Introduction
In any investigation process, understanding the causes and manner of death plays an important role. There are many steps to be taken to identify decedents, conduct medical examinations, and disseminate information. The Clark County Office of the Coroner/Medical Examiner (CCOCME) is an agency responsible for organizing various medicolegal death investigations with the help of which a further evaluation of an event is possible. This report aims to analyze the CCOCME’s purposes and roles in the community and discuss its major interventions. Such elements as the agency’s organizational structure, leadership, and cooperation with clients define the quality of services and the choice of interventions. The effectiveness of the CCOCME work depends on various factors, including the results of internal and external examinations, medical records reviews, and the ability to share information. This analysis is a unique opportunity to observe the CCOCME working processes and learn if the agency’s decisions correspond to its goals, resources, and environments.
Purpose and Mission
Clark County is a new, dynamic organization that provides American citizens with a variety of services in Las Vegas. It has many departments that develop their work in different directions, and the Clark County Office of the Coroner/Medical Examiner is chosen for the analysis in this paper. This agency focuses on investigating death cases as a result of criminal means, uncontrolled violence, or suicides. However, its purposes and mission are more detailed and thorough to ensure employees with clear obligations and responsibilities.
One should understand that the CCOCME organizes all services under its jurisdiction within the boundaries of its county in Nevada. Thus, this organization neither performs private services outside the region nor examines all deaths, and people get a recommendation to contact the local law enforcement agency. The District Attorney of Clark County or another legal representative should request a service from the CCOCME. Then, the agency obtains the authority to work with the body and choose the steps depending on the case. In addition to the development of services within the department, the CCOCME supports other divisions if the nature of the required business is within the agency’s scope.
The CCOCME’s mission is to become a leader in providing professional and efficient services and medicolegal death investigations. Within this statement, several critical goals need to be mentioned. The first goal is to determine the cause of death by applying available resources and methods like medical examinations and autopsies. There are many types of deaths, and the conditions under which an accident happens require additional assessment. Unattended deaths, suspected homicides or suicides, and deaths caused by violence or criminal acts may become the objects for the CCOCME work. The coroner has to sign a certificate of death where a clear reason or an explanation of death is given. This official document is further used by other legal authorities for their professional purposes.
The second goal is to cooperate with the victim’s relatives to locate next-to-skin and identify unknown decedents. Following the regulations of Nevada Revised Statutes (NRS), the coroner’s office might address several relatives of the victim, including a spouse, an adult child, a parent, a grandparent, or an adult sibling. Much attention is paid to personal property because the CCOCME should take responsibility for each detail and invent everything with a witness. A relative (who meets the NRS requirement) can take property only after an appointment. Such actual operations as fingerprint, dental, or DNA comparison are performed to support the goal and achieve the best and most effective outcomes. An Internet search, medical records, and communication with friends are also promoted to gain the necessary information. The CCOCME has the right to cooperate with the government to identify photographs of descendants. All these steps allow for success in defining the relationship between a victim and relatives who need support and evidence to accept death.
The last goal is based on the necessity to disseminate findings and contribute to the prevention of deaths in society. The CCOCME collects personal data, works with health facilities, and participates in various review processes. These activities promote improved knowledge of human death and the worth of examination for investigation. Thus, together with practice, scientific achievements play an important role in the agency’s work. It is correct to say that all the above-mentioned CCOCME’s purposes and mission are sustained by its actual operation. To develop this conclusion, the information from the official site of the organization was reviewed. Ordinary people are free to pose questions, and the CCOCME gives answers in its FAQs section.
The Actual Role
The CCOCME is involved in many activities related to human death and people’s reactions to these events. The actual role of the agency does not differ from its purpose because each step creates a solid contribution to promoting professional services and helping the community. As soon as the CCOCME team acts within its jurisdiction and completes the tasks to investigate the manner of death, no concerns emerge.
The only recommendation that can be given at this moment is the differentiation between the roles of a medical examiner and a coroner. The former has to examine the body and interpret laboratory tests, which help identify the cause of death. The latter learns the results of the investigation, gathers information about decedents, and signs death certification. The success of cooperation between the medical examiner and a coroner defines the level of services offered by the CCOCME in general.
Interventions
The programs that the CCOCME offers to the community introduce one of the most interesting and effective aspects of its work. Most interventions have an educative purpose of informing citizens, students, and other stakeholders about death causes and outcomes. The Coroner’s Visitation Program and the DUI Program are the two current interventions for analysis. Talking about the levels and types of these interventions, it is correct to say that these programs are employed at the meso level for local communities when a whole group of individuals obtains instructions and recommendations on a particular topic. At the same time, the size of groups can be reduced in certain cases, depending on the participants’ needs. Therefore, the interaction between the CCOCME team and attendees might be developed at the micro level, focusing on solving individual problems and concerns. Still, such shifts are not regular, and all CCOCME programs aim to educate a group of learners.
The first intervention offered by the CCOCME is the DUI Program. It is usually ordered by the court within the frames of a diversionary program for individuals who have been arrested for driving under the influence of alcohol. Although most classes were paused because of the pandemic restrictions, the essence of this intervention remains the same – educating people and helping them understand their mistakes that can be fatal. Traffic accidents may have different causes and outcomes, and people involved in reckless driving need to know that alcohol is not the only threat on the road. Marijuana, illegal drugs, and even medications prescribed by doctors for medical purposes can be dangerous and lead to human death. When a person makes a choice to drive under adverse influence, it is important to consider the consequences. During this intervention, participants are informed about the impact of death on families and society and get a chance to visit the freezer and observe autopsy suites. These activities are necessary to demonstrate what the CCOCME does and how the relationships between the team and the community might be developed.
The second intervention is the Coroner’s Visitation Program, which has a similar format and several specific characteristics. The participants are individuals aged between 14 and 22 who have a criminal history or have a traffic violation citation. As well as the previous intervention, this one is court-ordered, but parents may also apply for the program to educate their children and help them avoid joining a dangerous path. In addition to visits to the same places of the CCOCME work from the previous case, young people listen to stories about reckless driving and unwanted deaths. Participants need to learn how their wrong decisions might affect human life or their families. This communication and cooperation create a solid basis for the promotion of social responsibility and legal issues. Both interventions are appropriate for the client’s problems because they learn more about death causes and manners and observe how coroner and medical examinations enhance the investigation process.
Empirical Evidence for the Intervention’s Effectiveness
Intervention effectiveness has to be examined from several perspectives to prove the necessity of the step idea and its positive outcome for a community. Many primary and secondary studies identify process indicators and approaches to evaluating and disseminating results. Thus, empirical evidence can be applied to clarify the level of effectiveness of the employed intervention. The CCOCME’s interventions are based on the idea of showing people with a reckless driving history or arrest the possible outcomes of their decisions. A corpse is the only evidence that proves the most terrible threat of driving under the alcohol influence. There is no need to say something or search for additional explanations but to look at the dead body in a black bag and realize that the worst has already happened. A sobering effect of what the participants can see at the office is the major expected outcome, which leads to understanding how dangerous drunk driving is.
Many studies aim to discuss road accidents, but not all of them include the impact of coroners and medical examinations. For example, much information about the impact of mass media campaigns and electronic stability control is found in systematic reviews, which have Level I evidence (Gicquel et al. in 2017, Fisa et al. in 2022, or Konlan and Hayford in 2022). Controlled trials (Level III evidence) to reduce reckless behaviors on roads are promoted locally to optimize resource use and cooperation between community members (e.g., Weichelt in 2020). Defining the effectiveness of CCOCME programs is a retrospective task because the outcomes are impossible to observe once an intervention is offered. The evaluation of local traffic statistics and personal achievements of participants shows if CCOCME promotes positive behavioral changes. Currently, the interventions are effective because most participants report an immediate sobering effect when they see black bags with possible human bodies or their remains. The fact that the court and parents are interested in cooperating with the CCOCME proves that its programs positively contribute to public health and social order.
Interventions’ Basis
The CCOCME introduces two strong interventions with a clear range of participants and activities that fulfill the organization’s purposes. Road traffic deaths are common in any country where people drive a car or other vehicles. There is a belief that individuals with prolonged experience are aware of major risks on the road and address their knowledge to enhance safe driving. However, the World Health Organization or the Centers for Disease Control and Prevention, regional journals, and local magazines report that the number of deaths from reckless driving continues to grow. Therefore, it is important to prevent accidents and provide people with the necessary information at different stages of their life.
The CCOCME creates two programs: one is for at-risk youth to underline the worth of knowledge and prevention, and another is for people of any age with arrests for driving under the alcohol influence. The two critical elements in implementing the offered intervention are age and history of inappropriate driving. They are chosen on the basis of the official reports and the intention to assist individuals in understanding their decisions that might lead to death.
Together with age and driving history restrictions, the agency poses several more constraints on these choices, including the time of visits and the environment. The CCOCME does not have the right to ask the clients to perform any type of work, even if it is voluntary. The goal of their visits is to obtain information, observe the environment, and ask questions. All participants should come after morning examinations so they do not have access to dead bodies and do not see the details of the autopsy performance.
The creation of the environment is another requirement for employees as they should not leave open bodies or organs for observation. Still, they can use bags and boxes to hide the outcomes of their work, which has a sobering effect on visitors. The participants, in their turn, are obliged to keep order and silence during a learning process, show respect to all CCOCME workers, and follow the timetable introduced by the agency.
Organizational Structure and Leadership
One of the reasons for the CCOCME’s success is the sufficient choice of its organizational structure and leadership. The primary management team consists of a Coroner and a Deputy Coroner who participate in all decision-making processes. The board of county commissioners should approve the decision of the coroner to employ a deputy or several deputies, depending on the current administration’s needs and performance levels. If there is a need, several professional assistants may be hired temporarily on a contractual basis. The CCOCME also has three major divisions, namely, forensics, administration, and investigation.
In the Investigation division, there is a small team of Coroner Investigators who divide their functions to ensure they identify decedents and cooperate with other law enforcement agencies to obtain the necessary information and exchange findings. These individuals do not have one particular leader because all of them have the same goals and use similar working methods. As a rule, the Coroner Investigator determines jurisdiction on death, gathers medical history, contacts family members, and writes reports to the coroner’s office. In other words, all steps that are related to the examination of the available information about the case and cooperation with potential stakeholders should be taken.
The Forensic team aims to examine the cases, which usually do not exceed a 15-case-limit per day. As a rule, the staff members cannot use autopsies for each case without approval. They must address the NRS and check if a particular case meets the requirements. This department closely cooperates with the Investigation department because it is necessary to use the gathered information and evaluate all possible causes of death. They might take x-rays and compare DNA or fingerprints to obtain more evidence for a case.
The Administration department deals with case files and management reports. During the last several decades, the decision to destroy hard copies of the records was made and followed. The staff uses electronic scans and store information properly, following all record retention requirements. Finally, this group controls personal property and works with family members who want to take some things. The task of the administration is to define the level of relationship and ensure all documents are signed. At the end of each case, the administration completes death certificates and sends them to another department for dissemination. In general, such a division between the departments allows the CCOCME to achieve the agency’s goals and professionally cooperate with clients.
Clients’ Voice in Policies
The CCOCME clients are usually families of dead people and their descendants. They face a serious challenge in their life and have to deal with a moment when they lose a relative. The agency’s responsibility is to identify the cause and manner of death and share this information with other official stakeholders. The client’s voice in determining the CCOCME’s programs is hard to identify because it is the agency that becomes that voice. A professional team of coroners, investigators, and administrators examines a crime scene and bodies to discover the truth about the accident. Families cannot access all facts, and the agency should share information. If there is no specific request and reason, clients are not allowed to view the body at the office. In most cases, they come to identify and confirm the personality officially. They cannot affect the agency’s policies and operations because each examination type is usually determined by the circumstances, which are unique for each case. There is usually no coercion in the agency-client relationship; still, it is impossible to withdraw the service or freely walk away as the judge or another court representative orders procedures.
Regarding the offered interventions and contributions, the CCOCME might say that decedents and families are not their only clients. The agency finds it beneficial to participate in various programs and educational sessions, which makes the local community one of the CCOCME’s clients. In addition to professional help related to death, the team participates in various research projects and conferences to introduce recent facts in the field. Public health can be improved, and preventive interventions based on the material offered by the CCOCME become a fundamental step in a changing process. Thus, it is correct to say that ordinary citizens, students, and scholarly researchers depend on the information the CCOCME gathers and shares. As a rule, people who face the challenge of human death are not very interested in preventive initiatives, but their examples and reactions help other community members understand the levels of responsibility and the importance of safety and order in society.
Effectiveness in Meeting Program Goal
The main goal that the CCOCME promotes within its programs is to reduce the number of road accidents and unwanted deaths in the community. There are also several supplementary purposes that have a serious impact on the agency and participant, including the education of the attendees and the consequences of their actions. On the one hand, measuring the effectiveness of a program that focuses on education is not difficult as it is expected to ask the participants what they know about the topic. However, all people, regardless of their level of education or driving experience, understand that driving under the influence of alcohol, drugs, or other harmful substances is illegal and should be prevented. It is more important to allow individuals to visualize a problem and learn that the most effective solution is their own decision. Therefore, programs’ effectiveness can be strengthened if attention is paid to the overall effect of visitation. When people look at dead bodies and get information about accidents, they cannot ignore the sobering effect and start thinking about the existing threats and consequences.
Certain impediments should be mentioned regarding the current organizational structure and a variety of direct duties that are not related to education and cooperation with students or criminals. First, staff limitations cannot be ignored because the agency does not hire a specialized teacher or researcher to lead the intervention and work with the attendees only. Thus, medical examiners, investigators, and the members of the forensic and administrative teams have their purposes and resources. When they initiate programs to prevent reckless driving and reduce road deaths, they deprive themselves of working time. Therefore, hiring several employees in the administrative division to cooperate with individuals can make the programs more effective. The CCOCME has already decided to have a social worker who helps families to navigate the available information and resources. The next improvement should address the educational aspect to solve organizational issues and distribute duties.
Administrative Plan
An administrative plan that is properly created and explained becomes a solid navigational map for the agency to follow. Depending on the expected goals and available resources, the team thinks about the steps to be taken and the duties to be distributed. In the CCOCME’s case, the task is to organize educational interventions, not at the expense of the primary purposes and vision. The agency shares a vision of being a leader in providing efficient services in determining causes and manners of death, identifying and protecting decedents, and cooperating with next-of-kin. A new administrative plan is based on the intervention to educate individuals about the consequences of reckless driving. Thus, it is expected to add another objective – to educate attendees. This requirement implies additional expenses to cover the employee’s needs, buy new equipment, and find a place for meetings.
The first step is to hire a person for the Administration division who should work not with death certificates, case files, and clients’ records but with students. A new team member’s presence will improve the agency’s performance because each person is involved in their direct activities. The CCOCME is one of the departments in a fast-developing organization that covers the needs of the chosen population. Proving the relationship between death investigation and driving behaviors will help to explain the urgency of a new worker for a team.
The second step of the administrative plan that helps to offer competent services is the promotion of the equipment for education. The educator in the intervention program should have a personal computer to plan meetings and gather the material. Office supplies like paper, pencils, markers, calendars, and printing stuff should be available. The program’s participants and a new employee need some space to organize meetings and exchange information. Although the visitation of the office is a part of the program, there has to be free room for the visitors to gather and communicate.
The final step of this plan for the agency is cooperation between the departments. At this moment, the CCOCME demonstrates high-level communication and mutual support between the three divisions and the Coroner as the head of the department. However, a person responsible for the Coroner’s Visitation Program and the Coroner’s DUI Program should access all departments, obtain recent findings, and analyze the material to present it to the participants. Thus, the agency should reconsider the policy of mutual support and free access to its records for educational purposes.
Conclusion
Examining the CCOCME’s organizational structure, mission, purposes, programs, and clients introduces a unique opportunity to understand what has been done by the agency at the moment and what should be additionally done. Much work has been successfully demonstrated in terms of investigating deaths, performing autopsies, and supporting decedents and next-to-kin. As a part of its prevention initiatives, the agency has introduced two interesting programs for a particular group of people: individuals with a criminal driving history and the youth (aged between 14 and 22). Both interventions are effective due to their sobering effect and the evaluation of their behaviors on the road. An administrative plan to introduce a new employee has been offered to improve the agency’s performance and contribute to public health promotion.