John Oliver dissected America’s outdated and underfunded death investigation system on Last Week Tonight. “A death certificate isn’t like a degree from USC — it actually means something,” host John Oliver joked. And he spent the main segment detailing how the process of producing one has never been more of a “mess.”
Roughly 2.8 million Americans die each year, and in most cases a physician writes their cause of death on the certificate. But when people die under suspicious or unnatural circumstances — roughly half-a-million cases each year — their bodies are sent for further investigation or, potentially, forensic autopsy. It’s an important system: helping families get closure, identifying new trends in substance abuse and warning the public about defective products or infectious diseases.
But the reality of autopsy facilities is “shocking,” Oliver said. A 2016 report from the National Science and Technology Council found that “many death investigation facilities are antiquated and in need of repair or replacement,” and the U.S. government provides no funding.
Equally embarrassing, he argued, is our system for handling investigations. Two-thirds are overseen by coroners, and the rest by medical examiners — and there’s a crucial difference between the two. “While medical examiners are required to be doctors, coroners are not usually medically trained at all,” he said. “In fact, in Georgia, out of 154 coroners, only one is a physician, while the others include grocers, farmers, handymen and hairdressers.”
A local Fox 16 news report in Arkansas noted that coroners in the state can “run and be elected with zero medical knowledge, anatomical training or official certification of any kind.” And in some jurisdictions, the coroner is also the county sheriff, resulting in some serious conflicts of interest — like in California, where one doctor quit a county coroner’s office, “claiming that the coroner/sheriff there had repeatedly interfered in cases where police had used deadly force.”
Oliver envisioned a “best-case scenario” to improve the system: having “board-certified forensic pathologists running these offices and performing autopsies.” But that’s an unrealistic goal since there are only 500 pathologists currently practicing in the U.S. — less than half of what the National Association of Medical Examiners recommends. That shortage also comes at a terrible time, as the ongoing opioid crisis has resulted in more bodies that need examining. In sum, Oliver concluded, our system has been “pushed well past its breaking point.”
“It is not just dramatic consequences of murder investigations being compromised or epidemics potentially being missed,” he said. “Even just ordinary delays in processing death certificates can have serious practical consequences for families. Because ideally you’d want a death certificate within days or weeks, but it can take much, much longer than that.” The host focused on one woman whose husband passed away suddenly, and the death certificate took six months; without the certificate, she couldn’t receive life insurance and wound up relying on donations.
The comedian noted that “medical organizations have been calling for the coroner system to be abolished since 1857, arguing that the person appointed should be ‘a doctor in medicine.'” But the medical examiner system is also flawed in its current state — Oliver highlighted several horrifying stories of mismanagement that resulted in employees posing for pictures with a dismembered head, a former medical examiner stashing away organs in a storage facility and a dog eating a human spleen.
Fixing the death investigation system won’t be easy, but the host outlined a path forward. “You can’t hire forensic pathologists who don’t exist, so we need to find ways to incentivize med school students to become forensic pathologists — by paying them more and by properly funding the offices they’re going to be working in,” he said. “And the crazy thing is: It wouldn’t even cost that much. One  study recommended bringing public spending on these offices up to a minimum of just $3.75 per person per year. That is less than the amount of money that we inadvertently annually donate to our fucking couch cushions.”
To motivate us toward that goal, Oliver asked us to envision our favorite celebrities facing such a gruesome and/or shambolic process after they die. “Think of Beyoncé or Ted Danson or Glenn Close,” he said. “I would argue that Glenn Close deserves three things: two Oscars and not to have her spleen eaten by a dog.”
“No, I don’t want my spleen eaten by a dog,” she fired back. “Show my spleen some respect.”