human decedents…
→ Please specify the year of the oldest case(s): _________

a. are presently on record? ................................
b. are reported annually, on average? ...............

c. remained unidentified and underwent final disposition in calendar year 2004? ......
d. remain unidentified after 1 year, on average (e.g., cold cases)?............................
D4. How often does your office utilize computerized missing persons/unidentified remains databases or other
Internet resources during investigations of unidentified human remains?
1

→ Please specify the database(s)/Internet resource(s): ______________________________

Somewhat often......

______________________________

Rarely or never .......

Very often ...............

D5. How often does your office utilize the FBI's National Crime Information Center (NCIC)?
Very often ...............

Somewhat often......

Rarely or never .......

→ Skip to question D7.

D6. How does your office utilize the FBI's National Crime Information Center (NCIC)? Mark all that apply.
Direct entry capabilities ........................................

Direct query capabilities .......................................

Indirectly through local law enforcement liaison ...

D7. How often does your office utilize the FBI's Combined DNA Index System (CODIS)?
Very often ...............

Somewhat often......

Rarely or never .......

D8. Of the total cases accepted for investigation in calendar year 2004 (as entered in C2), enter the number of infant
death cases—defined as decedents less than 1 year of age based on actual birth date.
→ If 0, skip to question D10.
D9. Of the total infant death cases (as entered in D8), enter the number diagnosed as…
a. Sudden Infant Death Syndrome (SIDS) ......

→ If 0, does your office use SIDS diagnosis?

b. Sudden unexplained infant death................

Yes .......

c. Other natural disease ..................................

No .........

d. Stillbirth .......................................................
e. Accidental asphyxiation in bed ....................
f. Other accident..............................................
(continued)
6

g. Homicide .....................................................
h. Undetermined cause of death .....................
D10. For a sudden, unexpected infant death, which of the following procedures does the death investigation policy of
your office include? Mark all that apply.
Scene investigation .......................................................................

Complete autopsy..........................................................................

Comprehensive toxicology (e.g., multiple toxin screens) ..............

SECTION E

RECORDS AND EVIDENCE RETENTION

E1. Does your office have access to the Internet in the physical facility where your coroner or medical examiner
office is housed?
Yes ............................................
No..............................................

1
2

E2. How often do you use the Internet while performing your job as coroner or medical examiner?
Weekly.......................................
Monthly......................................
Seldom ......................................
Never .........................................

1
2
3
4

E3. Does your office currently have a computerized information management system (i.e., a computerized system
used to manage, compile, or track cases and/or evidence)?
Yes ............................................

No..............................................

→ Please specify type of system:___________________________

E4. Is your computerized information management system centralized or networked such that information on all
cases is available to authorized users?
Yes ............................................
No..............................................

1
2

E5. Enter the established period (in months) for retention for the following sources. If there is no established period,
leave the space blank and mark the square box to the right.
Indefinite
▼
a. Case records (paperwork) .............

months...............

b. Physical evidence..........................

months...............

c. Toxicology specimens ...................

months...............

E6. Are case records maintained for storage as hard copies, electronically, or both?
Hard copy .................................
Electronically ............................
Both ..........................................

1
2
3

E7. Where are copies of your official investigative records and reports archived? Mark all that apply.
On site………………………. ....
Permanent storage facility ........
Other .......................................
No archival storage system ......

1
2
3

→ Please specify location: ___________________________________________

SECTION F

RESOURCES

F1. Which of the following additional resources would be necessary to improve your overall turnaround time for case
completion? Mark all that apply.
Personnel ........................................................................
Training ...........................................................................

Laboratory/facility space ..................................................

Administrative and evidence storage facilities .................

Equipment (e.g., laboratory, computers, software) ..........

Analytical instrumentation and laboratory supplies..........

Other ...............................................................................

None of the above ...........................................................

→ Please specify:_______________________________

F2. Which of the following additional resources would be necessary to eliminate or reduce your inventory of
unidentified human decedents? Mark all that apply.
Personnel ........................................................................
Training ...........................................................................

Laboratory/facility space ..................................................

Administrative and evidence storage facilities .................

Equipment (e.g., laboratory, computers, software) ..........

Analytical instrumentation and laboratory supplies..........

Other ...............................................................................

None of the above ...........................................................

→ Please specify: ______________________________

F3. In which federal data collection efforts does your office currently participate? Mark all that apply.
National Violent Death Reporting System (NVDRS)........

Drug Abuse Warning Network (DAWN) ..........................

Other ...............................................................................

None of the above ...........................................................

→ Please specify: ______________________________

F4. Generally, what are the main potential barriers for your office to participate in federal data collection efforts?
Mark all that apply.
Lack of electronic records..................................................................

Lack of resources for data conversion to other systems ...................

Concerns about privacy ....................................................................

Unavailable personnel .......................................................................

Unwillingness to share data with federal agencies ............................

Redundancy of federal data requests from multiple agencies ...........

Resource limitations ..........................................................................

Concerns that the effort will not benefit my jurisdiction......................

Other barriers ...................................................................................

None of the above .............................................................................

→ Please specify: _____________________

Thank you for your participation!
Please return your completed survey to
RTI International
2005 Census of Medical Examiner and Coroner Offices
Data Receipt
P.O. Box 12194
Research Triangle Park, NC 27709-12194
FAX: 1-800-262-4292

Attachment 25. Cognitive Testing Report

November 29, 2018

2018 Census of Medical Examiners
and Coroner Offices
Cognitive Interview Report

Prepared for
Connor Brooks
U.S. Department of Justice
Bureau of Justice Statistics
810 7th Street, NW
Washington, DC 20531

Prepared by
Sarah Cook
Peyton Attaway
Hope Smiley-McDonald
Jeri Ropero-Miller
Crystal Daye
Alicia Frasier
RTI International
3040 E. Cornwallis Road
Research Triangle Park, NC 27709

RTI Project Number 0216093.000.002

Contents

Section

Page

Project Background

Methodology
1.1

Participant Recruitment ............................................................................... 1

1.2

Data Collection Procedures and Protocol ........................................................ 3

Question-Specific Discussion

2.1

Section A – Administrative ........................................................................... 4

2.2

Section B – Budget and Capital Resources .................................................... 11

2.3

Section C – Workload (Death Investigations) ................................................ 15

2.4

Section D – Specialized Death Investigations ................................................ 20

2.5

Section E – Records and Evidence Retention................................................. 24

2.6

Section F – Resources and Operations ......................................................... 26

Miscellaneous Topics

3.1

Burden .................................................................................................... 30

3.2

Data Availability........................................................................................ 31

3.3

General Feedback .................................................................................... 31

Appendix
A:

2018 Census of Medical Examiner and Coroner Offices Cognitive
Interview Recruitment Materials

A-1

2018 Census of Medical Examiner and Coroner Offices Cognitive Testing
Informed Consent

B-1

2018 Census of Medical Examiner and Coroner Offices Instrument

C-1

Cognitive Interview Protocol

D-1

iii

Tables

Number
1.

Page

Recruitment Summary by Agency Type and Size ................................................. 3

Project Background
In 2019, the Bureau of Justice Statistics (BJS) will field the Census of Medical Examiner and
Coroner Offices (CMEC). The previous administration was conducted in 2005 referencing
2004. As described by BJS in its generic clearance request to the Office of Management and
Budget (August 22, 2018), the purpose of this iteration of the CMEC is to survey the
universe of approximately 2,150 medical examiners and coroners who conduct medicolegal
death investigations in the United States with the goals of: 1) generating statistics that will
help BJS develop a detailed understanding the of U.S. medicolegal death investigation
system; 2) gathering information that will help address training, staffing, or jurisdictional
coverage needs; and 3) further developing an understanding of the relationship between
law enforcement agencies and medical examiner and coroner offices (MECs).
As part of the instrument development and design process, BJS asked RTI International to
conduct cognitive testing for the 2018 CMEC instrument. This report summarizes the
cognitive testing process and procedures, findings, and recommendations from 14 cognitive
interviews in October and November 2018. Since the last CMEC was last conducted, MECs
have changed in the way they operate, the technology they use, and the resources they
access. As a first step in preparation of a 2018 CMEC, an Expert Panel of medical examiners
and coroners was convened in February 2018 to discuss changes to the field of medicolegal
death investigation and topics important to MECs. As a result of the panel’s
recommendations, and conversations between RTI and BJS, the CMEC instrument was
completely redesigned. Cognitive interviews were conducted with the 2018 CMEC
instrument to identify potential issues with respondent comprehension and to ensure
capture of all pertinent information through the survey.
Section 1 summarizes the methods used to complete the cognitive interviews task and
describes the participants. The findings and recommendations from the cognitive interviews
are presented across Section 2 with question-specific discussion, while Section 3 discusses
notable miscellaneous considerations.

1. Methodology
Participant Recruitment
Initially, 18 MECs including local, state, and multiple jurisdictional offices, were identified as
possible cognitive interview candidates. To create a representative sampling of MECs, BJS
and the project team purposively selected coroners and medical examiner offices that
accounted for the following characteristics: (1) type of office: medical examiner or coroner,
(2) jurisdictional type (city, state, county, or regional office), (3) location of office by
Census region (West, Midwest, Northeast, or South), and (4) whether the office was
adjacent to federal tribal lands. For medical examiners, given the wide variety of

2018 CMEC

organizational hierarchies represented by this population, a diversity of offices was chosen
that served state, regional, or county level jurisdictions. For coroner offices, where possible,
the project team identified a diverse blend of coroners that considered the above primary
characteristics, but represented the various professions of coroners, such as morticians,
funeral parlor directors, forensic nurses, and medical doctors who are not forensic
pathologists (e.g., general practice doctors who serve as the county coroner).
When the project team encountered refusals or nonresponse among the initial purposive
sample, a substitute cognitive interview respondent was identified that corresponded with
the general profile of the refusal across the primary medical examiner or coroner
characteristics (i.e., a refusal coroner from the Midwest representing a medium-sized
city/county would be replaced by a respondent with the same characteristics). Notably, the
team also received some recruitment assistance from the National Institute of Justice’s
Jonathan McGrath during the National Association of Medical Examiners conference in
October. Dr. McGrath provided contact information to RTI for 5 medical examiners while he
was at the conference, some of whom participated. In all, invitations went out to 32 MECs.
Of those 32, invitations were accepted by 16 participants. Seven sample members refused
the invitation and 9 never responded to any contact attempts. Of the 16 that accepted the
invitation, one decided not to participate the day of the interview and did not respond to
follow-up communication.
Connor Brooks, the BJS Project Manager, emailed each prospective participant (and
alternate candidate, as needed) to describe the content and goals of the survey and
cognitive interviewing process. An RTI interviewer followed up with each candidate through
email and phone calls when necessary. If a prospective participant declined the interview,
an invitation was sent to another medical examiner or coroner as a replacement. ‘Thank
You’ letters were sent by mail to each participant who completed the survey.
Fourteen cognitive interviews were completed from October 1 through November 15, 2018.
Of the 14 participants interviewed, 7 were medical examiners and 7 were coroners. All
United States regions were represented, with 5 participants from the West, 5 from the
Northeast, 2 from the South, and 2 from the Midwest. Though we do not have data on the
actual size of each jurisdiction, anecdotally the participants represented large and small
jurisdictions in both urban and rural settings. Three participants had tribal lands in their
jurisdictions. A selection of participant characteristics is provided in Table 1.

Cognitive Interview Report

Table 1. Recruitment Summary by Agency Type and Size
Participant

Type

Jurisdiction

Region

Coroner

County

Northeast

Coroner

County

Northeast

Coroner

County

South

Medical Examiner

State

Northeast

Coroner

County

West

Coroner

County

West

Medical Examiner

State

Northeast

Medical Examiner

County

Midwest

Coroner

County

Midwest

P10

Medical Examiner

State

West

P11

Medical Examiner

County

South

P12

Medical Examiner

County

West

P13

Coroner

County

West

P14

Medical Examiner

County

Northeast

Data Collection Procedures and Protocol
The purpose of the cognitive testing was to identify potential issues with the instructions,
question wording, and response options, identify any improvements, and estimate the
respondent burden. Four cognitive interviewers from RTI conducted the cognitive interviews
during October and November 2018. Before the interviews, a training was held with all
interviewers and notetakers to discuss the interview protocol, explain the purpose of certain
probes, and answer questions. There was also a training on recruitment procedures for
those involved in that task.
The interviews were conducted over the phone and lasted approximately 2 hours each.
Once a candidate agreed to participate in the interview, RTI emailed a confirmation with the
scheduling information for the call. A day before the interview, RTI sent the candidate the
survey instrument, BJS goal card, and a consent form (see Appendices) with the specific
instructions to not go through any of the attachments until the interview to preserve all
their initial thoughts for the actual phone interview.
Once informed consent was obtained, the interviewers followed a cognitive interview
protocol with scripted concurrent and retrospective probes (Appendix A). Participants were
asked to review the purpose of the study and asked about their understanding of the survey
items. Generally, the participants were asked about the text clarity, their sources of
information and ability to provide answers, and recommendations for improving the survey.

2018 CMEC

The interviewers also used spontaneous probes when needed to clarify key concepts or
understand participant difficulty. The findings of all the interviews were used to identify
recommendations for potential revisions to the questionnaire. The interview team used a
formatted Excel spreadsheet to facilitate note-taking. With the participant’s permission, the
discussion was audio recorded.

2. Question-Specific Discussion
This section presents each question in which changes are recommended. The individual
questions from the draft CMEC survey are presented for convenient reference, followed by a
discussion of findings and recommendations related to that question. In all, 63 questions in
the instrument were tested in the interview, 25 of which resulted in recommendations for
change based on cognitive interviews. At the beginning of each section, we list the
questions that were tested for which the findings indicated no recommended question
changes. These questions performed consistently and were generally well understood by
participants.

Section A – Administrative
Of the 11 questions in Section A which addressed administrative topics, 5 items (i.e., A2,
A4, A8, A10, and A11) were determined by participants to be problematic, whereas 6
questions (i.e., A1, A3, A5, A6, A7, and A9) tested well and thus no recommendations are
made below. Question A8 and the new recommended measure regarding staff salaries
(called new Question A9 below) were previously discussed with BJS on November 19.

A2. Which of the following best describes your death investigation office?

O
O
O
O
O

Coroner office
Medical examiner office
Justice of the peace GO TO END OF SURVEY
My office does not investigate deaths  GO TO END OF SURVEY
Other medicolegal death investigation office (please specify)
__________________________________

A2 Findings
Participants had no issues answering this question. All participants felt that Justice of the
Peace should remain an option since they complete death investigations in some
jurisdictions in Texas. Five participants suggested including sheriff-coroner office as a
response option as they are technically more than just a coroner office. In those cases,
participants felt that the response option “Coroner office” was insufficient.

Cognitive Interview Report

A2 Recommendations
Add in “Sheriff-coroner office” as a response option to this question.

A4. Which of the following best describes the agency your office reports to?

O
O
O
O
O
O

Public health agency (e.g., department or division of public health)
Law enforcement agency (e.g., department or division of public safety)
Government attorney’s office (e.g., district attorney)
Department or division of forensic science
My office is a stand-alone agency that is not under the umbrella of another agency
Other (please specify) __________________________________

A4 Findings
Thirteen participants had no problem answering this question. Three of those participants
suggested changing wording of this question to “What level of government controls your
budget?” since they do not give any of these agency updates or are in contact with any of
them on a consistent basis. They only communicate to that agency when asking for
additional funding or discussing other budget-related issues. The one participant who had
an issue answering this question focused on the idea that even a stand-alone agency
reports to some entity. In their case it was an oversight board so selecting the “stand-alone
agency” option did not seem accurate. Nine participants either did not know what
“Department or division of forensic science” was or made guesses as to what it was.
However, none of these participants reported to such an agency and they did not have
difficulty selecting their correct answer.

A4 Recommendations
If the purpose of this question is to determine who controls the budget for these offices,
revise the question to ask, “Which of the following best describes the agency that controls
your budget?”
If the purpose of this question is to determine which agency has authority over the office,
revise the fourth response option to state “My office does not report to another agency.”

2018 CMEC

A8. On June 30, 2018, how many full-time employees, part-time employees, consultants
or contractors, and unpaid volunteers did your agency have on staff?
Count each employee only once.
Enter zero (0) if you do not have any staff in a category so no entry is left blank.
•
•

Full-time employees are those regularly scheduled for 35 or more hours per week.
Part-time employees are those regularly scheduled for 34 or less hours per week.
Full-Time
Employees
on June 30,
2018

Part-Time
Employees
on June 30,
2018

Consultants/
Contractors
on June 30,
2018

Unpaid
Volunteers
on June 30,
2018

a. Autopsy pathologists



b. Coroners/non-physicians



c. Death investigators (or
coroner investigators)



d. Forensic toxicologists



e. Other scientific
investigative support staff
(e.g., anthropologists,
histologists)



f. Administrative staff (e.g.,
secretary, accountant)



g. Ancillary staff (e.g., drivers,
photographers)



Role

Cognitive Interview Report

A8 Findings
Ten participants answered these questions almost instantly, and four participants got the
answers in less than 5 minutes by consulting either their administrative assistant or human
resource staff. When asked if there were any roles where participants would have trouble
providing staff numbers, three participants mentioned having an issue providing numbers
for ancillary staff, two participants mentioned that they would have issues providing a
number for forensic toxicologists, two noted they would have issues because of multiple
roles, and seven said they would have no problem providing staff numbers for any role
listed.
When participants were asked if there were any scenarios where they would not know
where to put an employee, there were multiple issues discussed. Four participants felt it
was unclear what defines the Consultants/Contractors column of this table, or what
differentiates that column from the Part-Time Employees column.
One issue with on-call staff was that in smaller jurisdictions, they may not work at all one
month but work more than 35 hours per week during the next month. In many offices,
people served in multiple roles, but the instructions say to count each staff member only
once. This caused some confusion for four participants, one of whom changed the answers
after the interviewer noted that the instructions said to count each employee only once.
Suggestions for improving A8 included:
Five participants suggested including autopsy technicians in row e. Other scientific
investigative support staff.
Two participants suggested clarifying that we are including only hours worked on
medicolegal death investigation-related tasks in the full-time and part-time
designations. The participants said they have employees who also work on testing
and investigations not related to death.
Four participants suggested adding in “Forensic chemists” after “Forensic toxicologists,”
since they are also an integral part to the toxicology process but are not considered
forensic toxicologists since they do not have training to include case interpretation
skills.
Three participants indicated that they would like to see more questions about salary and
benefits related to this field to gain more understanding into recruitment and
retention shortage issues.

A8 Recommendations
Change the instructions on full-time and part-time to say, “on average.”
Clarify the different employment types to include a definition for all categories similar to
what is provided for full-time and part-time staff. BJS should also consider whether
they want to know employment status on the basis of hours worked on medicolegal
death investigations or on one’s overall employment status and availability.

2018 CMEC

Add “Forensic chemists” in the matrix. There is a national shortage of forensic
toxicologists, so adding a new row instead of adding this into row d to include
forensic chemists would provide valuable information to the field. However, if BJS is
interested in minimizing the number of rows, we could include forensic toxicologists
and forensic chemists on the same row.
On the basis of the November 19 discussion, BJS and RTI agreed that a fourth column
should be added to capture “on-call” employees.
Regarding employees who take on multiple roles, during the November 19 discussion,
BJS and RTI decided that the instructions should include following language:
Enter the number of employees during the pay period including DATE.
Report each employee in only one category. If an employee fills more than one
role, put them in their primary role. If none, enter 0.
•

Full-time employees are those who work on average for 35 or more hours
per week.

•

Part-time employees are those who work on average 34 or fewer hours per
week.

•

Consultants/Contractors are those who work under another company or as
a consultant and are hired to work for your office.

•

On-Call employees are those who do not have regularly scheduled hours
and only work when needed.
Unpaid volunteers are those who do work for your office but are not
contracted or on the payroll

Moreover, on the basis of participant feedback for Section A, we suggest adding a new
question on salary like the example shown below. We recommend that that the
question asks for starting salary range for new hires and does not include contracted
staff. During the November 19 meeting with BJS, we discussed adding a measure
akin to the 2013 Census of Publicly Funded Forensic Crime Laboratories (CPFFCL):

Cognitive Interview Report

On the basis of our conversation with BJS on November 19, we suggest the following new
Question A-9:
NEW QUESTION A-9: Enter the starting annual salary range for full-time staff for
each position in your office as of DATE. Exclude benefits and overtime when reporting
annual salaries. If the position does not exist on a full-time basis, mark N/A. In cases where
there is not a range in salary, please write the same salary twice.
Starting Salary Minimum
a. Autopsy pathologist(s)
b. Coroners/non-physicians
c. Death investigators (or coroner
investigators)
d. Forensic toxicologists

Starting Salary Maximum

N/A

, $, 
$, $, 
$, $, 
$, $, 
$

2018 CMEC

A10. How many of your autopsy pathologists (i.e., medical examiners) are certified by
the American Medical Association (AMA)?

O All autopsy pathologists are AMA certified
O Some autopsy pathologists are AMA certified
O No autopsy pathologists are AMA certified

A10 Findings
No scripted probes were developed for this question; however, five participants were not
sure how to answer this question since they outsource their autopsy pathologists. Eight
participants volunteered that the American Medical Association (AMA) is merely a
professional organization and does not certify anyone, including autopsy pathologists. Seven
of those participants said that the actual entity that certifies the autopsy pathologists is the
American Board of Pathology. Three of those participants suggested breaking this question
down further into the different subspecialties that the board certifies including anatomical
pathology, clinical pathology, or forensic pathology.

A10 Recommendations
Change American Medical Association (AMA) to American Board of Pathology (ABP).
Revise question wording for this and all similar questions to, “How many of your internal
autopsy pathologists…? Do not count any contractors, consultants, or volunteers.”
Add a fourth response option to this and all similar questions, “We do not have any internal
autopsy pathologists.”

A11. How many of your forensic toxicologists are certified by the American Board of
Forensic Toxicology (ABFT)?

O All forensic toxicologists are ABFT certified
O Some forensic toxicologists are ABFT certified
O No forensic toxicologists are ABFT certified

A11 Findings
Similar to A10, no probes were scripted for this question, but many participants had
comments about it. This question was harder to answer than the previous one because
almost half (43%) of the participants contract out for their toxicology testing and are not
sure how many toxicologists in those labs are ABFT certified. One participant suggested

Cognitive Interview Report

adding a question asking if toxicologists were certified by the American Board of Clinical
Chemistry (ABCC). His reasoning was that the ABFT certification came out when his
toxicologist was further along in his career, so it did not make sense for him to go through
that process since he was already certified by ABCC.

A11 Recommendations
Revise this (and similar questions) to include instructions to consider only internal staff.
(i.e., “How many of your internal forensic toxicologists are certified by the American Board
of Forensic Toxicology [ABFT]? Do not count any contractors, consultants, or volunteers.”)
Add a fourth response option to this and all similar questions, “We do not have any internal
autopsy pathologists.”
If forensic chemist is added to the matrix in A8, include it here in A11 as well.

Section B – Budget and Capital Resources
In Section B, which covered budget and capital resource questions, five questions (i.e. B1,
B4, B5, B6, and B7) were determined by interview respondents to be confusing and require
some clarification. Questions B2 and B3 tested well and thus no recommendations are made
below for those two items. Note that Questions B1, B6, and B7 were discussed with BJS on
November 19.

B1. In the fiscal year that included June 30, 2018, what was your total budget?

$,,,.00 If estimate, check here: 
B1 Findings
Participants answered this question either almost instantly, with a simple search, or by
asking their chief administrative staff. During the cognitive interviews we discovered there
was no congruency on what fiscal year agencies use. Seven participants used a calendar
year, five participants used the state calendar from July 1 to June 30, and two participants
used the federal calendar from October 1 to September 30. Three participants did not
understand how to answer the question with the timeframe and date combination provided.

B1 Recommendations
Change B1 to mimic the 2016 Law Enforcement Management and Administrative Statistics
survey to include a section where respondents can provide the end date for their fiscal year
to clear up any confusion they may have. The revised B1 measure would look like:
B1. In the most recently completed fiscal year, what was your total budget?

2018 CMEC

$,,,.00 If estimate, check here: 
NEW QUESTION: What was the last day of your most recently completed fiscal year
(e.g., 06/30, 09/30, 12/31)?

 / 
M

M / D D

B4. In the fiscal year that included June 30, 2018, did you or staff spend any of their
own money to perform their job, including but not limited to, office supplies,
travel costs, certification, and training?

O Yes
O No

B4 Findings
All participants understood this question was asking about staff having to use their own
funds to complete their job and thought the examples listed did a great job summing up the
possible items that a medical examiner or coroner might have to buy with their own funds
to complete job-related duties. There is a wide range of how well offices are funded and
supported by their governing bodies, so all participants felt that this question is important to
ask. Five participants suggested teasing out the examples listed into their own questions to
see where the real issues are with agencies having to pay for their own resources and five
participants thought the question was clear and asked in the best way. One participant
suggested including textbooks and tools as an example. One participant suggested adding in
a second part to this question that asks, “Has anyone not undergone training or certification
because the county or agency could not fund them?” Two participants suggested including
the phrase “required to perform their job,” to emphasize that personally elected
certifications are not to be included.

B4 Recommendations
If BJS is interested in receiving more detailed responses on the basis of the interest and
importance expressed by cognitive interview participants, instead of providing examples,
this question could be made into a table.

Cognitive Interview Report

“In 2018, did you or staff spend any of their own money for the following job-related needs:

Yes

Don’t Know

a. Office supplies

b. Travel costs

c. Certification

d. Training

Need

Add in a new question asking participants “Has anyone in your agency not undergone
necessary training or certification because the agency could not fund them?”

B5. Does your office receive money from any of the following?
Yes

Don’t Know

a. Consultant fees

b. Cremation waiver or permit fees

c. Private autopsy fees

d. Report fees

e. Testimony fees

g. Grants

h. Other (please specify)
_______________________________

Revenue Source

Transportation fees

B5 Findings
All participants understood “receive money” to mean any source of revenue the office
receives outside of their allocated budget. Participants commonly understood what row b.
Cremation waiver or permit fees were, but offices used different terminology. Nine
participants recognized the term ‘cremation waiver or permit fee’ and used it in their office,
two participants use the term ‘cremation authorization’ in their office, one participant uses
the term ‘cremation investigation/certification fee,’ one participant uses the term ‘cremation

2018 CMEC

approval,’ and one participant has never heard of this fee before. Suggestions from
participants on other revenue sources to add to the list include:
One participant suggested including teaching fees, as many might be involved in
external trainings, public speaking, or teach courses at a university.
One participant suggested changing row d to Report/record fees, since those fees go
hand in hand for most offices.

B5 Recommendations
To avoid confusion, include authorization in the response option: “Cremation
waiver/authorization or permit fees.”
Include “teaching fees or speaking honorariums “as a response option in the table.
Include record fees in the response option: “Report/record fees.”

B6. In the fiscal year that included June 30, 2018, what was your average cost for
conducting a full autopsy?

$,.00 If estimate, check here: 
B6 Findings
There was a polar dichotomy with this question regarding whether people knew the average
cost for conducting a full autopsy. Six participants knew the exact cost of conducting a full
autopsy because they contract that service out and know what they pay per case. Eight
participants claimed they would calculate this number by taking their full operational budget
and dividing it by the number of full autopsies they completed. One participant said they
would use the price they give to the National Association of Medical Examiners (NAME) for
reaccreditation every year. Two participants said they would guess and use the estimate
check box. Some suggestions from participants included:
One participant suggested adding in a formula for how we would like them to calculate
the average cost of a full autopsy.
One participant suggested clarifying that we are only talking about a body examination,
because some offices think of the whole death investigation to be part of an autopsy.

B6 Recommendations
BJS decided during the November 19 meeting that Question B6 will be dropped from the
survey.

Cognitive Interview Report

B7. In the fiscal year that included June 30, 2018, what was your average cost for
conducting forensic toxicology testing per case?

$,.00 If estimate, check here: 
B7 Findings
Participants had similar problems answering this question as they did B6. Twelve
participants knew this number because they contract forensic toxicology out and therefore
knew the exact cost. Two participants mentioned there being a wide range in what
toxicology tests could cost, based on the specificity of testing and other factors, so they
were not sure how to answer this question.

B7 Recommendations
BJS decided during the November 19 meeting that Question B7 will be dropped from the
survey.

Section C – Workload (Death Investigations)
The 15 questions in Section C addressed workload-related questions, including measures
related to caseload, functions, and responsibilities. Participants had trouble with 4
questions, including C1, C11, C12, and C14. The remaining 11 items (i.e., C2, C3, C4, C5,
C6, C7, C8, C9, C10, C13, and C15) were well understood and thus no recommendations for
these measures are provided. Notably, Question C12 was discussed with BJS on November
19.

C1. In the fiscal year that included June 30, 2018, did your office receive any referred
cases?

O Yes
O No

C1 Findings
In this question, the term, “referred,” was confusing to every participant interviewed. Six
people understood it as receiving cases from outside agencies, two people understood it to
mean all reported cases to your agency, and six people did not understand it at all. With no

2018 CMEC

congruency in understanding, we will be unable to receive accurate information about
caseload. The intent of this question was to see if the agency had any cases reported to
them but that does not appear to be what the question is capturing. Some suggestions from
participants include:
Two participants suggested changing the term “referred” to “reported.”
Two participants suggested including a definition of what we mean by “referred cases.”
Three participants suggested including the term “jurisdictional cases” to clarify that we
are asking about cases that came to them from the jurisdiction they serve.

C1 Recommendations
On the basis of these findings, the word “referred” should be changed to “reported” with a
definition attached to it, like in Question C3 for “accepted cases.” The inclusion information
from C2 should also be included in C1.

C11. In the fiscal year that included June 30, 2018, how many full autopsies did your
office conduct?

, Full autopsies If estimate, check here: 
C11 Findings
All participants considered a full autopsy to include opening the head and examining all the
internal, visceral organs. One participant suggested including the NAME definition of a full
autopsy for complete clarity on what we are asking for in this question. Six participants said
that it was not possible for a jurisdiction to have zero referred cases but still have autopsies
to report and three participants said that it was possible for a jurisdiction to have zero
referred cases but still have autopsies to report. When participants were asked further
about how their office tracked the number of autopsies completed, eight participants said
they tracked it in their case management system (CMS), one participant tracked it through
billing, one participant tracked it through reports sent to family, and one participant tracked
it manually.

C11 Recommendations
Add in inclusion information after the question, which would read, “A complete autopsy is
defined as an examination and dissection of a dead body by a physician for the purpose of
determining the cause, mechanism, or manner of death, or the seat of disease, confirming

Cognitive Interview Report

the clinical diagnosis, obtaining specimens for specialized testing, retrieving physical
evidence, identifying the deceased or educating medical professionals and students.”
The above definition reflects the National Association of Medical Examiner’s most current
definition, as noted in their Terms and Definitions section of the 2016 Forensic Autopsy
Performance Standards guide. RTI can provide this guide to BJS if requested.
Change the phrase from “full autopsy” to “complete autopsy.”

2018 CMEC

C12. Some functions of a medical examiner or coroner’s office are done within one’s
own office (internally). Other functions may be done by using an outside organization
or independent facility, such as a health department or commercial laboratory
(externally).
Below, please indicate if most of the time your office provides these functions
internally, externally, if the function or service is not available to your office, or
if the function or service is not necessary for your office. Please mark one
response for each row.
My Office
My Office
Provides
Provides Function or Function or
this
this
Service Is
Service is
Function
Function
Not
Not
Function
Internally
Externally
Available
Necessary
a. Death scene investigation

b. Medical record review

c. External examinations

d. Partial autopsy
(Minimal dissection, less than a
complete autopsy)

e. Complete autopsy
(Remove and examine the brain,
thoracic, and abdominal organs)

g. Autopsy photography

h. Forensic toxicology testing

Radiology (X-rays)

Metabolic screen

k. Ancillary scientific investigative
functions
(e.g., microbiology,
anthropology, histology,
neuropathology, cardiac
pathology)

Characterization of skeletal
remains

Cremation waivers

m. Certified death certificates

Cognitive Interview Report

C12 Findings
Twelve participants thought this table was easy to complete but two participants were
confused about the differences between the “not available” and the “not necessary” columns
of the table. Four participants suggested adding “Notifying next of kin” as a function, three
participants suggested adding “odontology” as a function, and two participants suggested
adding “death scene photography” as a function.
Five participants suggested breaking out row k. “Ancillary scientific investigative functions,”
because their office provides some of those functions internally and some externally. This
was a source of confusion for them since the instructions specify that they could only mark
one answer.
Two participants suggested including CT scans as its own line item, separate from row i.
“Radiology,” as research in this area is growing and having a baseline for how many offices
have this technology now will be important in the future. Three participants had difficulty
responding about certified death certificates. They claimed that they were the ones who
completed the death certificates, but it was another agency (e.g. county, state) that
provided the certificates.

C12 Recommendations
Split this into two tables, one a.-j. and one k.-m.
Make separate rows for each suggestion in row k. and use those to replace ancillary
services.
Revise option l. to “Cremation waivers/authorizations” per the findings in B5.
Revise option m. to “Death certificate distribution.”

C14. In your office, who is responsible for notifying the next of kin? Check all that apply.






Medical examiner/coroner personnel
Family services personnel (either internal or external)
Law enforcement personnel
Someone else (please specify) __________________________________

C14 Findings
Eleven participants noticed that they could check all that apply. Two participants who did
not notice they could select more than one answer changed their responses after they were

2018 CMEC

questioned further, and one participant did not. Eleven participants said that there was
nothing confusing about this question. Two participants mentioned that the responsible
party may vary, and they did not want to be misleading by checking all possibilities when
only one did it the majority of the time. One participant did not understand what “family
service personnel” meant. Two participants suggested adding “about death” to this question
for absolute clarity, because MECs also must alert the next of kin about completing an
autopsy or other postmortem testing.

C14 Recommendations
To make it clear that multiple response options may be chosen and that the question asks
about the death of the individual, revise the question to “In your office, who of the following
is responsible for notifying the next of kin about the individual’s death? Check all that
apply.”

Section D – Specialized Death Investigations
The 10 measures in Section D related to specialized death investigations, including items
related to unidentified human remains, sudden infant deaths, and toxicology testing. Four of
the questions tested well (i.e., D5, D6, D7, and D9) and thus, no recommendations are
provided for these measures below.

D1. Does your office have a written policy for final disposition (e.g., burial, cremation,
long-term storage) of unidentified remains after a specified period?

O Yes
O No
O Don’t know

D1 Findings
All participants knew what the phrase “written policy,” meant and were familiar with the
phrase “final disposition.” Twelve participants thought that the examples listed for final
disposition were accurate and helpful. Two other participants said that long-term storage
was only a temporary disposition and therefore should not be included in the examples.

D1 Recommendations
Take out “long-term storage” as an example as it was not seen as a final disposition.

Cognitive Interview Report

D2. In the fiscal year that included June 30, 2018, did your office have any unidentified
remains on record?

O Yes
O No

D2 Findings
All participants were familiar with the term “unidentified remains.” Eleven participants use
the term “unidentified remains” in their office, one participant uses the phrase “skeletal
remains,” one participant uses the term “unidentified,” and one participant uses the phrase
“John/Jane Doe.” Ten participants understood the phrase “unidentified remains on record”
to mean any bones/skeletal remains to be in their office’s possession, one participant
understood it to mean that they had the physical report of unidentified remains, and three
participants did not receive this question. Two participants also mentioned there being
confusion about “unidentified” versus “unclaimed.”

D2 Recommendations
Revise the question to be more specific, such as, “In 2018, did your office have possession
of any unidentified remains that were not identified by the end of 2018?”

D3. In your office, how many total cases of unidentified remains …
a. Were on record as of June 30, 2018?

, Unidentified remains on record If estimate, check here: 
 Don’t know
b. Were on record as of June 30, 2018 and have had DNA evidence collected
from them?

, Have had DNA evidence collected If estimate, check here: 
 Don’t know

2018 CMEC

D3 Findings
Of the 11 participants that received this question, 10 knew the answers to both a. and b.
almost instantly and only one participant had a hard time determining how they would come
up with their answer. Two participants thought we should clarify if we are asking about
historically or currently on record. In part b, 3 participants either were not sure what
constitutes “DNA evidence collected from them” or struggled answering this part of the
question. They did not know if that included the DNA being tested and/or uploaded into
CODIS, or just physically collected.

D3 Recommendations
Clarification from BJS on what constitutes “DNA evidence collected” will help determine the
best course of action for clarifying the question. One suggestion is to clarify b. by adding in
“Please count DNA that has been collected even if it has not yet been tested.”

D4. What is the year of your oldest case of unidentified remains currently on record?


 Don’t know

If estimate, check here: 

D4 Findings
Of the nine participants who had unidentified remains on record, all of them knew the date
of the oldest case of unidentified remains either almost instantly, by looking into their case
management system, or by asking an administration assistant. Eight participants provided
the date that the death was reported to their office, and one participant used the date that
the remains were found, even though it was not when the remains were reported to their
office.

D4 Recommendations
Clarify, if it matters, what date respondents should be using. For example, “Report the date
the remains were reported to your office.”

Cognitive Interview Report

D8. Are the following procedures standard parts of your office’s death investigations
for sudden, unexpected infant deaths?
Procedure

Yes

Don’t Know

Scene investigation

Scene reenactment

Comprehensive forensic toxicology
(e.g., multiple toxin screens)

Complete autopsy

Child or infant death review

D8 Findings
All participants were familiar with the procedures in this table. One participant suggested
adding in a clarification or definition of what was meant by “complete autopsy” to get
correct answers on that row. Five participants suggested adding radiology to this list, two
participants suggested adding pediatric skeletal survey to this list, four participants
suggested adding metabolic screening to this list, two participants suggested adding doll
reenactment, two participants suggested adding genetic testing, and two participants
suggested adding microbiologic testing

D8 Recommendations
Add in the following rows on the basis of participant feedback:
Radiology
Pediatric skeletal survey
Metabolic screening (e.g., pediatric inborn errors of metabolism)
Genetic testing (e.g., sudden cardiac deaths)
Revise row b. to ask, “Scene or doll reenactment.”

2018 CMEC

D10. Does your office perform presumptive toxicology testing, either on scene or at
autopsy, before sending specimens to a toxicology laboratory?

O Yes
O No

D10 Findings
Participants thought of presumptive toxicology testing in different ways. Nine participants
thought that it meant any test that resulted in just a positive or negative result (e.g., urine
dip, saliva test, fecal test), three participants thought it meant any testing done at the
beginning of an autopsy, and two participants did not know what the term meant.

D10 Recommendations
Add in a definition to capture information on the exact testing that needs to be accounted
for in this question. For example, "Does your office perform a screening test that indicates a
preliminary positive result that must be confirmed for a target substance prior to reporting,
also known as presumptive toxicology testing?

Section E – Records and Evidence Retention
Seven questions in Section E covered the infrastructure in place to manage and store
records, such as computerized information management systems, evidence retention
policies, and case record storage. Participants had suggestions for improving two items (i.e.,
E3 and E6) while the remaining questions in the section were easily understood and thus,
no recommendations are provided below (E1, E2, E4, E5, and E7).

E3. Does your office have a written retention schedule for the following sources?
Yes

Don’t Know

a. Case records

b. Forensic toxicology specimens

c. Physical evidence

d. Unidentified remains (including xrays, fingerprints, DNA)

Source

Cognitive Interview Report

E3 Findings
Eleven participants considered a written retention schedule to be a written protocol or
timeline for how to deal with these items. When asked if “source” was the best word to
describe the items in the table, six participants said that source was fine, one participant
said that it would be better to use the term “items,” one participant suggested just dropping
the word from the question, and one participant suggested it would be better to use the
term “area.” One participant had a concern with row d. of this table, because they had a
written retention schedule for the records of unidentified remains (x-rays, fingerprints, DNA)
but did not have a written retention schedule for the actual unidentified remains.

E3 Recommendations
Create a new row specifically for records pertaining to unidentified remains and remove the
parentheses on d. Change the word “Source” to “Items.”

E6. Are hard copies of your official investigative records and reports archived at any of
the following places? Please mark one response for each row.
Yes

a. On site

b. A government-owned or government-paid
storage facility

c. Some other location

Location

E6 Findings
All participants understood this question. When asked about how they knew where their
hard copies or archived records or reports were stored, two participants said they knew
because of their written policy, four participants said they knew because they put the
records there, and two participants said they knew because they pay for the site. Eight
participants said that they have heard of hard copies of documents being stored in
someone’s home or other unofficial locations and two participants said they had not heard
of this practice before. Two participants suggested adding a definition of “on site” for
clarification in this question. A few participants chose “Some other location” and referred to
Iron Mountain as their method of storage. Though not a government or on-site storage
facility, Iron Mountain is a secure and regulated facility, especially when compared to
alternatives such as an individual’s garage.

2018 CMEC

E6 Recommendations
Add in a category for “A regulated third-party storage facility.”

Section F – Resources and Operations
Thirteen measures in Section F were designed to capture information about resources and
operations within the MECs, such as access to resources like databases, trainings,
technologies, and specialized investigative teams. Eight items in this section tested well
(i.e., F1, F3, F4, F6, F9, F11, F12, F13) and therefore no recommendations are made for
these questions. Questions F5 and F8 were discussed with BJS on November 19, 2018.

F2. Does your office have access to the following resources?
Yes

a. Criminal history databases

Fingerprint databases

Prescription drug monitoring programs

Resource

F2 Findings
Six participants understood “access” in this question to mean that they can directly enter
any of these databases and programs to get the information they are looking for. Three
participants understood it to mean being able to ask law enforcement or other partners for
information on these databases and programs. Four participants understood it to mean a
combination of direct access and asking partnerships and one participant had trouble
understanding the question and suggested adding a definition of access to make it clearer.
One participant suggested adding Regional Health Information Organizations as a resource
option though no other participant brought this up.

F2 Recommendations
Revise the question to ask, “Can your office access the following resources, either internally
or externally?”

Cognitive Interview Report

F5. Does your office have access to the following investigative technologies, either
internally or externally?
Yes

a. Computerized axial tomography (CAT) scan

b. Magnetic resonance imaging (MRI)

c. Non-targeted forensic toxicology analysis

Technology

F5 Findings
Participants understood access to mean if they did not have that technology in house, they
could access it through other outside partnerships. Other technologies that participants
would like to have access to range from tablets at the death scene to virtual reality and
artificial intelligence. Eleven participants did not know what “non-targeted forensic
toxicology analysis” was.

F5 Recommendation (Based on Interviews)
On the basis of the November 19 discussion with BJS, it was decided that item c. (nontargeted forensic toxicology analysis) would be dropped and items a. and b. would become
two separate questions.

F7. Does your office have access to the following specialized investigative teams,
either externally or internally?
Yes

a. Child fatality

b. Drug case review/surveillance

c. Vulnerable adult fatality review

Specialty Area

F7 Findings
Nine participants were asked what the term “access,” as it is used in this question, means
to them. Of those, six participants understood access to these teams as meaning that they
could call on any of them for assistance in a case, and three participants understood access
to these teams to mean that they or someone on their staff was a part of the team.

2018 CMEC

In response to another probe, ten participants said that they would answer yes to a
specialty team if they had never used it before but knew that they could. Some suggestions
for additions to this list include: poison case review, suicide review, elderly case review,
maternal death, infectious disease and drowning review.

F7 Recommendations
For consistency with F2, revise the question text to “Can your office access the following
specialized investigative teams, either internally or externally?”
Unless there is a concern with the length of the survey, we suggest adding the following
suggested investigative teams:
Poison investigative team
Suicide investigative team
Elderly investigative team
Maternal death investigative team
Infectious disease investigative team
Drowning investigative team

Cognitive Interview Report

F8. To what extent are the following resources needed to improve your ability to
complete cases?

Not at all

To some
extent

To a
moderate
extent

To a great
extent

a. Death investigation staff (e.g.,
medical examiners, coroners, death
investigators, anthropologists,
histologists, forensic toxicologists)

b. Administrative and ancillary staff
(e.g., technicians, autopsy
technicians, photographers,
administrative assistants,
accountants, drivers)

c. Training

d. Laboratory/facility space

e. Administrative and evidence storage
facilities

g. Analytical instrumentation and
laboratory supplies

h. Access to literature resources (e.g.,
books, journals, electronic mailing
lists, databases)

Resources

Office equipment (e.g., computers,
software)

Other (please specify)
_______________________________

F8 Findings
Four participants understood this question to mean that if they had more of these people
and resources, they could take on a larger workload. The rest of the participants had mixed
understandings that ranged from feeling that we were saying they are unable to complete
cases—resulting in a defensive tone—to thinking we just wanted to know if they thought
these items were important in an office. One suggestion from a participant was to ask how
many of these positions in office are unfilled to gather more accurate information about
workload capacity and staffing issues.

2018 CMEC

F8 Recommendations
On November 19, BJS decided that this question will be removed.

F10. Does your office have access to the following support services, either externally or
internally?
Support Service

Yes

Advocates for families of victims

Grief and bereavement services for survivors (e.g.
counseling or therapy, homicide survivor groups)

On-scene support or advocacy for bystanders or
other family and friends of the deceased

Other (please specify)
_______________________________

F10 Findings
Participants did not have any problems answering this question. All 9 who were questioned
further understood access to mean that they were aware of these resources and could call
on them as needed to come to a scene. Six participants understood “on-scene support” to
mean they could have someone come directly to the scene and assist bystanders, 3
participants understood it to mean they could provide contact information for one of these
services to people on the scene, and 4 participants were not asked this probe due to time
constraints. Of the 10 participants who answered ‘yes’ to having access to the support
services listed, 7 participants said these services were provided externally and 3 participants
said some were provided externally and some were provided internally.

F10 Recommendations
To be consistent with F2 and F5, revise the question wording to “Can your office access the
following support services, either internally or externally?”

3. Miscellaneous Topics
Burden
Participants reported a great deal of variation in the amount of time that they estimated it
would take to complete the survey. Two participants said that it would take them less than

Cognitive Interview Report

30 minutes, five participants said it would take them 30 minutes and 1 hour, three
participants said it would take them between 1 hour and 1 hour and 30 minutes, three
participants said it would take them between 1 hour and 30 minutes and 1 hour and
45 minutes, and one participant said it would take 2 hours. Assuming the upper bound of
these estimates, the average time it was estimated to complete the CMEC was 1 hour and
16 minutes. Thus, to be conservative, we recommend that the burden estimate for this
survey be 90 minutes.
Notably, five participants mentioned enlisting the aid of other staff (Director of Operations,
Chief Investigator, Accountant, Human Resources) in filling out the survey.

Data Availability
Twelve out of 14 of the participants had a computerized information management system
that they could reference to get exact numbers for questions concerning caseload. Five
participants had to ask other staff members such as the Director of Operations, Human
Resources, or the accounting department about budgetary questions. When asked about
how they may respond to the questionnaire on their own, six participants said they would
provide exact numbers throughout the survey, three participants said they would use a mix
of both estimates and exact numbers when filling out the survey on their own, and five
participants did not answer this probe due to time.

General Feedback
There were three questions in which there was interest in knowing whether the field
believed the data captured would be important enough to include on the CMEC. These three
questions are listed below, followed by quotations from the participants. Notably, across all
three measures, all participants agreed that each measure was important.

B4.

In the fiscal year that included June 30, 2018, did you or staff spend any of their
own money to perform their job, including but not limited to, office supplies,
travel costs, certification, and training?

Is this question important?
“Yes, because it will show how underfunded people are and why they aren’t more educated
and certified”
“Yes, there are jurisdictions that are having to use their own money for cars, body bags,
etc. This is a huge issue.”
“Without a doubt. I think it’s one of the most important [issues to provide information to
BJS about the MDI community]”
“Yes, it’s helpful to know about how [frequently] employees are paying to meet agencies’

2018 CMEC

missions.”

F1. Does your office have access to the Internet separate from a personal device?
“Yes, because [accessing the Internet] is something people should be able to do, and it
would be indicative of the electronic capabilities of an office. If a medical examiner
didn’t have it, that would be a big red flag.”
“Yes, I can’t imagine working for an office that doesn’t have access to Google, but I’m sure
that is the case in some offices”
“You would think that in this day and age this wouldn’t be important, but it is. There are lots
of agencies that do not have access to computers, so yes.”
“I actually do. This just came up in [REDACTED] about how many coroners work out of their
house and don't have money to pay for Internet.”
“Yes, there is a lot of stuff happening out there that would scare people to death. So, this
tells you where those people are able to do their job.”

F4. Does your office participate in county/statewide emergency response drills?
Do you view this question as important?
“Absolutely, and it needs to be asked to know if they are doing those currently. If they are
not training like this, how could they react if something happened? And, if they are
not participating, then it could also show that disciplines are really siloed and not
working together.”
“Yes, we don’t get enough trainings for the increasing amount of incidents that require
training.”
Respondents believed that the above three questions were crucial in understanding the lack
of resources, funding, and training that MECs across the country are currently experiencing.
These interviews suggest that these three topics are important to the MEC community.

CMEC Overall
At the beginning of each cognitive interview, interviewers read the BJS goal card for the
CMEC to participants. After the participants had gone through the instrument, they were
asked if they felt that the instrument aligned with all three of the goals listed. Five
participants were not asked this probe due to time constraints. Three participants believed
that the survey was responsive to all three goals. Five participants believed that the survey
was responsive to the goals except for the third goal that discussed the relationship
between MECs and law enforcement. One participant believed the survey was responsive to

Cognitive Interview Report

only the first goal regarding creating statistical data for the medicolegal death investigation
field.
In general, the cognitive interview participants were supportive of the CMEC and multiple
participants expressed gratitude to BJS for conducting this survey and asking some of these
difficult questions. It was clear to all involved in the interviews that the participants had
concerns about their field that will be addressed in the 2019 CMEC.

Appendices A, B, and C removed for brevity.
See generic clearance package (OMB
1121-0339) for all materials related to
cognitive interview process:
https://www.reginfo.gov/public/do/
PRAViewIC?
ref_nbr=201512-1121-004&icID=232935

Appendix D:
Cognitive Interview Protocol

D-1

Cognitive Interview Protocol
Participant#________
Date of Interview__________________
READ (OR PARAPHRASE) THE FOLLOWING TO THE SUBJECT AFTER THE INFORMED CONSENT IS SIGNED:
On behalf of the Bureau of Justice Statistics and the project team at RTI, thank you for participating in
the testing of the 2018 Census of Medical Examiners and Coroners. We’re talking today because we
want to see how well people understand these questions and how they might answer them. BJS’s goals
for the 2018 survey are listed on the reference card you received with the survey.
During this process, you and I will go through the survey items together while you answer the questions
you can without doing additional research. For those questions for which you would need to do
additional research, please tell me whether you would be able to answer the question and, if so, how
long it would take to get the answer. In the same spirit, you do not need to provide exact numbers; you
can just estimate. However, please let me know if you would not be able to provide exact numbers
when we are actually collecting these data next year.
After some questions, I may stop you and ask how you came up with your answer, or what specifically
you were thinking about. These questions will help me understand your thought process when
answering the questions. In order for me to know where you are in the survey, I ask that you read
aloud anything your read on the paper whether it’s instructions, questions or response options.
There are no right or wrong answers to the questions I ask. Our goal is to make sure that the questions
make sense and that people like yourself can answer them and follow the questionnaire instructions
easily. You can help us by pointing out anything you find confusing or unclear. If something doesn't
make sense, please tell me that and why that phrase or item is unclear. Or, if you're not sure about your
response, please tell me that too.
Do you have any questions? [ANSWER ANY QUESTIONS]

Ok, let’s begin.
First, I have a few general questions about you.
Probe1. What is your job title?
Probe2. How long have you been in this position?
Probe3. (If needed) How long have you been at your agency?

SECTION A

ADMINISTRATIVE

A1. What is the title of the chief position in your medical examiner or coroner office (e.g.,
Chief Medical Examiner, Coroner) and who holds that title?
Title:

__________________________________

Name: __________________________________
A2. Which of the following best describes your death investigation office?

O
O
O
O
O

Probe1. Is anything missing from the list of responses?

Probe2. Do you believe that justices of the peace should be included in the scope of this survey
given BJS’s goals for this effort?

A3. What level of government best describes your office?

O
O
O
O

City office
County office
District/regional office
State office

A4. Which of the following best describes the agency your office reports to?

O
O
O
O
O
O

Probe1. What does a “department or division of forensic science” mean to you?

Probe2. Is anything missing from the list of response options?

A5. What jurisdictions does your office serve (e.g. Illinois State, Los Angeles County, New
York City, First Judicial District)?

A6. Is your office accredited by the International Association of Coroners & Medical
Examiners (IAC&ME)?

O Yes
O No
O I expect that my office will be accredited by IAC&ME by December 31, 2019.

A7. Is your office accredited by the National Association of Medical Examiners (NAME)?

O Yes
O No
O I expect that my office will be accredited by NAME by December 31, 2019.

Full-time employees are those regularly scheduled for 35 or more hours per week.
Part-time employees are those regularly scheduled for 34 or less hours per week.

Role

Full-Time
Employees
on June 30,
2018

Part-time
Employees
on June 30,
2018

Consultants/
Contractors
on June 30,
2018

Unpaid
Volunteers
on June 30,
2018

a. Autopsy pathologists



b. Coroners/non-physicians



c. Death investigators (or
coroner investigators)



d. Forensic Toxicologists



e. Other scientific investigative
support staff (e.g.,
anthropologists, histologists)



f. Administrative staff (e.g.,
secretary, accountant)



g. Ancillary staff (e.g., drivers,
photographers)



Probe1. What would be involved in obtaining these numbers for your office?

Probe2. How long do you think it would take to get these numbers?

Probe3. Are there any roles for which you would have trouble providing staff numbers?

Probe4. Are there any scenarios here where you would not know where to put an employee (i.e.,
fits in multiple categories, missing category)?

If you do not have any coroners or death investigators, SKIP to box above A10.
A9. How many of your coroners or death investigators are certified by the
American Board of Medicolegal Death Investigators (ABMDI)?

O All death investigators are ABMDI certified
O Some death investigators are ABMDI certified
O No death investigators are ABMDI certified
Probe1. What does the response option “No death investigators” mean to you?

If you do not have any autopsy pathologists, SKIP to box above A11.
A10. How many of your autopsy pathologists (i.e., medical examiners) are certified
by the American Medical Association (AMA)?

O All autopsy pathologists are AMA certified
O Some autopsy pathologists are AMA certified
O No autopsy pathologists are AMA certified

If you do not have any forensic toxicologists, SKIP to B1.
A11. How many of your forensic toxicologists are certified by the American Board
of Forensic Toxicology (ABFT)?

O All forensic toxicologists are ABFT certified
O Some forensic toxicologists are ABFT certified
O No forensic toxicologists are ABFT certified

SECTION B

BUDGET AND CAPITAL RESOURCES

B1. In the fiscal year that included June 30, 2018, what was your total budget?

$,,,.00

If estimate, check here: 

Probe1. What time frame are you thinking about when answering this question?

Probe2. When does your fiscal year begin and end?

Probe3. How easy or difficult will it be for you to come up with this number?

B2. Does your office have a specific personnel budget for items such as wages, salaries
and benefits?

O Yes
O No
Probe1. What do you consider a “personnel budget”?

If your office does not have a specific personnel budget, SKIP to B4.
B3. How much of the total budget was allocated for personnel costs?

$,,.00 If estimate, check here: 
Probe1. How easy or difficult will it be for you to come up with this number?

B4. In the fiscal year that included June 30, 2018, did you or staff spend any of their own
money to perform their job, including but not limited to, office supplies, travel
costs, certification, and training?

O Yes
O No
Probe1. What do you think this question is asking?

Probe2. Can you give me an example of a situation that should be counted in this question?

Probe3. Is this question important?

Probe4. Is there a better way of asking this question?

B5. Does your office receive money from any of the following?
Revenue Source

Yes

Don’t Know

a. Consultant fees

b. Cremation waiver or permit fees

d. Report fees

e. Testimony fees

g. Grants

h. Other (please specify)
_______________________________

Private autopsy fees

Transportation fees

Probe1. What do you think we mean by “receive money”?

Probe2. What do “cremation waiver or permit fees” mean to you? Is there a better way of
describing this type of fee?

Probe3. Can you think of anything missing from this list?

B6. In the fiscal year that included June 30, 2018, what was your average cost for
conducting a full autopsy?

$,.00 If estimate, check here: 
Probe1. How would you come up with your answer to this question?

B7. In the fiscal year that included June 30, 2018, what was your average cost for
conducting forensic toxicology testing per case?

$,.00 If estimate, check here: 
Probe1. How would you come up with your answer to this question?

SECTION C

WORKLOAD (DEATH INVESTIGATIONS)

C1. In the fiscal year that included June 30, 2018, did your office receive any referred
cases?

O Yes
O No
Probe1. What do you consider to be a “referred case”?

Probe2. What do you think about using the term “reported” instead of “referred” (i.e. …did your
office receive any reported cases?)
IF THEY LIKE “REPORTED” BETTER: Did you like the way the question was worded, or
can you think of a better way to phrase it, such as, “In the fiscal year that included June
30, 2018, were any cases reported to your office?”
Probe 3. What would you think if we asked about “reported or referred cases?”

If your office did not receive any referred cases, SKIP to C11.

C2. In the fiscal year that included June 30, 2018, what was the total number of
cases referred to your office, including all cases in which your office
conducted an investigation or documented referral of the case to your
office?
 We did not track referred cases

, Total cases referred

If estimate, check here: 

Probe1. Would you be able to access this number easily?

Probe2. IF NEEDED, What would you have to do to come up with this number?

Probe3. What do you think of the checkboxes provided here? How would you use them?

C3. “Accepted cases” are cases for which the office completes the death certificate or
otherwise determines the cause and manner of death. For the fiscal year including
June 30, 2018, did you have any accepted cases? Do not include cremation approval
cases or cases in which jurisdiction was declined.

O Yes
O No
Probe1. Would you be able to access this number easily?

Probe2. What did you think of the definition of “accepted cases” that we provided?

If your office did not have any accepted cases, SKIP to C5.

C4. In the fiscal year that included June 30, 2018, what was the total number of
cases accepted by your office? Do not include cremation approval cases or
cases in which jurisdiction was declined.
 We did not track accepted cases

, Total cases accepted

If estimate, check here: 

Check Your Numbers! The number of your “accepted cases” in C4 should be LESS THAN
or EQUAL TO the number of “referred cases” in C2.
Probe1. How would you come up with the total number of accepted cases?

Probe2. What are your thoughts on the “Check Your Numbers!” box?

Probe3. IF NEEDED, Did you read the information on what cases not to include?

C5. In the fiscal year that included June 30, 2018, did your office receive any referred
cases from tribal lands? The term ‘tribal lands’ includes areas labeled Indian Country,
federal or state recognized reservations, trust lands, Alaska Native villages, and tribal
communities.

O Yes
O No
Probe1. Do you have any tribal lands in the jurisdiction you serve?

Probe2. IF NO, Do you think we should have a way for you to indicate that your jurisdiction does
not serve tribal lands?

Probe3. IF NEEDED, Did you read the description of what should be considered “tribal lands”?

If your office did not receive referred cases from tribal lands, SKIP to C11.

C6. In the fiscal year that included June 30, 2018, how many of the total cases
referred to your office were from tribal land(s)?
 We did not track referred cases from tribal lands

, Referred from tribal lands

If estimate, check here: 

C7. Did you include cases referred from tribal lands (C6) in the total number of
referred cases (C2) you reported?

O Yes
O No
Probe1. In your own words, what do you think this question is asking?

C8. In the fiscal year that included June 30, 2018, did your office accept any cases from
tribal lands?

O Yes
O No
Probe1. Do you think we need to provide the definition of “tribal lands” again on this question?

If your office did not accept any cases from tribal lands, SKIP to C11.

C9. In the fiscal year that included June 30, 2018, how many of the total cases
accepted by your office were from tribal land(s)?
 We did not track accepted cases from tribal lands separately

, Accepted from tribal lands

If estimate, check here: 

Check Your Numbers! The number of your “accepted cases” from tribal lands in C9 should
be LESS THAN or EQUAL TO the number of “referred cases” from tribal lands in C6.

C10. Did you include cases accepted from tribal lands (C9) in the total number of
accepted cases (C4) you reported?

O Yes
O No
Probe1. In your own words, what do you think this question is asking?

C11. In the fiscal year that included June 30, 2018, how many full autopsies did your
office conduct?

, Full autopsies

If estimate, check here: 

Probe1. What do you think we mean by “full autopsies”?

Probe2. Is it possible for a jurisdiction to have zero referred cases but still have autopsies to
report? What about accepted cases?

Probe3. How does your office track the number of autopsies completed?

My Office
Provides
this
Function
Externally

Function or
Service Is
Not
Available

Function or
Service is
Not
Necessary

a. Death scene investigation

b. Medical record review

c. External examinations

d. Partial autopsy
(Minimal dissection, less than a
complete autopsy)

e. Complete autopsy
(Remove and examine the brain,
thoracic, and abdominal organs)

g. Autopsy photography

h. Forensic toxicology testing

Radiology (X-rays)

Metabolic screen

Function

Characterization of skeletal
remains

k. Ancillary scientific investigative
functions

(e.g., microbiology, anthropology,
histology, neuropathology, cardiac
pathology)
l.

Cremation waivers

m. Certified death certificates

Probe1. How easy or difficult was it to complete this table?

Probe2. IF NEEDED, How did you decide whether a function was “not necessary”? GO BACK
THROUGH TABLE IF NEEDED.

Probe3. IF NEEDED, How did you decide what functions were provided internally vs. externally?
GO BACK THROUGH TABLE IF NEEDED.

Probe4. Were there any function descriptions in the first column that you were not sure what they
meant, or that you would change?

Probe5. Are there any functions you think are missing?

C13. For those functions that are conducted internally at your office, who are the people
that perform those duties? Please mark all that apply.
Not
Performed
by My
Office

Autopsy
Pathologists

Coroner/NonPhysician

Death
Investigators

Other
Internal
Staff

a. Death scene
investigations



b. Determination of
which cases are
accepted/ declined



External
examinations



d. Determination of
which cases are
autopsied



e. Determination of
which cases
receive forensic
toxicology testing



Duty

Probe1. How easy or difficult was it to understand how to complete this table?

Probe2. Where there any items here you weren’t sure how to answer?

Probe3. How would you answer if you outsourced any of these duties?

Probe4. IF ANSWERED OTHER: What other internal staff were you thinking of?

Probe5. IF ONLY MARKED ONE ANSWER EACH, Was it clear that you could pick more than one
answer per row?

C14. In your office, who is responsible for notifying the next of kin? Check all that apply.






Medical examiner/coroner personnel
Family services personnel (either internal or external)
Law enforcement personnel
Someone else (please specify) __________________________________

C15. In your office, who is responsible for follow-up communication with the next of kin,
such as cultural preferences, returning belongings, and other policies and
procedures? Check all that apply.






Medical examiner/coroner personnel
Family services personnel (either internal or external)
Law enforcement personnel
Someone else (please specify) __________________________________

Probe1. Did you notice that you could check more than one option?

Probe2. Was there anything confusing about these questions?

Probe3. Is anything missing from the list of responses?

SECTION D

SPECIALIZED DEATH INVESTIGATIONS

D1. Does your office have a written policy for final disposition (e.g., burial, cremation,
long-term storage) of unidentified remains after a specified period?

O Yes
O No
O Don’t know
Probe1. What do you think we mean by a “written policy”?

Probe2. Is the phrase “final disposition” familiar to you?

Probe3. What do you think of the examples listed?

D2. In the fiscal year that included June 30, 2018, did your office have any unidentified
remains on record?

O Yes
O No
Probe1. What does having “unidentified remains on record” mean to you? Can you give an
example?
Probe2. Does your office use the term “unidentified remains” or do you call them something else?

If your office did not have any unidentified remains on record, SKIP to D6.

D3. In your office, how many total cases of unidentified remains …
a. Were on record as of June 30, 2018?

, Unidentified remains on record If estimate, check here: 
 Don’t know

b. Were on record as of June 30, 2018 and have had DNA evidence collected from
them?

, Have had DNA evidence collected If estimate, check here: 
 Don’t know
Probe1. How easy or difficult is it for you to come up with these numbers?

Check Your Numbers! Make sure the number of unidentified remains that have had DNA
evidence collected in D3b is LESS THAN or EQUAL TO those presently on record in D3a.

D4. What is the year of your oldest case of unidentified remains currently on
record?

 If estimate, check here: 
 Don’t know
Probe1. Describe how you would determine what the “oldest case of unidentified remains
currently on record” was.
Probe2. What year do you think we are asking for when we ask for the year of your oldest case of
unidentified human remains? (e.g., year they were found, expected year of death, etc.)?

D5. In the fiscal year that included June 30, 2018, how many unidentified remains
were classified as unidentified in their final disposition?

, Unidentified in final disposition If estimate, check here: 
 Don’t know
Probe1. What does “unidentified in their final disposition” mean to you?

D6. Does your office use the Sudden Infant Death Syndrome, or SIDS, diagnosis?

O Yes
O No

D7. Does your office use the Sudden Unexplained Infant Death, or SUID, diagnosis?

O Yes
O No
Probe1. On these last two questions, would it effect either answer if we asked if the “certifying
pathologist” used these diagnosis, as opposed to “your office”?

D8. Are the following procedures standard parts of your office’s death investigations for
sudden, unexpected infant deaths?

Procedure

Yes

Don’t Know

Scene investigation

Scene re-enactment

Comprehensive forensic toxicology
(e.g., multiple toxin screens)

Complete autopsy

Child or infant death review

Probe1. Are you unfamiliar with any procedures listed here?

Probe2. Is anything missing from the list of responses?

D9. Has the increase in novel psychoactive substances and the opioid epidemic changed
your strategy for forensic toxicology testing?

O Yes
O No

Probe1. What drugs come to mind when you see the phrase “novel psychoactive substances”?

Probe2. Do you think your strategy for toxicology testing will change any time soon?

Probe3. IF YES, What changes have been made to your strategy for forensic toxicology testing?

D10. Does your office perform presumptive toxicology testing, either on scene or at
autopsy, before sending specimens to a toxicology laboratory?

O Yes
O No
Probe1. What does the phrase “presumptive toxicology testing” mean to you?

SECTION E

RECORDS AND EVIDENCE RETENTION

E1. Does your office have a computerized system used to manage, compile, or track
cases or evidence? Such a system is also known as a computerized information
management system or CMS. This does not include the use of Excel or other
spreadsheet software to manage case information.

O Yes
O No
Probe1. How does your office keep track of cases and/or evidence?

Probe2. What time frame are you thinking about when answering this question? Currently? The
fiscal year including June 30, 2018?

If you do not have a computerized system, or CMS, SKIP to E3.

E2. Is your computerized information management system or CMS networked so
that information on all cases is available to all authorized users?

O Yes
O No
Probe1. What do you think we are asking about in this question?

E3. Does your office have a written retention schedule for the following sources?
Source

Yes

Don’t Know

a. Case records

b. Forensic toxicology specimens

Physical evidence

d. Unidentified remains (including x-rays,
fingerprints, DNA)

Probe1. In your own words, what is a written retention schedule?
Probe2. Does it make sense to use the word “source” to describe the items in the table? Any
suggestions for other terminology?

E4. Are case records maintained for storage as hard copies, electronically, or both?

O Hard copies
O Electronically
O Both
Probe1. When answering this question, were you thinking of only new cases or all cases?

E5. Does your office archive hard copies of your official investigative records and
reports?

O Yes
O No
Probe1. IF YES, Does your office archive hard copies of both investigative records and reports?

Probe2. IF NO, Does your office archive hard copies of neither investigative records nor reports?

If your office does not archive hard copies, SKIP to F1.
E6. Are hard copies of your official investigative records and reports archived at
any of the following places? Please mark one response for each row.
Location

Yes

a. On site

b. A government-owned or government-paid storage
facility

Some other location

Probe1. How do you know where hard copies of archived records and reports are stored?
Probe2. Have you seen or heard of hard copy archives being stored at personal or non-official
locations, such as at someone’s house?

Probe3. IF NOT SOME OTHER LOCATION, What other locations can you think of where hard
copies may be stored?

If your office does not archive hard copies at some other location (you answered ‘No’ to
E6C), SKIP to F1.
E7. At what other location do you archive hard copies of your official investigative
records and reports?
______________________________________________________________________
______________________________________________________________________

SECTION F

RESOURCES AND OPERATIONS

F1. Does your office have access to the Internet separate from a personal device?

O Yes
O No
Probe1. What do you think we are asking for in this question?

Probe2. Do you think this question is important to ask?

F2. Does your office have access to the following resources?
Resource

Yes

a. Criminal history databases

Fingerprint databases

Prescription drug monitoring programs

Probe1. What does “access” to these resources mean to you?

F3. Does your office currently have access to the following trainings or resources, either
externally or internally?
Training or Resource
a. Mass Fatality Investigation

Yes

Disaster planning (e.g., National Incident
Management System [NIMS])

Bloodborne pathogens

Proper lifting procedures

Stress management

Probe1. Is anything missing from the list of responses?

Probe2. What does access to trainings mean to you?

F4. Does your office participate in county/statewide emergency response drills?

O Yes
O No
Probe1. Would it be better to ask offices if they have ever participated in emergency response
drills?
Probe2. Do you view this question as important?

F5. Does your office have access to the following investigative technologies, either
internally or externally?

Technology

Yes

a. Computerized axial tomography (CAT) scan

b. Magnetic resonance imaging (MRI)

Non-targeted forensic toxicology analysis

Probe1. What does it mean for you to have “access to” an investigative technology?

Probe2. What are some other technologies you have or would like to have access to?

Probe3. What does “non-targeted forensic toxicology analysis” mean to you?

F6. What other investigative technologies not listed here does your office have access
to?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

F7. Does your office have access to the following specialized investigative teams, either
externally or internally?

Specialty Area

Yes

a. Child fatality

b. Drug case review/surveillance

Vulnerable adult fatality review

Probe1. What does it mean to have access to specialized investigative teams?

Probe2. Would you answer yes to a specialty team if you have never used them but knew that you
could if you needed to?

Probe3. Can you think of any other investigation teams we should add to this list?

F8. To what extent are the following resources needed to improve your ability to
complete cases?

Not at all

To some
extent

To a
moderate
extent

To a great
extent

a. Death investigation staff (e.g., medical
examiners, coroners, death
investigators, anthropologists,
histologists, forensic toxicologists)

b. Administrative and ancillary staff (e.g.,
technicians, autopsy technicians,
photographers, administrative
assistants, accountants, drivers)

d. Laboratory/facility space

e. Administrative and evidence storage
facilities

g. Analytical instrumentation and
laboratory supplies

h. Access to literature resources (e.g.,
books, journals, electronic mailing lists,
databases)

Resources

Training

Office equipment (e.g., computers,
software)

Other (please specify)
_______________________________

Probe1. What do you think this question is asking?

Probe2. What do you think we mean by “ability to complete cases”?

Probe3. Are there any additional resources we should add to this list?

Probe4. What did you think of the examples provided in the table? Were they helpful?

Probe5. Would it make a difference to you if we listed the resources in a different order?

F9. Does your office currently participate in any of these data collection efforts?

Data Collection

Yes

Don’t
know

Combined DNA Index System (CODIS)
Sponsor: Federal Bureau of Investigation (FBI)

Fatality Analysis Reporting System (FARS)
Sponsor: National Highway Traffic Safety Administration
(NHTSA)

National Crime Information Center (NCIC)
Sponsor: Federal Bureau of Investigation (FBI)

National Forensic Laboratory Information System (NFLIS)
Sponsor: Drug Enforcement Agency (DEA)

National Missing and Unidentified Persons System (NamUs)
Sponsor: Department of Justice (DOJ)

National Violent Death Reporting System (NVDRS)
Sponsor: Centers for Disease Control and Prevention (CDC)

State or local data collections

Other data collection

Probe1. Have you heard of all of these data collection efforts?

Probe2. Have you participated in any of these in the past?

Probe3. IF STATE/LOCAL OR OTHER, What is the other data collection effort you participate in?

F10. Does your office have access to the following support services, either externally or
internally?
Support Service

Yes

a. Advocates for families of victims

b. Grief and bereavement services for survivors
(e.g. counseling or therapy, homicide survivor
groups)

On-scene support or advocacy for bystanders or
other family and friends of the deceased

d. Other (please specify)
_______________________________

Probe1. What does it mean to “have access” as it is used in this question?

Probe 2. What does “On-scene support or advocacy for bystanders or other family and friends of
the deceased” mean to you?

Probe3. IF YES TO ANY, How do you have access to these services? Internally? Externally?

Probe4. IF NO, Do you know of any of these services that exist that you don’t have access to?

F11. Is your office located within another business, such as a funeral home?

O Yes
O No
F12. Does your office have a Department Originating Agency Identifier Number or, ORI
number?

O Yes
O No
O Don’t know
If you do not have a Department Originating Agency Identifier Number (ORI), SKIP to END.

Probe1. IF NO, Have you heard of a Department Originating Agency Identifier Number or ORI
number?

F13. What is your Department Originating Agency Identifier Number or ORI
number?


END. Thank you for your participation in the 2018 Census of Medical Examiner and
Coroner Offices (CMEC). Your feedback is very important to us!
GENERAL PROBES
1. How long do you think it would take to complete the survey, including gathering all of the
data necessary to answer these questions?
2. Overall, what did you think of this survey?
3. Were there any questions that were unclear or confusing that we did not already talk
about?
4. What did you think about the “estimate” checkboxes? What about the “don’t know”
checkboxes? (Examples: D3-D6)
a. Would any of your answers have been different if those checkboxes weren’t there?
b. If you weren’t sure of an answer, would you estimate and use the checkbox or
would you leave it blank?
5. Did you notice that some questions had words in italics for emphasis? (See F8)
6. When completing this survey, would you provide your exact numbers or would you guess
and estimate?
7. IF NOT ALREADY DETERMINED: How many people would be involved in supplying the
answers to these questions?
8. Who at your office would be responsible for completing this survey? Do you think

you/they would prefer to fill it out on paper or on the web?
9. If we were to ask about the size of the population you serve, what would be the best way to
collect those data? Do you think that is important to ask?
10. What could we do to make it easier or more likely for you to complete the survey?
11. Can you let me know if these questions are responsive to BJS’s goals? POINT OUT GOAL
SHOWCARD.
On behalf of BJS and RTI, thank you so much for your time. Those are all of the questions I have. If you
think of anything else that would be helpful for us to know as we refine this survey, please don’t hesitate
to send us an email.

</pre><Table class="table"><tr><Td>File Type</td><td>application/pdf</td></tr><tr><Td>Author</td><td>Howard Snyder</td></tr><tr><Td>File Modified</td><td>2019-02-22</td></tr><tr><Td>File Created</td><td>2019-02-14</td></tr></table></div></div></div><hr>
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