Coroner Training Seeks to Raise Standards for California Death Investigations

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Decades ago, the California State Coroners Association and the Orange County Sheriff's Department recognized the need to standardize training for the job of conducting death investigations. Here, an investigator trains with a mannequin at the California Coroner Training Center. (Courtesy Behind the Badge OC)

Every year, hundreds of death investigators from across California travel to a unique training facility in Santa Ana to sharpen their skills and deepen their knowledge of the critical job.

The people responsible for investigating sudden, suspicious or violent deaths in a county take photos of the body, collect evidence, interview witnesses and prepare a report of their findings that ultimately contributes to a decision on how and why someone died, and what goes on a person's death certificate.

Decades ago the California State Coroners Association and the Orange County Sheriff's Department recognized the need to standardize training for the job. In 1989 they began offering courses, often out of hotel ballrooms. But that limited what they could do. Years later they secured $15 million to build the California Coroner Training Center. The doors opened in 2004, and so did the opportunity to provide hands-on courses.

'There's No Real Dead People in Here'

"What we did is we built just one big wide open room," said Assistant Chief Deputy Coroner for Orange County Bruce Lyle on a recent tour. "There's a drain in the floor in case we needed blood or fluids  -- fake fluids -- to mock it."

Lyle, who teaches some of the courses, quickly added, "There's no real dead people in here."


Contained inside the room is a set of a two-bedroom apartment built out of plywood. From the outside it doesn't look like much, but inside the place is decorated and furnished with furniture, props and eerily realistic latex dummies.

"He's not a very clean person," Lyle said of one dummy. "He's kind of grubby. He's got a 5 o'clock shadow. You can feel it on his face."

The dummy's name, Emmanuel Quin -- or "Manny" Quin for short -- provides comic relief to the otherwise grim task of identifying the decedent and determining how long ago he died.

"There are certain changes in the body" Lyle explained, "and one of them is the decomposition."

The dummy was commissioned by Burbank's Burman Studio to exhibit signs of decomposition, including discoloration of the skin.

The trainers load the set with other clues, including cigarette butts, an empty bottle of tequila, a dated prescription for pills, and a dried-out slice of pizza in a box on the floor.

Lyle said the barrage of stimuli simulates what investigators typically encounter at the scene of someone's death.

"We have to sort of teach people to cut through all that business and get to the important stuff," Lyle says.

The California Coroner's Training Facility in Orange County.
The California Coroner Training Center in Orange County trains coroners from across California. (Courtesy Orange County Sheriff's Dept.)

When trainings are in session, actors play bereaved relatives or roommates with information the investigator has to elicit.

"The last thing I want to do is have somebody come in and just look at the body and think that that's the extent of their investigation," Lyle says.

Most of the death investigators that come for the training work for one of 41 counties in California where the sheriff and coroner’s office are one.

Lyle, who is also incoming president of the California State Coroners Association, says the philosophy for the training is to get attendees to apply their experience investigating crimes to death investigations.

According to the Orange County Sheriff's Department website, "The ultimate vision of the Training Center’s leadership is to 'raise the bar' in the coroner profession by improving the caliber of investigations conducted throughout the state."

Varying Levels of Expertise

The level of expertise in death investigations varies widely from county to county.

Some of the larger sheriff's departments in Orange County and San Bernardino County created a separate coroner's division and assigned dedicated deputies to investigate deaths, which allowed them to develop expertise over years, even decades.

Smaller counties such as San Joaquin County dedicated a handful of deputies for coroner's work who typically investigate more complex death scenes such as a homicide -- but often patrol deputies who received minimal training in death investigations respond to the scene of a death.

The Orange County Sheriff-Coroner's Office is working with the California State Coroners Association to establish an accreditation program for death investigators.

Some Counties Could Be Required to End Sheriff's Role as Coroner

Some of those offices could change under state Senate Bill 1303. The bill would force several large counties to create a completely separate medical examiner’s office for death investigations -- with a physician in charge.

The measure was introduced by Sen. Richard Pan in response to a scandal in Joaquin County that erupted last year.

Two forensic pathologists who worked for Sheriff-Coroner Steve Moore accused him of pressuring them to change their autopsy findings in deaths involving law enforcement officers. Moore denied the allegations.

The doctors also faulted the inexperience among deputies responding to coroner calls for driving up costs and creating backlogs and delays.

If passed, SB 1303 would not interfere with the plans to expand coroner training at the facility in Orange County.