By Megan Flaherty
Illustration by Malcolm Garris/PhotoDisc
February 18, 1999

Nurses who work as death investigators learn to expect the unexpected and try to make sense of the senseless. For them, no day is typical and no case is routine. They investigate everything from homicides and suicides to deaths from drug overdoses, car accidents, and occupational injuries.

"Our job is to determine the facts surrounding the manner and cause of death," said Steve Woods, LPN, deputy coroner-investigator for Washoe County in Nevada. Susan Chewning, RN, the coroner of Charleston County in South Carolina, said, "We’re there to represent the deceased and the families and make sure they get a fair investigation."

The eyes and ears

According to the national Centers for Disease Control and Prevention, coroners and medical examiners are responsible for investigating sudden or violent deaths and providing accurate and detailed determinations of the manner and cause of these deaths.

Death investigators—who are sometimes nurses—are the "eyes and ears" for a medical examiner or coroner, said Mary Dudley, MD, MS, RN, a forensic pathologist for the Maricopa County medical examiner’s office in Arizona who teaches death investigation courses through the International Association of Forensic Nurses.

A death investigator’s job description differs by jurisdiction. Common responsibilities include going to a death scene—a person’s home or an accident site, for example—and observing and photographing the body. Death investigators regularly interview family members and gather evidence and information, such as medications the deceased may have recently taken and medical records. The evidence helps a coroner or pathologist decide whether an autopsy needs to be performed. Death investigators may also inform family members of a death. In homicide cases, they occasionally may testify in court.

Although traditionally the domain of law enforcement officials, death investigation comes naturally to nurses who are cross-trained in criminalistics and legal issues, experts say. The experience of interacting with physicians and families gives nurses an advantage, Chewning said. A nurse’s knowledge of medical terminology and interviewing skills are also helpful. "We have the necessary psychosocial as well as the scientific background," Chewning said. A nurse’s background in anatomy, physiology, and pharmacology is also useful in death investigations, Woods said. Individuals who have at least 4,000 hours’ experience as coroners or as death investigators in coroner’s or medical examiner’s offices are eligible to become certified medicolegal death investigators, according to the American Board of Medicolegal Death Investigators.The starting salary for death investigators is between $34,000 and $45,000 in Woods’ jurisdiction.

Nurses often are more effective as death investigators than police officers, said John McPhail, PhD, RN, of the Colorado Mental Health Institute in Pueblo, who conducts clinical forensics programs for health professionals, law enforcement officials, and attorneys. "It’s easier to teach investigative skills to nurses than medical skills to police officers," he said.

Although it sometimes takes a little sleuthing to determine a cause of death, usually a death investigator’s detective work ends there. "Catching the crooks is up to the law enforcement agencies," Woods said.

Challenges and rewards

Investigating deaths can be difficult and intense at times, but the rewards can be great. McPhail once spent three days in an autopsy room taking photos of different types of injuries. For weeks afterward he compiled the photos into a slide show for one of his courses. Because he spent so much time looking at them, the photos—especially those of children—started to disturb him. "I found I wasn’t sleeping well at night," he said.

However, the slides have been invaluable in teaching health professionals to identify injuries such as bite marks, "pattern injuries" (mirror images of the object that caused the injuries), and other subtle indications of trauma associated with abuse or neglect. "Sometimes a nurse in the audience will suddenly recognize an injury she has seen previously but hadn’t been able to identify, and a light will go on," McPhail said.

Most nurses who take death investigation courses work with victims of child, domestic, or elder abuse or other mistreatment and can use what they learn to make a difference for their patients. "We learn so much that will benefit the living through the dead," McPhail said. "We’re trying to teach people to question an injury when they see it. We’ve got to ask, ‘Did someone do this to you?’ "

Death investigators focus on the positive aspects of their job—finding answers for and dealing sensitively with grieving families—rather than the sometimes unpleasant paths they take to arrive at their conclusions.

In the lobby of a restaurant one night, Chewning said a woman recognized and hugged her and told her what a good job she had done informing her of a loved one’s death. "That to us is the reward. It’s confirmation that we did the best we could under the worst conditions."

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