Forensic pathologists perform autopsies for the police. These are medical doctors who have completed specialized training in determining how and why people die, particularly in cases involving crime, accidents, or unexplained circumstances. They work within a broader medicolegal death investigation system that varies significantly depending on where you live in the United States.
Forensic Pathologists: The Doctors Behind the Autopsy
A forensic pathologist is a physician who first completes medical school, then finishes at least two years of residency training in anatomic pathology (the study of disease through tissue and organ examination), followed by a fellowship specifically in forensic pathology. After all of that, they must earn board certification from the American Board of Pathology. This training gives them the ability to integrate what they find during an autopsy with evidence from the crime scene, witness interviews, and the person’s medical history to determine a cause and manner of death.
These doctors don’t just cut and observe. They’re trained to assess trauma patterns, identify signs of poisoning, distinguish between injuries caused before and after death, and recognize subtle indicators that might point toward homicide, suicide, accident, or natural causes. Their written report and, if necessary, their testimony in court can make or break a criminal case.
Medical Examiners vs. Coroners
The system that orders and oversees autopsies for police differs dramatically from one jurisdiction to the next. In the U.S., death investigations fall under either a medical examiner system or a coroner system, and the distinction matters.
Medical examiners are appointed professionals, typically board-certified forensic pathologists themselves. They run offices staffed with trained investigators and have the medical expertise to interpret autopsy findings directly. Twenty states plus Washington, D.C. have laws requiring that autopsies be performed only by pathologists.
Coroners, by contrast, are usually elected officials. In most states, they are not required to be physicians or forensic pathologists. Some coroners are funeral directors, prosecutors, or even sheriffs, which can create conflicts of interest. A coroner who lacks medical training will contract out the actual autopsy to a forensic pathologist, but the coroner still holds legal authority over the investigation. Because coroners are elected rather than appointed based on qualifications, the quality of death investigations can vary widely. Coroners do hold unique legal powers, including the ability to issue subpoenas and convene inquests, which medical examiners typically cannot.
State law determines which system a jurisdiction uses, and some states use a hybrid of both. Each state also sets its own standards for which types of deaths require investigation and what training death investigators must complete.
The Team Inside the Autopsy Suite
While the forensic pathologist leads the examination and draws the conclusions, they don’t work alone. Forensic autopsy technicians handle much of the physical preparation and hands-on work. Their responsibilities include preparing the autopsy suite and paperwork, labeling specimen containers, assisting with evisceration of organs, removing the skullcap to expose the brain, weighing organs, and collecting toxicology samples. After the examination, technicians restore the body by replacing organs, packing cavities, suturing incisions closed, and washing and disinfecting the remains before returning the body to refrigerated storage.
Technicians also assist investigators at crime and death scenes, helping collect, label, preserve, and transfer trace evidence to the state crime laboratory. Forensic investigators (sometimes called medicolegal death investigators) typically handle the scene work before the body reaches the morgue, gathering background information, photographing the scene, and interviewing witnesses.
What Happens During a Forensic Autopsy
A complete forensic autopsy has two main phases: external and internal examination. The external exam includes inspecting the body’s clothing and accessories, documenting injuries, scars, tattoos, and any other identifying features. Photographs and sometimes video are taken throughout for use as evidence in court.
For the internal examination, the pathologist makes a large incision down the front of the torso, most commonly an I-shaped or Y-shaped cut, to open the chest and abdominal cavities. A separate coronal incision across the scalp, running from behind one ear over the top of the head to behind the other ear, allows access to the brain. In cases of suspected custodial death, an X-shaped incision on the back and limbs can reveal hidden bruising beneath the skin.
Beyond the physical dissection, the pathologist collects samples of organs and body fluids for toxicology testing (checking for drugs, alcohol, or poisons) and histopathological examination (looking at tissue under a microscope for signs of disease or injury). The entire process is meticulously documented, and the pathologist produces a detailed written report explaining their findings and the reasoning behind their conclusions.
How Evidence Is Protected
Every piece of evidence collected during a forensic autopsy follows a strict chain of custody. This is the documented trail showing who handled the evidence, when, and where, from the moment it’s collected until it’s presented in court. The purpose is to prove the evidence is authentic and hasn’t been tampered with or contaminated.
Each sample container gets a unique identification code along with the location, date, and time of collection, the collector’s name and signature, and witness signatures. Evidence is sealed in tamper-evident bags, and every time it changes hands, the new recipient signs, dates, and timestamps a chain of custody form. Separate forms accompany different evidence containers. If any link in this chain is broken or poorly documented, a defense attorney can challenge the evidence’s admissibility in court.
How Long Results Take
Preliminary findings from the physical examination itself are often available within a day or two, but the final autopsy report takes considerably longer. Toxicology results alone can take weeks. A large multi-institutional study found that only about 48% of final autopsy reports were completed within 30 days, roughly 29% took between 31 and 60 days, and nearly 24% took longer than 60 days. Complex cases involving multiple types of ancillary testing or pending investigation details push timelines even further. Police and prosecutors typically receive preliminary verbal findings quickly but may wait months for the finalized, court-ready report.
Who Pays for a Police Autopsy
When law enforcement or a medical examiner’s office orders an autopsy as part of a death investigation, the government covers the cost. Families are not billed for autopsies performed under the authority of a coroner or medical examiner. Costs for copies of reports vary by jurisdiction. In Delaware County, Pennsylvania, for example, the medical examiner’s findings are free to request, while a full autopsy report costs $500 and toxicology reports cost $100 when requested by non-governmental entities like insurance companies. These fees apply to outside requests for documentation, not to the investigation itself.