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Modern Death Investigation: Hub and Spoke Models for Adequate Workforce

Event Dates
Event Duration
1 Hour

This webinar describes the history, structure, and operations of the Virginia Office of the Chief Medical Examiner. The system includes four regional offices staffed by forensic pathologists supervising over 100 Local Medical Examiners. Decedents requiring autopsy are transported to a regional office, while most external examinations are performed in the community by appointed Local Medical Examiners. The regional medical examiner facilities are located within the regional forensic science laboratories of the Virginia Department of Forensic Sciences, providing single regional full-service facilities for law enforcement, attorneys, and citizens. Local Medical examiners are licensed physicians, nurse practitioners, or physician assistants who agree to serve their community by participating in specific medicolegal death investigation and examination training to serve as agents of the Commonwealth. They are paid on a case-by-case basis. 

The Commonwealth includes almost 43,000 square miles, with urban areas in the north and eastern portions of the state and very rural areas in the west. This system allows consistent high-quality medicolegal death investigation and examination services for all citizens of the Commonwealth regardless of their location. It is also efficient, saving time and money for families of the victims and the Commonwealth by reducing the distance remains must be transported for autopsy and avoiding transport for external examinations performed in the local community. 

Since about 60% of medical examiner cases are examined by Local Medical Examiners, Virginia is able to meet national accreditation standards with fewer forensic pathologists. The forensic pathologists (Assistant Chief Medical Examiners) can focus on autopsy examination. The forensic pathologists also provide supervision for the Local Medical Examiners by reviewing documentation of external examinations, finalizing the case reports, and providing feedback to the Local Medical Examiner. 

Detailed Learning Objectives

  1. Attendees will learn how regional state medical examiner offices, combined with state forensic science laboratories, are able to provide comprehensive high-quality death investigation services to law enforcement, attorneys, and all other citizens of the state. 
  2. Attendees will learn that, with training and supervision, local licensed physicians, nurse practitioners, and physician assistants may perform external examinations and collect toxicology specimens, enabling a more efficient use of the limited supply of forensic pathologists. 
  3. Attendees will recognize that, while regional offices provide better service at a lower cost, the need to keep current imaging technology, such as Lodox® machines and CT scanners, in each office creates some budget management problems. 

Date Created: October 13, 2023