CMEC2018 OMB Package Part A

SUPPORTING STATEMENT – Part A
CMEC 2018 Census of Medical Examiner and Coroner Offices (CMEC)
Overview
The Bureau of Justice Statistics (BJS) seeks clearance to implement the 2018 Census of Medical
Examiner and Coroner Offices (CMEC). The survey builds on the previous iteration of the
CMEC data collection that used 2004 as its reference year. Like the 2004 CMEC data collection,
the 2018 project includes all known medical examiners and coroners offices in the United States
that conduct medicolegal death investigations (MDIs). BJS plans to field the 2018 CMEC from
May through November 2019.
In the United States, medical examiner and coroner offices are responsible for investigations of
deaths involving injury or violence, or are of a suspicious, unusual, or unnatural nature in
accordance with state statutes. There are important differences between medical examiners and
coroners. Generally, coroners hold elected positions while medical examiners are appointed or
hired by a state or local government. In most cases, medical examiners are trained physicians,
while coroners do not need to have any medical or forensic science training. Through the CMEC,
BJS collects data on the expenditures, workload, records and evidence retention policies, and
resources of the approximately 2,200 MEC offices operating in the United States. The CMEC
also gathers information on administrative characteristics of MEC offices, including the type of
office (e.g., coroner or medical examiner), staffing levels and titles (e.g., forensic pathologists,
specialists, or support personnel), specialized death investigations, and size and type of
jurisdiction the office served.
For the purposes of the 2018 CMEC, a coroner or medical examiner’s office is eligible for
participation if the following criteria are met—
1. the office investigates to determine a cause and manner of death;
2. the coroner or medical examiner or forensic pathologist within the office signs death
certificates; and
3. the office determines when autopsies should be performed, even if the autopsy is
performed outside of the office.
CMEC is part of BJS’s law enforcement statistics program. Consistent with BJS’s authorizing
statute (34 U.S.C. § 10132; Attachment 1), BJS is expanding statistical activities related to
forensic science and medicolegal death investigations (MDI), critical components of the criminal
justice system. MECs examine all violent deaths and bridge the realms of forensic science and
law enforcement. The forensic sciences are a key element of MDI as they aid the determination
of causes and manners of death and the toxicology and pathology of cases investigated by MEC
offices. The CMEC complements BJS’s Census of Publicly Funded Forensic Crime Laboratories
(OMB #1121-0269), which gathers information about the organizational structure and operations
of forensic crime laboratories, including personnel, budgets, caseload, equipment, policies, and
technology.

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The CMEC will gather information on staffing, employee training, and certification; resources,
including budget, information technology, and examination capabilities; workload; policies and
procedures for investigations and disposition of remains; participation in information sharing
efforts; accreditation status; autopsy and toxicology outsourcing costs, policies, and practices;
and access to databases, trainings, and support services.
BJS has modified the format and design of several survey items from the 2004 survey to improve
measurement and ease respondent burden. Central questions concerning budget, staffing, and
caseload were modified to increase clarity based on expert panel and cognitive interview
feedback with an eye toward preserving our ability to compare 2004 and 2018 results. The 2018
instrument has increased emphasis on assessing “access” to resources (staffing, technology, and
services) with yes/no questions based on expert panel feedback to reduce burden and improve
responses. Moreover, BJS has refined questions and response options to reflect 2018 operations,
nomenclature, and relevant, emerging topics. See the discussion of the differences in the
instruments in “Section 5. Efforts to Minimize Burden”.
The design of the 2018 CMEC survey instrument is consistent with best practices of survey
design including several design elements intended to increase the ease of reading and
understanding the questionnaire. First, related questions are grouped together in topical sections.
In addition, the survey instrument begins with the most salient items, as respondents can
sometimes lose focus and attention towards the end of a questionnaire. Questions and
instructions are presented in a consistent manner on each page to facilitate comprehension. On
both web and paper survey administrations, proper alignment and vertical spacing are used to
help respondents mentally categorize the information on the page and to aid in a neat, wellorganized presentation.
The design uses informative section headers to assist respondents in recognizing different
sections of the survey. Clear instructions regarding skip patterns assist the respondent in
navigating the survey. These skip patterns are programmed into the web instrument. Finally, in
choosing a method for asking questions, the use of complex matrices has been minimized. When
a matrix-type question cannot be avoided, it is presented simply and with straightforward
directions to help ensure that respondents understand the question being asked and the available
answer choices.
In collecting the 2018 CMEC data, BJS will use a multi-mode approach in which respondents are
directed to a web-based format as the primary mode of data collection. BJS prefers a web-based
collection to increase response rates, expedite the data collection process, simplify data
verification, enhance data quality by using validation checks, reduce burden by using automated
skip logic, and facilitate report preparation. Due to the project team’s strong encouragement to
respond using the web-based data collection tool, BJS expects that most agencies will use this
option for the 2018 CMEC. However, hard copy questionnaires will be available to agencies as
an alternative mode for response.
RTI International, BJS’s data collection agent for the 2018 CMEC, is a well-established federal
contractor that has successfully conducted several BJS surveys including fielding the original
CMEC with a reference year of 2004 and the recent 2016 Law Enforcement Management and
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Administrative Statistics (OMB #1121-0240). RTI International is also the data collection agent
for the ongoing 2018 Census of State and Local Law Enforcement Agencies (OMB #1121-0346)
and 2018 Census of Law Enforcement Training Academies (OMB #1121-0255) surveys.
A. Justification
1. Necessity of Information Collection
Under Title 34, United States Code, § 10132, the Bureau of Justice Statistics (BJS) is authorized
to collect and analyze statistical information concerning the operation of the criminal justice
system at the federal, state, tribal, and local levels. The CMEC furthers the Department of
Justice’s mission by providing insight into the nation’s MDI system process and infrastructure to
identify trends and challenges.
MDI is a critical operation in the criminal justice and public safety systems that investigates all
suspicious or violent deaths, determines whether to pursue criminal investigations surrounding
deaths, and acts as an early warning system of instances of increased mortality related to drug
overdoses, biological or chemical terrorism. As such, MECs operate alongside and within the
criminal justice system to ensure justice and public safety. These agencies are also a key
contributor to statistical data on the medicolegal death investigation infrastructure. They
contribute to federal data collections such as the Centers for Disease Control’s (CDC) National
Violent Death Reporting System (NVDRS), the National Vital Statistics System (NVSS), State
Unintentional Drug Overdose Reporting System (SUDORS), the Enhanced State Opioid
Overdose Surveillance (ESOOS), and the National Highway Traffic Safety Administration’s
(NHTSA) Fatality Analysis Reporting System (FARS). Notably, BJS is the only federal agency
to collect administrative, budgetary, staffing, and related information from MECs, which other
federal agencies, such as the Centers for Disease Control and Prevention and others within the
Department of Health and Human Services, use for context to inform public health statistics.
Thus, the 2018 CMEC will provide the only systematic basis to produce national estimates of
personnel, resources, policies, and practices of MECs. Key findings from the 2004 CMEC
showed that MEC offices employed an estimated 7,320 fulltime employees and had an estimated
annual budget that totaled $718.5 million, for an average of $387,000 per office. Moreover, the
2004 CMEC data illuminated that MECs nationwide were referred 956,000 deaths, of which
487,000 were investigated by their offices (Hickman, Hughes, Strom, & Ropero-Miller, 2007).
The final project report also highlighted that there were about 4,400 unidentified human
decedents each year, of which an estimated one fifth remain unidentified after 1 year (Hickman,
Hughes, Strom, & Ropero-Miller, 2007).
Although national data are sparse regarding caseload, local evidence suggests that the caseloads
of MECs are increasing substantially in comparison to operational capacity. For example, in
September 2016, the Cuyahoga County Medical Examiner (CCME) reported 1 there were 330
fatalities from January 1 through the Labor Day weekend compared to a total of 228 deaths in all
Please see the following press release from the Cuyahoga County Medical Examiner’s Office:
http://executive.cuyahogacounty.us/en-US/ADozenFatalitesThruLaborDay.aspx.
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of 2015. By April 2017, the CCME Office was at risk for losing its National Association of
Medical Examiners (NAME) accreditation because its three pathologists performed more
autopsies than allowed (MacDonald, 2017). 2 Notably, fewer than 100 of the nation’s 2,200 MEC
offices can achieve and maintain accreditation through NAME. 3
There are three main goals for the 2018 CMEC: 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; and 3) further develop the
understanding of the relationship between law enforcement agencies and MEC offices.
Design of the 2018 CMEC Survey
BJS will use CMEC data to gain a basic understanding of the national caseload of deaths that
require medicolegal death investigations, as well as the staffing, infrastructure, and resources that
are available to process these cases. It is expected that since the 2004 CMEC, MDIs will have
gained access to and use technology that has since emerged to investigate deaths, such as
advanced imaging techniques (e.g., computed tomography and magnetic resonance) in forensic
radiology to identify injury and disease prior to autopsy; and high-resolution mass spectrometry
to identify newer psychoactive substances (e.g., synthetic opioids and cathinones) which require
sensitive, modern technologies to overcome analytical challenges. Notably, the 2018 CMEC will
also document the status of the MEC’s case management and laboratory information
management systems, which have been slower to transition to automated systems compared to
other forensic agencies. It is not known the extent to which MECs have adopted these
technologies, testing practices, and reporting and evidence tracking capabilities.
Based on the 2004 survey and feedback from an expert panel convened in April 2018, the topics
for the 2018 CMEC include the caseloads of offices, including tribal lands cases; MEC
accreditation status; certification status of investigative staff; expanded and refined office
functions and responsibilities (e.g., next of kin communications); autopsy and toxicology
outsourcing costs, policies, and practices; the number of unidentified human remains in the
custody of each office; access to databases, trainings, support services, and resources; expenses;
specialized investigation teams; and participation in emergency drills.
The 2018 CMEC data will allow for needed comparisons with the 2004 CMEC. The proposed
2018 CMEC instrument (Attachment 2) has been revised to include modifications and new
items stemming from expert and methodological reviews as well as cognitive testing of the
survey instructions, question wording, and hard copy format. BJS will evaluate all comments and
suggestions for improvement provided by respondents to the 2018 CMEC for possible
incorporation into the next CMEC survey. The instrument has 63 items that fall into 6 sections—

2
MacDonald, E. (2017, April 21). Cuyahoga County Medical Examiner’s Office seeks $200k budget increase due to
overdose epidemic. Cleveland.com, Metro News. Retrieved from
http://www.cleveland.com/metro/index.ssf/2017/04/cuyahoga_county_medical_examin_6.html
3
https://www.thename.org/index.php?option=com_mcdirectorysearch&view=search&id=12295#/

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1. Section A – Administrative (A1–A13)
This section collects information on the type of office being surveyed (coroner, sheriffcoroner, medical examiner, etc.), the level of government they represent, the type of
agency or government body the office reports to, geographic jurisdictions served,
accreditation and certification, and number of employees. This information will be used
for future frame development and allows BJS to make comparisons between types of
offices and to link the population of jurisdictions back to the office that serves them.
2. Section B – Budget and Capital Resources (B1–B5)
This section collects information on overall budgets available to offices, budgets
designated for personnel, and sources of funding for offices.
3. Section C – Workload (C1–C16)
This section collects information on the number of cases reported to offices, the number
of cases the offices accepted and investigated in 2018, including from tribal lands, the
number of autopsies the office conducted, whether procedures and functions are
conducted within the office or contracted to an external agency, and which personnel
perform which duties. Information from this section will allow BJS to describe the
amount of work MEC offices undertook in 2018, and the policies and procedures
surrounding this work.
4. Section D – Specialized Death Investigations (D1–D11)
This section collects information on the number of unidentified human remains in MEC
offices, policies surrounding the remains, and procedures and policies concerning infant
deaths. This information will allow BJS to produce an estimate of how many unidentified
decedents were in MEC at the end of 2018. BJS will also be able to describe how many
offices use specific diagnoses such as Sudden Infant Death Syndrome (SIDS) and Sudden
Unexplained Infant Death (SUID).
5. Section E – Records and Evidence Retention (E1–E6)
This section asks respondents about their ability to track cases, their use of computerized
case management systems, policies for record retention, and storage of case records. With
varied office types, needs, and populations served, MEC offices have varying capacities
of electronic case management. This section will allow BJS to summarize how and where
offices store their records and evidence.
6. Section F – Resources and Operations (F1–F12).
This section asks about what resources and technologies are available to MEC offices,
whether directly through their office, through their relationship with an external office or
agency, or not at all. It also asks about various programs and federal data collection
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efforts that these offices might participate in, such as the National Missing and
Unidentified Persons System (NamUs).
BJS plans to conduct a census rather than a sample survey for the 2018 CMEC. The universe of
training MECs is small (about 2,200) relative to the size needed for a representative sample with
stratification dimensions needed to address variations by agency type, size, and jurisdictional
characteristics. Interest among other federal, state, and local agencies in data collected through
CMEC relies on the study to ascertain the basic needs of MECs nationwide since these data have
not been collected since reference year 2004. Since the last CMEC, there is a known crisis within
MDIs given the shortage of forensic pathologists and medicolegal death investigation staff
nationwide. 4 However, the extent of the problem as measured by national caseload is largely
being based on the 2004 CMEC. A significant goal of the 2018 Census is to identify the national
caseload of death investigation cases and the staffing in place to address this caseload. Caseload
data are even more imperative given the opioid epidemic which has stretched the resources of
MECs nationwide with record-breaking overdose deaths. With a census design, these data will
comprehensively inform national, state, and local policy-making and budget planning.
The 2018 CMEC will update and document any changes in MEC programs that have occurred
since the 2004 CMEC. Information generated by the 2018 CMEC will help to improve our
national understanding of MECs and their operations. The information will be useful for federal,
state and local governments to assess the areas in which additional resources for development,
improvement, or expansion of criminal justice death investigation capabilities may be necessary.
2. Needs and Uses
BJS/OJP/DOJ Needs and Uses
Since 2002, BJS has conducted two surveys that inform forensic sciences: the Census of Publicly
Funded Forensic Crime Laboratories (OMB # 1121-0269) and the CMEC (OMB # 1121-0296).
The CMEC complements the Census of Publicly Funded Forensic Crime Laboratories as both
MECs and Forensic Crime Laboratories serve as primary support agencies to law enforcement
agencies and their operations. Through the 2004 CMEC, which achieved an 86% response rate,
BJS documented the number of MECs conducting MDIs in the United States and provide key
statistics regarding their operations, infrastructure, and resources. BJS’s report on the 2004
CMEC, published in 2007, remains the only comprehensive source of basic data about the U.S.
MDI system and 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 and budget).
Information collected by the CMEC concerning caseload, staffing, and certification of MDIs and
accreditation of MEC offices nationwide will inform the national need for pathologists and
supporting staff, as well as support and inform national efforts currently underway by the
National Institute of Justice (NIJ) to provide funding that will facilitate MECs to achieve
Committee on Identifying the Needs of the Forensic Sciences Community, National Research Council. (August
2009). Strengthening Forensic Science in the United States: A Path Forward. National Academies Press,
Washington D.C. https://www.ncjrs.gov/pdffiles1/nij/grants/228091.pdf

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accreditation status and entice more forensic pathologists to the field via fellowship awards
through its Strengthening the Medical Examiner-Coroner System Program (see
https://nij.gov/funding/documents/solicitations/NIJ-2018-13743.pdf). The 2018 CMEC will also
provide needed data to inform the development of current and future Department of Justice
funding programs to provide assistance where needed. For example, NIJ’s Paul Coverdell
Forensic Science Improvement Grants Program aims to improve the quality and timeliness of
forensic science and medical examiner and coroner services by providing funds to implement
new technologies, train forensic pathologists, and help eliminate backlogs. Having updated data
will help inform NIJ about the most efficient areas to target its grant funding, as well as to
inform their forthcoming needs assessment of the MDI. 5
The Department of Justice’s Office of Justice Programs and the Department of Health and
Human Services formed the Medicolegal Death Investigation (MDI) Federal Interagency
Working Group (MDI-WG; https://ojp.gov/resources/ojp-hhs-mdi-wg.htm) in March 2018 to
coordinate federal initiatives to strengthen the MDI system and support death investigation
services practiced by medical examiner and coroner offices across the United States. The MDIWG has identified several important goals, including—
•
•
•
•
•
•

Developing technologies/systems to facilitate information/data sharing between MEC
offices; toxicology laboratories; and federal, state, and local entities;
Addressing the shortage of forensic pathologists;
Coordinating MDI research priorities;
Strengthening drug death investigations;
Strengthening drug death data reporting mechanisms; and
Supporting post-mortem toxicology screening and analysis, particularly for novel
synthetic drugs.

The 2018 CMEC supports this effort by providing data that will speak to many of these areas
(see the comprehensive list of topics that will be covered in the 2018 CMEC in the Overview
section) and provide relevant data to inform the working group of appropriate next steps in terms
of budgets, planning, needs, and areas for program growth and outreach. The key types of
information that the CMEC will make available include—
•
•
•
•
•

Number and types of MEC offices
Number of full-time and part-time personnel and their responsibilities and roles
Average total operating budgets
Caseloads and autopsies performed
Policies and procedures regarding autopsies and medicolegal death investigation.

BJS will use the data gathered by the 2018 CMEC to disseminate information about the MDI
system to the public. A past BJS report using CMEC data was Medical Examiners and Coroners’
Offices, 2004 (https://www.bjs.gov/content/pub/pdf/meco04.pdf).

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Justice for All Reauthorization Act of 2016, Pub. L. No. 114-324, 130 Stat. 1948 (2016).

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Uses of the CMEC by others
Because medical examiners and coroners are situated at the crossroads of public health and
safety, information generated from CMEC is highly relevant to the work of law enforcement
practitioners, the professional research community, and public health agencies as the collection
provides authoritative statistics on the staffing, budget, resources, and infrastructure in place to
investigate questioned deaths.
Officials from federal, state, and local agencies have used the 2004 CMEC for comparative
statistical purposes and benchmarks for funding or resources. The 2004 CMEC also provided
needed benchmarks for comparisons, such as the average operating budget for MECs by
jurisdiction size. Although the 2004 Census data are outdated, the first CMEC’s impact on the
field endures: the collection remains highly cited and is frequently used by the government,
research, public health, and MDI communities because it remains the definitive source regarding
the state of the MDI system. For example—
•

•

•

•

•

An April 2018 NIJ journal article 6 focused on the National Missing and Unidentified
Persons System (NamUs) program and referenced the CMEC’s findings regarding the
4,400 unidentified decedents in 2004. Moreover, the 4,400 estimate is also an
unattributed reference on the NamUs main webpage (https://www.namus.gov/).
In November 2017, the Congressional Research Service 7 published a report on missing
adults for the United States Congress. In addition to referencing the CMEC’s finding
about the 4,400 unidentified decedents, the authors highlighted the findings associated
with the MDI’s lack of infrastructure to fully investigate these unidentified or unclaimed
deaths, including x-rays, DNA, and fingerprints as well as a lack of record retention
among large jurisdictions.
The National Science and Technology Council’s 2016 seminal Strengthening the
Medicolegal Death Investigation System: Improving Data Systems report to the White
House used the CMEC data to report on the national death caseload from 2004 because it
remains the best estimate for the U.S. caseload for death investigations.
Dr. Andrew Baker, former National Association of Medical Examiners president and
Chief Medical Examiner of Hennepin County, MN, referenced the CMEC 2004 data to
highlight caseload and workforce numbers in his keynote address at the 2018 Society of
Forensic Toxicologists in Minneapolis, MN in October 2018.
Dr. Michael Murphy, former forensic pathologist for the Clark County Coroner’s Office,
NV, used the map from the BJS report “Medical Examiners and Coroners’ Offices, 2004"
to show the U.S. states by type of MEC system during his presentation at the 2018
International Association of Coroners and Medical Examiners (IAC&ME) in Las Vegas,
NV in July 2018.

Weiss, D., Schwarting, D., Heurich, C., & Waltke, H. (2018). Lost but Not Forgotten: Finding the Nation’s
Missing. NIJ Journal, 279. https://nij.gov/ journals/279/Pages/lost-but-not-forgotten.aspx
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Fernandes-Alcantara, A.L. (November 2017). Missing Adults: Background, Federal Programs, and Issues for
Congress. Congressional Research Service, Washington, DC.
https://crsreports.congress.gov/product/pdf/RL/RL34616
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“Medical Examiners and Coroners’ Offices, 2004”, published by BJS in 2007, is referenced
frequently in the scientific literature:
• Lowder, E.M., Ray, B.R., Huynh, P., Ballew, A., & Watson, D.P. (2018). Identifying
Unreported Opioid Deaths Through Toxicology Data and Vital Records Linkage: Case
Study in Marion County, Indiana, 2011–2016. American Journal of Public Health, e1-e6.
• Parks, Connie L. & Monson, K.L. (2018). Automated facial recognition of manually
generated clay facial approximations: Potential application in unidentified persons data
repositories. Forensic Science International, 133-136.
• Castle, I.J., Yi, H.Y., Hingson, R.W., & White, A.M. (2014) State Variation in
Underreporting of Alcohol Involvement on Death Certificates: Motor Vehicle Traffic
Crash Fatalities as an Example. Journal of Studies on Alcohol and Drugs, 75(2), 299-311.
• 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.
• Davis, G., Warner, M., Paulozzi, L., Nolte, K., & S. Nelson, Lewis. (2013). State
Variation in Certifying Manner of Death and Drugs Involved in Drug Intoxication
Deaths. Academic Forensic Pathology, 3, 231-7.
The 3-year usage of the public use file archived at the National Archive of Criminal Justice Data
(NACJD) show that the CMEC public use file is frequently downloaded. From November 2015
to November 2018, NACJD shows that the CMEC data were downloaded 316 times across 75
unique users (including university faculty and staff, undergraduate and graduate students, and
anonymous users). 8
3. Use of Information Technology
The 2018 CMEC plans to use a multi-mode design in which respondents are directed to a web
survey through mailed and emailed instructions. The web survey will be hosted by BJS’s data
collection agent RTI International (RTI).
The CMEC instrument has been designed for online data collection and will export survey data
and paradata in various data formats specified by BJS. This software will allow RTI to send an
email to respondents explaining the CMEC program and containing a hyperlink to the
questionnaire. Respondents will have a unique Personal Identification Number (PIN) and
password provided by RTI to access the website to complete the census form.
The web survey application will include data validation and logic checks to help ensure
responses are consistent, within range, and follow proper skip patterns as necessary. If a
respondent provides an answer that seems out-of-range or inconsistent with answers elsewhere in
the survey, they will be prompted to verify their answers as accurate. These processes will help
improve data quality and minimize respondent burden by reducing the need for extensive data
verification follow-up contact. Respondents will be able to start the survey, break off, and
resume the survey from where they left off. The software allows for real-time online tracking of

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See the NACJD CMEC usage report: https://pcms.icpsr.umich.edu/pcms/reports/studies/20342/utilization

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respondents thereby allowing BJS to track the completion of each office’s responses. The
software supports exporting survey response data and paradata in formats specified by BJS.
Agencies may have several reasons why they do not respond via the internet; for example, some
might not have reliable internet access and others might find it difficult to complete the CMEC
online because of the complexity of the requested data or the need to involve multiple people in
preparing the response. Respondents will also be able to respond to the survey using mobile
devices, such as tablets. Agencies that request printed versions of the census form will have
multiple methods of receiving paper versions of the instrument. A paper copy of the
questionnaire will be mailed in a reminder mailing to nonresponders. In addition, agencies will
be able to download a PDF version of the survey from the survey website that can be printed or
e-mailed to MEC staff. Respondents can then complete the survey by hand and transcribe it into
the online survey instrument, scan and return the completed form via email, or return the
completed form via mail. Completed hardcopy questionnaires will be data entered by RTI staff.
The dataset and supporting documentation will be made available without charge at the National
Archive of Criminal Justice Data at the Inter-University Consortium for Political and Social
Research (ICPSR). The BJS-produced findings from the 2018 CMEC will be provided to the
public in electronic format (e.g., Microsoft Excel or comma delimited files). The survey reports
will be available on the BJS website as PDF files.
4. Efforts to Identify Duplication
Based on our knowledge of the federal statistical system in general, and medical
examiner/coroner surveys in particular, BJS has determined that, by and large, the 2018 CMEC
does not cover topics found in surveys conducted by any other federal agencies. This is mainly
due to the fact that CMEC is an agency survey that is designed to gather data on the “business”
and operations aspects of the MDI. Other federal agencies that collect data from MECs are
interested in collecting information about the deaths the MECs investigate and process.
Examples of these latter collections include the Centers for Disease Control and Prevention’s
(CDC’s) National Violent Death Reporting System (NVDRS), the National Vital Statistics
System (NVSS), and the Enhanced State Opioid Overdose Surveillance (ESOOS), the Sudden
Death in the Young Case Registry (SDY), and the National Highway Traffic Safety
Administration’s Fatality Analysis Reporting System (FARS). All of these collections are
designed to collect information about the deaths themselves rather than about the work of MEC
offices.
BJS’s other data collection concerning forensic sciences, the Census of Publicly Funded Forensic
Crime Laboratories (CPFFCL) (OMB #1121-0269), was last fielded in 2014 and included 14
MEC offices. In certain jurisdictions, an MEC office may be within a forensic crime laboratory,
or conversely, a crime laboratory may be located within an MEC office. The CMEC will specify
that we are interested only in information related to the MDI portion of the office and in those
personnel who are assigned to MDI related roles and duties. The CPFFCL asks questions
relevant to a broader array of forensic sciences while the CMEC asks questions related
specifically to MDI personnel, policies, and practices. BJS plans to field the next CPFFCL in
2020. CMEC and CPFFCL are designed to complement each other.
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BJS’s Census of State and Local Law Enforcement Agencies (CSLLEA) (OMB #1121-0346)
includes sheriffs’ offices. Some of these offices, notably in California, are also coroner offices.
In the 2004 CMEC, 44 offices, largely concentrated in California, were sheriff-coroner offices.
While there is a small overlap in the offices included in both studies, the questions asked in the
CMEC are different from CSLLEA. The CSLLEA includes items on the number and sex of law
enforcement officers employed by law enforcement agencies, and duties performed by the
officers. This study does not ask about MDI personnel or practices. The CSLLEA launched in
September 2018 and data collection will be completed by May 2019.
The only survey identified that includes a small set of overlapping data collection items is the
Drug Enforcement Administration’s 2017 National Forensic Laboratory Information System
(NFLIS) Medical Examiner/Coroner Office survey, which was primarily focused on obtaining
toxicology-related policies and requesting practices from MECs nationwide in 2017. The 4month 2017 NFLIS MEC survey data collection yielded a 47% response rate for complete
surveys and a 61% response rate for critical item response (i.e., caseload).
BJS identified six potential areas of overlap between CMEC and NFLIS:
•

Type of office – NFLIS asked respondents to indicate the type of office in which they
work (State medical examiner, district/regional medical examiner, etc.). CMEC, on the
other hand, asks two questions: 1) what best describes the death investigation office
(coroner or medical examiner) and 2) what level of government best describes the office
(city, county, district, state). Although both data collections ask about the type of office,
it is a very low burden for offices to answer, and it is crucial to identify the type of office
surveyed. Asking this question consistently will allow for analysis of any changes in the
type of office operating and provide important context for the office’s data (e.g.
caseload).

•

Jurisdiction(s) served – Both CMEC and NFLIS ask respondents to identify (via an open
text field) which jurisdictions they serve (e.g., Illinois, Los Angeles County, New York
City, First Judicial District). While NFLIS also asked respondents to identify the size of
the population they serve, CMEC does not. BJS needs to collect this information in order
to link population size estimates to the office based on what jurisdictions it serves. It is
also important to obtain an up-to-date understanding of jurisdictions served because this
may change over time. Most coroners are elected officials. In counties in which the
coroner’s elected position is unfilled, it is common to outsource coroner responsibilities
to a neighboring jurisdiction. Keeping this information up-to-date is necessary to link the
population served information to reasons for potential increases or decreases in caseload
and budget.

•

Accreditation by NAME and IAC&ME – Both CMEC and NFLIS include nearly
identical measures regarding accreditation status through the National Association of
Medical Examiners (NAME) and the International Association of Coroners & Medical
11

Examiners (IAC&ME). Since the 2017 NFLIS survey (referencing 2016), two notable
circumstances have changed. The ongoing opioid epidemic has made it difficult for some
agencies to achieve or maintain accreditation. For example, NAME-accredited MECs
only allow pathologists to perform 250 autopsies per year, yet the rising number of lethal
drug overdoses in some areas has challenged MECs to maintain this ratio, particularly in
light of the national forensic pathologist shortage. Secondly, the National Institute of
Justice released the Strengthening the Medical Examiner-Coroner System program which
provides funding to help agencies achieve accreditation status. NIJ also supports
accreditation through its Paul Coverdell Forensic Science Improvement Grants Program.
In FY2015-2016 alone, Coverdell funding was used by MEC jurisdictions across 47
awards to support new accreditation or maintenance fees. Obtaining more updated
information about accreditation status, as well as plans for accreditation status if none is
currently held, supports the federal government’s push for increased accreditation among
the MEC community as a whole by providing updated statistics.
•

Caseload – Both CMEC and NFLIS ask about the number of cases (deaths) referred to
offices, accepted by offices, and autopsies performed by offices. CMEC also asks how
many referred and accepted cases came from tribal lands. While both collections may
collect the same data point, it is necessary that CMEC ask this to be able to understand
the context in which cases from tribal lands are referred to and accepted by MEC offices.

•

Use of computerized management system – NFLIS focused on the office’s use of
laboratory information management systems (LIMS) with probing questions on data
fields, file types, and specific software used for the information management system.
CMEC asks more broadly whether offices have a computerized management system
(CMS) beyond spreadsheet software (e.g. Excel) and whether the CMS is networked so
that it is available to all authorized users.

•

Participation in federal data collection efforts – Both NFLIS and CMEC ask whether
MEC offices participate in several federal data collection efforts. However, only two of
the data collections are mentioned in both instruments, the Fatality Analysis Reporting
System (FARS) and the National Violent Death Reporting System (NVDRS). CMEC
asks about six specific data collection efforts, and NFLIS asks about only these two
specifically.

The NFLIS had a reference year of 2016. CMEC will use a reference year of 2018. The answers
to most of these questions, especially those of caseload, use of computerized management
systems, and participation in federal data collection efforts may have changed in the intervening
years. Collecting this information with a different reference year affords BJS and others the
ability to analyze more current data. BJS understands that NFLIS will be fielded again in 2021.

12

5. Efforts to Minimize Burden
The proposed 2018 CMEC instrument was designed to minimize response burden in several
ways. First, based on feedback received from the agencies through an expert panel and cognitive
interviews, the new instrument features questions that have been refined to increase clarity and
improve response options where needed. Second, the 2018 CMEC was modified for a web-based
data collection and includes built-in skip patterns and data checks. It was designed with bestpractice web layouts including matrices where appropriate. The 2018 CMEC was also designed
to have more yes/no questions to obtain information about access to resources based on expert
panel feedback that suggested dire basic needs within the community.
For the 2018 CMEC BJS consulted with an expert panel that was composed of medical
examiners and coroners from various states and sized agencies. BJS incorporated feedback from
this panel and cognitively tested a revised version of the instrument with 14 respondents (7
coroners and 7 medical examiners) under BJS’s generic clearance (OMB # 1121-0339). The
resulting instrument represents a thorough redesign. See Attachment 24 for the complete
cognitive testing report, including the protocol for testing the instrument. The changes are
summarized below—
•

Section A. Cognitive testing resulted in changes to five items and the addition of two
items. Three questions received an additional response row, one received a wording
change in its response options and two received wording changes in their question stems
and an additional response row in each. Item A8, which asks for the number and types of
employees in several roles, received additional clarification instructions and definitions, a
new personnel role, and a new column for ‘on-call’ employees. Both through the expert
panel review and cognitive testing, participants expressed interest in getting information
on salaries of personnel in MEC offices. To this end, the project team added a new
question (A9) to ask for starting minimum and maximum salaries of autopsy pathologists,
coroners/non-physicians, death investigators, and forensic toxicologists. An item asking
whether all, some, or none of the autopsy pathologists employed by the office are
certified by the American Board of Pathology (ABP) was also added.

•

Section B. Cognitive testing resulted in the addition of one item, changes in wording for
two questions, and the removal of three items. BJS added a question to ascertain the end
date of respondents’ fiscal years. For two questions, BJS changed the phrasing to make
questions more clear. Two items (average cost for conducting a full autopsy and average
cost for conducting forensic toxicology testing per case) were dropped because
respondents had difficulty answering, particularly if they performed these procedures in
the office rather than contracting them out. Further review within BJS resulted in the
removal of the question asking whether staff in respondent offices spent any of their
personal money on training, supplies, equipment, or other items needed to conduct their
work.

•

Section C. Question wording throughout the section changed as a result of cognitive
testing. In several items the reference to the specific fiscal year date of June 30, 2018 was
dropped due to confusion it caused respondents. Instead, the questions begin with “In
13

2018…” to prompt respondents to provide answers for the calendar year. BJS also added
clearer definitions to questions throughout section C. Respondents asked that C12, which
contains a matrix of response options, be further broken out into smaller categories. BJS
added the requested categories to this item and split the item in two for ease of reading
and answering on the web survey.
•

Section D. Throughout this section, reference date of June 30, 2018 was changed to
December 31, 2018 to prompt respondents to answer for the calendar year. BJS also
revised wording for several questions to make items easier to understand. Item D10 was
seen as double barreled, so the wording was changed to be more easily understood and a
sub item was added to ask respondents whether they routinely perform toxicology tests to
confirm results from drug screening tests performed at earlier stages of investigation.

•

Section E. Items E3 and E6 each received an additional response row. Item E7 which
asked respondents to specify what other locations their records were kept at was dropped.

•

Section F. Six items in section F were changed and two were dropped. Questions F2, F3,
F7, and F10 asked respondents whether they can access several types of resources
internally or externally with two response options: yes or no. After testing and discussion
on the goal of the questions, it was decided that the question will have three response
options: “Yes, we have direct access”, “Yes, we can ask as partner agency”, and “No”.
Question F7 received additional response rows. Question F5 was originally asked in a
matrix question, but was split into two items to allow for more clarity in answers. A
question which asked respondents to indicate to what extent (ranging from “not at all”
through “to a great extent”) a variety of resources were needed to improve their ability to
complete cases was dropped due to inconsistent understanding of the question and
evidence that it was not capturing what was intended. An open ended question that asked
about what other technologies not included in the survey that offices have access to was
also dropped.

We expect that many respondents will complete the survey online. Web-based system functions
will be in place to ease the burden of survey completion. RTI uses an intelligent log-in program
for data collection, which will store MEC office information and responses, allowing for multisession completion of the survey instrument. Since many offices, particularly the larger ones,
will need to seek multiple information sources within their organizations to answer different
sections, this will reduce burden by facilitating data entry from different sources. It will also
reduce burden by allowing respondents to stop response entry pending confirmation of
information from others in the office.
Since some respondents will complete the CMEC using paper forms, survey methodologists
have evaluated the questions and layout to ensure that the instrument is formatted appropriately
for what is being asked of respondents. This includes ensuring that instructions and questions are
clear, adjacent to one another, and definitions for terms are provided as necessary and placed
near the question to which they refer. This evaluation, along with feedback from expert panelists
and cognitive interview participants, has helped refine the current survey instrument.

14

RTI will also provide assistance by phone and email. A toll-free help line will be established and
staff will be available during regular business hours. When staff are not available, calls will be
routed to voicemail. Messages will be responded to within 24 hours. A dedicated CMEC help
email address will be provided with all written materials and emails. Phone numbers and email
addresses will be provided to respondents to ensure timely communications.
6. Consequences of Less Frequent Collection
Based in part on recommendations from the National Research Council (Groves and Cork,
2011), BJS has determined that it is necessary to improve the timeliness of the publications
flowing from its law enforcement data collections. For CMEC, the collection was last done 14
years ago. BJS anticipates that the CMEC will be fielded every 4–5 years and will be staggered
with the Census of Publicly Funded Forensic Crime Laboratories so that the two never field in
the same year.
Notably, BJS traditionally fields its data collection efforts more regularly (e.g., 3–5 years)
compared to the current 14-year gap for the CMEC. BJS understands from the field leadership—
i.e., leadership from the National Association of Medical Examiners, International Association of
Coroners & Medical Examiners, and the American Board of Medicolegal Death Investigators—
that there is great interest and support of the CMEC to update our national understanding of the
state of the MDI since the 2004 findings continue to be used so prevalently by MDI stakeholders.
More frequent data collection efforts will allow BJS and federal, state, and regional governments
to examine more timely data and changes in trends. As discussed elsewhere, the CMEC
complements the BJS’s Census of Publicly Funded Forensic Crime Laboratories (CPFFCL). BJS
plans to field the CPFFCL in August 2020 with a reference date of 2019. Keeping these
collections on a similar schedule will allow BJS and others to examine trends in the fields of
forensic sciences more broadly. Should the 2018 CMEC not be fielded, the 2004 data will
remain—at least in the short term—as the most comprehensive information about the MDI
system. These data are dated and provide little insight into the access and use of new forensic
technologies that have been developed and evolved since the 2004 CMEC. Moreover, federal
programs aimed to support the MDI system through a funding—e.g., NIJ’s Strengthening the
Medical Examiner-Coroner System Program—will continue to base some of the funding and
programmatic needs on these old, outdated data.
7. Special Circumstances
No special circumstances have been identified for this project.
8. Federal Register Publication and Outside Consultation
An expert panel of practitioners was gathered to assess the instrument used for the 2004 CMEC.
These panelists included practitioners from both medical examiner and coroner offices. Panelists
were provided with the survey instrument and materials from BJS and RTI introducing the
project and BJS’s goals in conducting the census. Panelists were asked to assess the survey form
for clarity of the questions, relevance of the questions to the field, and to provide the project
15

team with updates from the field that ought to be included in the form. BJS, RTI, and the expert
panelists gathered for a one-day meeting to discuss the form item-by-item. Feedback from this
expert panel was used to inform instrument design for cognitive testing discussed above. Expert
panelists are included in Table 1.
Table 1. Expert panelists
Panelist
Ms. Karla Knight Deese
Coroner
Mr. John Fudenburg
Coroner
Ms. Kelly Keyes
Deputy Coroner
Dr. Robert Mitchell, MD
Chief Medical Examiner
Ms. Bobbi Jo O’Neal
Deputy Coroner
Dr. Deborah Radish, MD
Chief Medical Examiner
Dr. Ruth Winecker, PhD
Chief Toxicologist

Office
Lancaster County Coroner
South Carolina
Clark County Office
Nevada
Orange County Coroner
California
District of Columbia Office of the Chief
Medical Examiner
Charleston County Coroner’s Office
South Carolina
North Carolina Office of the Chief Medical
Examiner
North Carolina Office of the Chief Medical
Examiner

The research under this clearance is consistent with the guidelines in 5 CFR 1320.6. The 60-day
notice for public commentary was published in the Federal Register, Volume 83, Number 238,
page 63909 on Wednesday, December 12, 2018 (Attachment 4). The 30-day notice for public
commentary was published in the Federal Register, Volume 84, Number 35, pages 5501–5502,
on Thursday, February 21, 2019 (Attachment 5).
9. Paying Respondents
Neither BJS nor RTI will provide any payment or gift of any type to respondents. Respondents
will participate on a voluntary basis.
10. Assurance of Confidentiality
According to 34 U.S.C. § 10134, the information gathered in this data collection shall be used
only for statistical or research purposes, and shall be gathered in a manner that precludes their
use for law enforcement or any purpose relating to an private person or public agency other than
statistical or research purposes. The data collected through the 2018 CMEC represent
institutional characteristics of MECs. Information collected from these organizations is
considered within the public domain. The fact that participation in this survey is voluntary and
that information about individual agency responses will be available to the public will be
included on the first page of the survey instrument. However, it will also be made clear to them
that BJS and RTI will not release the names, phone numbers, or email addresses of the actual
persons responsible for completing the 2018 CMEC instruments.
16

11. Justification for Sensitive Questions
There are no questions of a sensitive nature in the proposed 2018 CMEC.
12. Estimate of Hour Burden
BJS has estimated the respondent burden for the proposed 2018 CMEC Survey at 3,575 hours.
The 2018 CMEC burden estimate was calculated using an estimate of 1.5 hours per respondent
for the completion of the 16-page, 64-question questionnaire being completed by an estimated
2,200 MECs. In addition, BJS plans to conduct data quality follow-up with approximately 1,100
offices at 15 minutes per call, totaling 275 hours.
The 90-minute estimate is based on feedback received during the administration of the 2004
CMEC instrument, the input of the expert panel, and estimates provided during cognitive testing
for the 2018 CMEC. This includes the time needed by responding agencies to research the
information being requested on the form.
Table 2. Estimated Burden Hours for the CMEC
Average time Average time
to complete
pre- and
Collection
Sample size
form
post-survey

Total
average
time

Reporting
hours

2018 CMEC, All
Agencies

2,200

0.75

0.75

1.5

3,300

Data Quality
Follow-Up

1,100

.25

n/a

.25

275

Total

3,575

Based on results from the 2004 CMEC, it is expected that 95% of the approximately 2,200
MECs will be eligible for the 2018 CMEC data collection and will respond with a completed
survey.
13. Estimate of Respondent’s Cost Burden
Approximately 2,200 agencies will be asked to participate in the 2018 CMEC. Assuming a pay
rate approximately equivalent to the GS-12 / 01 level ($63,600 per year), the estimated agency
cost of employee time would be approximately $30.58 per hour. Based on the estimated time
burden per response and employee pay rate, the total respondent employee time cost burden to
complete the census form is estimated at $100,914. Additionally, BJS estimates that in about half
of the cases, we will conduct data quality follow up, taking approximately 15 minutes to
complete. The additional estimated respondent employee cost burden for the 275 data quality
follow-up hours is $8,410. There are no anticipated costs to respondents beyond the employee
17

time needed to complete the survey and participate in data quality follow up. Therefore, the total
cost burden to respondents associated with this clearance request is $109,324.
14. Costs to Federal Government
The total expected cost to the federal government for this data collection is $1,062,360 to be
borne entirely by BJS. This work consists of planning the project, developing the questionnaire,
preparing the materials, collecting the data, evaluating the results, and generating the data
reports. The budget for this project is shown in table 3:
Table 3. Estimated costs for the 2018 CMEC
Category
BJS costs
Staff salaries
GS-12 Statistician (25%)
GS-15 Supervisory Statistician (3%)
GS-13 Editor (10%)
Other Editorial Staff
Front-Office Staff (GS-15 & Directors)
Subtotal salaries
Fringe benefits (28% of salaries)
Subtotal: Salary & fringe
Other administrative costs of salary & fringe (15%)
Subtotal: BJS costs
Data Collection Agent (RTI)
Personnel (including fringe)
Travel
Supplies
Other – outreach, call center, computer expenses
Total indirect
Subtotal: Data Collection Agent Costs
TOTAL COSTS

Cost
$20,400
$4,000
$10,000
$5,000
$3,000
$42,400
$11,872
$54,272
$8,141
$62,413

$487,046
$5,555
$0
$101,223
$406,123
$999,947
$1,062,360

15. Reason for Change in Burden
No change in burden is expected for the 2018 CMEC from the 2004 CMEC. The burden estimate
for the 2004 CMEC was 90 minutes, and we estimate the 2018 burden to also be 90 minutes.
16. Project Schedule and Publication/Analysis Plans
Pending OMB approval, the 2018 CMEC data collection is scheduled to begin in May 2019 (see
Attachment 2 for the paper instrument and Attachment 3 for example screen shots of the web
18

version of the survey instrument). The data collection period (see Table 4) is scheduled to end in
November 2019.
Table 4. Project Schedule
Contact

Type of respondent

Timing

Survey Pre-notification Letter
Survey invitation letter (with URL
and login instructions), endorsement
letters
Email invitation (with URL and
login instructions), endorsements
letters as attachments
First reminder – letter and email
Telephone prompting for incomplete
responses begins and data quality
follow-up
Second reminder – postcard
Third reminder – email or letter
Fourth reminder – letter with
questionnaire and business return
envelope
Telephone and email non-response
follow up begins
Fifth reminder – postcard
End-of-study email/letter reminder
Completion thank-you
Close data collection
Analysis
Reports

All

Day 1

Attachment
number(s)
6

All

Week 2

7, 22, 23

All

Week 3

8, 22, 23

Non-respondents

Week 6

9, 10

Partial respondents

Week 8

16, 17

Non-respondents
Non-respondents

Week 11
Week 14

11
12, 13

Non-respondents

Week 17

14, 2

Non-respondents

Week 19

18

Non-respondents
Non-respondents
All
Non-respondents
N/A
N/A

Week 20
Week 22
Variable
Week 25
Months 8-15
Months 12-15

15
19, 20
21
----

The dataset and supporting documentation will be made available for download without charge
at the National Archive of Criminal Justice Data at the Inter-University Consortium for Political
and Social Research (ICPSR). It is expected the data will be available to the public for download
in July 2020. Around the same date as the archiving of the data, BJS plans to release at least one
report presenting findings from data gathered from this collection. Access to these data permits
analysts to identify the specific responses of individual MECs and to conduct statistical analyses.
17. Display of Expiration Date
The expiration date will be shown on the survey form, both in web and paper format.
18. Exception to the Certificate Statement
BJS is not requesting an exception to the certification of this information collection.
19