‘Very concerning’: Idaho autopsy rates fail to meet national standards

If someone kills you in Idaho, the chances that your body will be autopsied are worse than almost anywhere else in the country. The same is true if you die by suicide.

In fact, regardless of manner of death, Idaho has some of the worst autopsy rates in the country, according to a recent state investigation into the county coroner and death investigation system.

The Office of Performance Evaluations, an independent office that audits state agencies and programs, issued a 96-page report after lawmakers requested an analysis of the system. The investigation found Idaho is trailing national and industry standards in crucial aspects of death investigations.

The report highlighted myriad shortcomings in the system, including vague rules, insufficient resources and instances of coroner’s offices not meeting the education standards set for them in state law. It also included several recommendations for reworking the state system, from requirements for autopsies to significant changes in how coroner’s offices and death investigations are funded.

In his presentation of the report to a legislative panel, senior evaluator Casey Petti told legislators his investigation unearthed “very concerning” anecdotal evidence from coroners that deaths warranting investigation went without autopsies.

“We do know for certain that there are deaths that are not properly investigated and are not properly certified,” Petti said.

Idaho autopsy rates fail to meet standards

Idaho is one of 14 states with a county coroner system rather than a medical examiner system or a combination of the two. While most states’ autopsies are conducted by medical doctors trained in forensic pathology, coroners in Idaho are elected by county, or appointed if no one runs for the office, without any requirement of having a medical background.

Idaho has fewer types of deaths that are reported to coroners, including unattended deaths, suicides and homicides, when compared with other states and rates recommended by industry best practices. And the decision to do an autopsy in any of those cases is entirely up to a coroner rather than a mandatory procedure.

Idaho has had at least one high-profile criminal case in which a death initially wasn’t investigated. Chad Daybell was eventually charged with the first-degree murder of his then-wife, Tammy Daybell, a Rexburg woman whose death was originally attributed to natural causes. Officials performed an autopsy two months after her death and determined she died of asphyxiation. Lori Vallow Daybell was found guilty of conspiracy to commit murder in Tammy Daybell’s death last year.

Ada County Chief Deputy Coroner Brett Harding told the Idaho Statesman in a phone interview that Idaho’s death investigation system is “not the worst, but it is definitely in need of improvement.”

“That Idaho is the lowest rate of autopsy for homicides is really disheartening,” Harding said. “The forensic standards are there for a reason, and if you don’t adhere to them, that’s when things can slip through the cracks.”

From 2018 to 2022, 3.9% of all deaths in Idaho were investigated by autopsy. The national average during that time was 7.8%.

Idaho coroners performed autopsies in child deaths from external or unknown causes in 49% of cases during that time period — the lowest nationwide. The national average was 79%.

Idaho had among the lowest rate of suicide autopsies at 14%. It also had the lowest autopsy rate for homicides from 2018 to 2022 at 93%, lower than the rate recommended by industry standards.

Unlike some other states with county coroner systems, Idaho has no state-level oversight committee or official. The state’s death investigation protocol is vague enough that coroners around the state reported different approaches, the state review found.

“Nearly every aspect of the county coroner role is left to the interpretation of the individual coroner,” the state’s investigative report said. “This extends to how death investigations are conducted, what information is gathered in an investigation, how information is disclosed to the media, how records are kept, how a decedent is transported and how next of kin are notified of a death.”

In Idaho’s more rural counties — where the coroner often works part-time and is paid a median annual salary of about $18,000 — coroners look to Ada and Canyon counties or even offices out of state for guidance and assistance with autopsies.

Harding told the Statesman he worries “a part-time job translates to part-time caring” when it comes to death investigations.

“I don’t really think that translates to most of the coroners in Idaho, but I’d hate for somebody have to make that choice between a job that puts a roof over your head and feeds your family and your civic duty that doesn’t pay you hardly anything,” Harding said.

Petti pointed out that state law requires coroners attend “a coroner’s school,” but there is not state or industry definition of what constitutes a coroner school.

Additionally, while Idaho law requires coroners to complete 24 hours of continuing education every two years, the review “found that most coroners are either failing to participate in education or are not submitting completed education” to the Idaho State Association of County Coroners, a non-governmental body tasked with tracking continuing coroner education.

Pam Garlock, president of the association and Boise County coroner, did not immediately respond to a request for comment, but association vice president and Bannock County Coroner Torey Danner told lawmakers during the legislative committee hearing that the association fully supports the report’s findings.

Deputy coroner seeks change

Harding said the policy suggestions in the report, which include more strict autopsy requirements, clarifications on the role of coroners and definitions of terms like “unattended death,” would be welcome changes. He also urged additional funding, which currently comes from county budgets and a $1 fee for death certificates.

“You need to redo the state statutes, but you also need to address the address the funding thing, because an unfunded mandate means it never happens,” Harding said.

It’s unclear whether legislators plan to consider policy changes for death investigations. Sen. Melissa Wintrow, D-Boise, co-chair of the legislative committee that requested the review, told the Statesman in a text message that the committee is “very concerned and very sincere” in its desire to make legislative changes.

Wintrow said the report was “eye-opening,” and that a statewide office overseeing coroners could be a good first step to bring coroners and other stakeholders together and begin addressing other systemic issues.

“Our coroners are doing a great job and they need our help in creating a system that supports their work and leads to more consistent approaches in the state,” Wintrow said.

Stewart Wilder, director and co-founder of the Idaho Suicide Prevention Coalition, told the Statesman in an email that the report is “a damning indictment on the state of Idaho’s coroner and forensics system on many levels.” Wilder said overhauling the system would likely be a lengthy process but considers it necessary.

“Without proper reporting on all deaths and inability to autopsy, the state will continue to make decisions on bad data,” Wilder said.

Harding said he would like to see state laws “with a little bit of teeth” when it comes to coroner responsibilities and the potential consequences for straying from them. He also suggested three regional forensic pathology facilities could increase autopsy capabilities in the state. Already the Ada County Coroner’s Office provides those services for much of the state, but Harding said a planned facility in eastern Idaho will open later this year and serve that region. Adding a North Idaho facility would also prove useful, he said.

“If we don’t have a good system in place, we’re going to miss everything, from potential overdoses to homicides,” Harding said.