'An Absolutely Fascinating' Local Government Job

Well before Covid-19 arrived in Idaho, Ada County Coroner Dotti Owens was running out of places to store dead bodies.

The population in her county—home to Boise, the state’s largest city and one of the fastest-growing metro areas in the country—had exploded, increasing by more than 26% over the past decade. Her staff was already overworked, her cooler already full. If Covid-19 hit the county in any substantive way, Owens knew, they’d be screwed. 

“I got on the horn with my emergency management operator and my Ada County commissioners, and I said, ‘Look, we need to prepare for this,’” she said. “‘If this hits us, and we don’t do something immediately on storage, body bags and PPE, you’re going to be looking for help for this office, because we can already barely handle the population increase. If you add pandemic on top of that, we’re going to sink pretty flipping quick.’ ”

County officials agreed. The board approved the purchase of a $140,000 refrigerated trailer, which arrived in mid-April 2020 and has been parked outside the coroner’s office, in constant use, ever since. Not wanting reporters and residents to drive by and see it out of context, Owens posted a photo on social media. The backlash was swift.

“I got so much crap for that. I got accused of fear-mongering. I got accused of just trying to get money from the state. I got accused of all kinds of things, and meanwhile I’m just trying to prepare the community,” Owens said. “If I ended up with extra deaths from the pandemic I was not going to have a place to store them. I wanted to be transparent. You’re damned if you do and you’re damned if you don’t.”

To anyone other than a coroner, the request for extra body storage may seem macabre. For Owens, it was one of a thousand job duties that existed before the pandemic but have become more constant, and difficult, since its onset nearly two years ago. Advocating for more space, more supplies and more staff members is a common refrain. Doing it amid an ongoing global health crisis, public skepticism, rancorous politics and a background of ignorance about her job—that’s new.

“The comments we’ve gotten from the community—that covid isn’t real, that we’re fear-mongering—all of that is because of the fact that they have no idea,” Owens said. “They don’t know what we’re seeing. They don’t know we’re using the trailer every single day and have 10 to 15 bodies in there all the time now. I can’t be angry at that, when it really, truly is that they don’t know and they don’t understand it.”

A Misunderstood Profession

Coroners are an ubiquitous part of county government, but their jobs vary greatly from place to place and their duties are rarely uniform or routine. They are often conflated with medical examiners—in practice a different profession altogether—but some jurisdictions use the terms interchangeably, adding to the confusion. Broadly, both coroners and medical examiners are charged with investigating unnatural deaths, but even county officials who technically supervise both professions often can’t explain what either does, said John Fudenberg, executive director of the International Association of Coroners & Medical Examiners and the former coroner of Clark County, Nevada.

“People are intimidated and afraid of death, so even local government officials don't tend to jump in to see what the coroner’s office is doing or what they’re expected to do,” Fudenberg said. “It's kind of like wastewater treatment, in that if the toilets are flushing, everyone thinks everything’s great. If the decedents are being picked up and inventoried and there aren’t bodies piled up, then everyone thinks everything’s fine. We kind of operate in the shadows of local government.”

While that allows coroners a measure of independence, it can also hamstring their offices. Coroners are usually elected, meaning they answer to voters but depend on other elected officials for their funding. And because the job is so misunderstood, turnover on those supervisory boards—a regular occurrence every election year—can throw budgets into jeopardy.

The main distinction between coroners and medical examiners is their training. Medical examiners are often physicians or forensic pathologists, while coroners can be laypeople and, in many states, require no training at all. Generally, coroners are tasked with identifying deceased residents and determining their cause of death; medical examiners may run similar investigations, but also perform autopsies and other pathology, according to the Institute of Medicine.

But there is no standardized training requirement or official definition for either position, and the regulatory framework that governs their work is a patchwork of systems that vary from state to state and, sometimes, county to county. Because of this, no one tracks coroners in an official capacity, and it’s unclear exactly how many there are. 

In 2004, the first and last time the federal government conducted a census of the profession, there were 16 states with a centralized medical examiner system, 14 that utilized county coroners, seven with county medical examiners, and 13 with a mix of both.

Eighty percent of county offices nationwide—a total of 1,590—were helmed by coroners, most of them serving jurisdictions of fewer than 25,000 people, according to that data. Less than a third of those required coroners to have specific training for the position. And because coroners are mostly elected positions that require a political party declaration, that’s a problem, Owens said.

“It makes it dangerous,” said Owens, who identifies as a Democrat but says her work is entirely nonpartisan. “In my last two elections, I have had people run against me that didn’t know anything about the job, had never been on a death scene, couldn’t tell you one last thing about it. I’ve had to fight like heck through the whole thing.”

‘Absolutely Fascinating’ Work

Owens came to the coroner field late in life and somewhat by accident. She’d gone back to school after years of working in the mortgage industry with the intention of pursuing a law career when a counselor at Boise State University suggested that she intern with the county coroner.

“He just thought I’d be a good fit for it. I thought he was totally nuts,” she said. “I had no idea what a coroner even did. It wasn’t anything I was remotely even interested in. But he talked me into it.”

The first death she investigated was an eight-month-old. The mere thought of it made her anxious. She wasn’t a blood-and-guts person; she had, in fact, purposely avoided a career in nursing because of an aversion to that kind of thing. And this was a baby. She called her mother, a pediatric neuropharma nurse.

“She said, ‘Here’s the deal,’” Owens said. “‘You can either do it, or you can’t, and this will be a good case for you to test the waters and see if it’s something you can handle.’”

This made sense, Owens thought, so she pulled it together and assisted the coroner and forensic pathologist with the autopsy. To her surprise, the work came naturally to her. To her greater surprise, she genuinely enjoyed it.

“It wasn’t difficult for me, and that’s what was weird,” she said. “I just thought it was absolutely fascinating. I was like, ‘Well, this is my thing.’”

Owens graduated from Boise State with a bachelor’s in criminal justice administration, then obtained a master’s degree in the same subject from Arizona State University. She worked as a medicolegal death investigator at the Twin Falls County Coroner's Office for three years before accepting the same position in Ada County. In November 2014, four and a half years later, she was elected as coroner.

Today, Owens oversees 28 employees, including 10 investigators, a forensics team and an administrative staff that’s dedicated mostly to recordkeeping. Her office spearheads investigations of any unattended death (essentially, anyone who passes away without a physician present), including car accidents, homicides and drug overdoses—but also people who have died at home in their sleep or alone in their rooms at a nursing home. Owens participates and oversees each of those tasks, along with administrative responsibilities that include revising policies and procedures, finalizing the budget and signing death certificates.

“We collect evidence, we obtain medications. We bring in anything that’s going to help us determine the cause and manner of death,” she said. “We’re the ones that train law enforcement to leave the deceased as they were found until we get on the scene. We photograph everything, and we have our own investigative process.”

Coroners and their employees are first responders, but they’re rarely recognized that way, Fudenberg said. Because most people don’t understand what coroners do, they have far fewer resources for things like depression or post-traumatic stress disorder than police or paramedics—even though they’re responding to the exact same crime scenes, often working hand in hand with those other agencies. 

It’s not even clear how common mental distress is among coroners, because researchers historically have not paid attention to the issue. As of 2018, for example, there were only three studies that assessed the likelihood of PTSD in coroners, compared to hundreds that examined the same thing in paramedics.

Owens is conflicted on this topic. The job can be gruesome, and it involves near-daily exposure to tragedy, but that’s never personally affected her, she said. When her employees struggle with that fatigue, it is sometimes difficult for her to sympathize with their plight.

“I can go home and shut it off and I don’t think about the cases. Because we deal with it every day, and it’s just normal life for me,” she said. “So I really have to step back as a leader and say, ‘OK, not everybody is wired the same.’ When I have employees that are struggling, it’s taken a bit for me to be able to recognize that, because I, personally, don’t understand it.”

But even Owens isn’t immune to the added stress of the pandemic. Despite being on the front lines of any major health crisis, coroners do not receive specific training for rapid spread of infectious diseases—they participate only in occasional exercises that simulate “regular” disasters, like plane crashes or flipped buses. 

Preparing for and responding to Covid-19, then, was a scramble. In the early days, when supplies were scarce and Owens publicly tried to procure them, she was accused of fear-mongering. Once the virus arrived, the way that local governments responded to it quickly became politicized. In ruby-red Idaho, that meant laxity in public health restrictions. Owens would spend all day cataloguing dead bodies and then go to the grocery store to find dozens of people shopping without a mask. Her employees worked 60-hour weeks with no break, only to have their friends and family tell them the virus wasn’t real or that its local effect—as of Thursday, 3,501 deaths statewide, 768 of them in Ada County—didn’t seem that bad. There are 1.84 million people living in Idaho, which is the nation’s 11th largest state, according to the 2020 U.S. Census. 

“My thought is, what do you mean it’s ‘only’ 3,300 deaths?” Owens said. “There’s so much frustration because we do so much prevention work and then you hear people say, ‘Well, it’s only affecting the elderly, it’s only so many deaths,’ and we’re like, ‘Wait a minute, we’re doing everything we can to stop opioid overdoses, everything we can to stop suicides, but you’re OK if people die from this?’ I don’t understand that. These are still tragic deaths. There are still families losing people.”

The result, for Owens and her staff, is total exhaustion, both physical and emotional. Under normal circumstances, vacation might help, but there is no time for time off, so they push through. Cases abated earlier this year, providing a brief respite, but then the delta variant caused a second surge that at one point was so bad that Idaho hospitals required staffing help from the National Guard. The majority of those cases were among unvaccinated residents (just 43% of Idahoans are fully vaccinated, ranking 50th among the states and the District of Columbia). 

Even amid that backdrop, Owens’ office fields daily calls from family members of deceased residents, asking that covid not be listed as the cause of death on the death certificate. It’s not real, they claim, and Owens is only using it to pad the county’s statistics.

“I am so sick and tired of all these flipping people going on about how we’re lying about covid,” she said. “Everyone’s at capacity. I have funeral homes calling and wanting to know how we can help them out, and meanwhile, they’re holding a football game at Boise State with 35,000 people and everyone’s throwing a fit about them wanting people to wear masks. It’s just been a flipping mess.”

After nearly two years of exhausting extra work, Owens’ office is still nearly fully staffed (she lost several employees to stress and will lose two more—one to retirement and one that’s staying home to raise her children—in the coming months). But it’s possible more will follow, she said. Not everyone can compartmentalize when they go home at the end of the day.

For the first time, Owens said, she understands the feeling. Her term expires in January 2023. She has yet to decide if she’ll run again.

“I love the work, but I love the work of three to four years ago,” she said.  “I don’t enjoy having to defend every flipping that we do with this. It’s constant.”

But even if she left, she wouldn’t leave the field. There’s advocacy work that interests her—championing legislation to ensure better benefits, including mental health provisions, for coroners, or helping other jurisdictions become accredited. There are supervisory roles that might be available at the state level. Some of that could be done in addition to her work now. 

But only if that work changes. Fighting for resources has always been part of the job. Fighting misinformation and political bias is an entirely different thing.

“Administrators of our hospitals have come forward and pleaded with people to get vaccinated because they’re at capacity, and they’re being accused of lying. People call it political propaganda, and how do you battle that?” Owens said. “There are a lot of different things I’d like to do in addition to what I do. It’s just going to be a question of mechanics: do I do it as coroner, or do I do it on my own? I don’t know.

“We’ll see how much fighting I have to do for the next year and a half. I never thought I would consider it, honestly. I absolutely love what I do. But I’m sick of the crap.”