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Quality Assurance
17-09-2010
The single most important quality control or assurance (QC/QA) mechanism in the ME’s office is the appointment of qualified and certified forensic pathologists, particularly in the position of chief medical examiner. In modern medical practice, board certification of physicians is expected and usually required for the full exercise of the practice privileges in a medical specialty.
Similarly, such certification is necessary in the field of forensic pathology to indicate that a practitioner has met the minimum standards of training and knowledge in the field. In the United States, the only path to certification in forensic pathology accepted by NAME34,35 is through the American Board of Pathology (a member board of the American Board of Medical Specialties).
This organization sets requirements and standards for training, examination, and certification in the field of pathology and its subspecialties, in this case, forensic pathology.
This requires completion of accredited (by the American Council of Graduate Medical Education) residency and fellowship training programs in both anatomic and forensic pathology, with subsequent successful completion of qualifying examinations given by the American
Board of Pathology in both areas. If these requirements are met, the physician will receive certification in anatomic pathology, and special qualification in the field of forensic pathology, also referred to as board certification.
At this point NAME recognizes the individual as a forensic pathologist.
While this certification does not guarantee excellent practice, it does show that the practitioner has met a minimum level of training and performance in the field. While some physicians utilize the term board eligible to indicate that they have taken the requisite training in pathology or its subspecialties but have not passed the board certification examinations, this designation is not recognized by the American Board of Pathology, and should not be used or accepted.
In addition to board certification, practitioners may now be held to professional standards of practice in the field of forensic pathology. The National Association of Medical Examiners has published such standards to provide guidance and objective criteria for the assessment of the practice of forensic pathology.
In 2003, NAME formed a committee to investigate the advisability of formally adopting standards for medicolegal autopsy practice.
After much debate and discussion, including surveying the membership about proposed standards, the “Forensic Autopsy Performance Standards” were approved by the membership of NAME and published in 2006 in the American Journal of Forensic Medicine and Pathology. These set forth standards for practice of forensic autopsy pathology, provide some defnitions elated to the field, and discuss standards for associated techniques, such as toxicological analysis, radiography, histology, and written reports. While broad and relatively basic, such standards do require a certain level of practice by physicians and can serve as an objective guide in assessing an individual’s level of practice.
While certification and standards refer to the practitioner and his or her practice, accreditation refers to the assessment of a death investigation system or office as an organization, without assessing the performance of any individual practitioner. Currently the only organization accrediting medical examiners’ offices on a national basis is NAME.
In 1975 the organization established a voluntary peer review system using criteria developed for inspection and accreditation of death investigation systems.
Accreditation of a medical examiner or coroner’s office involves a thorough inspection of the office by an outside trained forensic pathologist, utilizing a checklist devised by the Standards and Accreditation Committee of NAME. Criteria within the checklist are divided into two categories: Phase I requirements, which are desirable, but the lack of which will not significantly impact on the function of the system, and Phase II requirements, which are considered essential for the system to function adequately. Upon successful completion of this inspection, with no Phase II deficiencies and no more than fifteen Phase I deficiencies, the office is issued a certificate of accreditation for a period of five years. If the inspection is not successful, the ffice management will be counseled regarding deficiencies and methods of correcting them. Provisional accreditation for a brief period and reinspection are available to assist offices in meeting this goal.
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Comments
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Articles for theme “Forensic Dentistry”:
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17-09-2010
The majority of ME’s offices are funded and chartered by government entities, such as counties, cities, or states. These organizations are established by statute, and function as agencies of that government. Typically, a chief medical examiner is appointed by the local city, county, or state executive, and he or she then appoints deputy medical examiners and other personnel as needed in order to meet the mission and statutory mandate of the office. The personnel of the office are employees of the jurisdiction, and the office is funded by the county, city, or state.
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17-09-2010
Death CertificationA majorcommon denominator in any modern death investigation system is thedocumentation of death and the determination of its cause and manner, alsoreferred to as death certification. In early times, records of birth and deathwere kept inconsistently, if at all, but in 1538, clergy in England were required to keep aledger of births, deaths, and marriages in their parishes. This customof registration persisted for many years, but gradually became a function of governmentsinstead of the church.
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17-09-2010
As will be seen subsequently, the systems of death investigation in the United States are widely varied. However, they generally share a number of mission components in common. To paraphrase DiMaio and DiMaio, the various components of a death investigation system are as follows: 1. Determine the cause of death, and how the death came about 2. Identify the decedent 3. Determine the time of death and injury 4. Collect evidence from the body that may be useful in the police investigation 5. Document injuries that are present, or their absence 6.
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17-09-2010
Tough the cause of death was undoubtedly investigated in ancient times, it was likely an ancillary duty of tribal elders, magistrates, priests, or other authorities. The frst instance of an official office charged with the investigation of death, as we know it today, was probably the English coroner.Tough officials with this responsibility are reported as far back as 871 A.D., in the time of Alfred the Great, the beginning of the coroner system in England is generally taken to have been in 1194, with the publication of the Articles of Eyre, the Eyre being a system of roving “circuit” justices in England in the twelfth century.
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17-09-2010
The most primitive societies likely had a well-developed sense of the causative relationship of trauma, old age, and illness to death, and early “investigations” occurred even in tribal societies to determine why a member of the family group had died, though they were more likely to invoke superstition or magical thinking instead of the “rational” methods employed by modern societies. Early Mesopotamian civilizations, and those of ancient Egypt, Greece, and India, had well-developed legal codes (the earliest being the Code of Hammurabi, 2200 B.
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