SF Office of the Chief Medical Examiner Achieves Full Accreditation

The Office of the Chief Medical Examiner re-earns full accreditation from the National Association of Medical Examiners after 10 years, recognizing success of key investments and reforms.
December 15, 2022

SAN FRANCISCO, CA--The San Francisco Office of the Chief Medical Examiner (OCME) has achieved full accreditation from the National Association of Medical Examiners (NAME). The full accreditation, an achievement shared by only one other office in the State of California, recognizes the success of key reforms and structural improvements implemented since 2021 to increase efficiency and improve the delivery of critical services.

NAME is the premier accreditation organization for medical examiner and coroner offices nationwide and promotes the highest quality forensic pathology practice and medicolegal death investigation in the world. NAME grants accreditation through an extensive peer-reviewed process and on-site inspection, with close to 350 requirements measuring quality and success. The OCME earned and maintained accreditation from 1982 to 2017. However, its provisional accreditation lapsed from 2017 in 2021.

In February 2021, Mayor London N. Breed appointed then Assessor-Recorder Carmen Chu as City Administrator. Among City Administrator Chu’s first priorities was appointing a new Chief Medical Examiner and supporting the office to regain accreditation. City Administrator Carmen Chu appointed Dr. Christopher Liverman, MD, PhD in April 2021 after a nationwide search. Under Dr. Liverman’s leadership and with full support from the City Administrator, the OCME focused on increasing staffing and improving procedures to move towards accreditation.

“This is a big deal and I want to thank Chief Medical Examiner Christopher Liverman and the entire team at the Medical Examiner’s Office. Through smart investments, unyielding focus, and a willingness to dive into our business processes, the team has been marching steadily towards re-accreditation”, said City Administrator Carmen Chu. “San Franciscans deserve to know the facts behind the deaths of their loved ones. Today’s announcement by the National Association of Medical Examiners highlights our commitment to this.”

Since his appointment, Dr. Liverman has led the office in implementing critical process improvements, developing new quality assurance measures, and drafting policy initiatives to reduce delays in reporting. As a result, OCME earned provisional accreditation from NAME in November 2021. The provisional status was valid for one year, allowing time for OCME to make additional improvements as outlined in the NAME inspection report.

To achieve full accreditation, OCME had to satisfy, without interruption, the completion of autopsy and toxicology reports in a timely manner (within 90 days in at least 90% of cases) and balancing of medical examiner caseloads.

OCME has successfully met these metrics since February 2022, and, after thorough review, NAME granted full accreditation in November 2022. Full accreditation is an endorsement of the reform work of the OCME team in its effort to meet the highest standards of ethics, excellence, and empathy in the prompt certification of the cause and manner of death for decedents under its jurisdiction, as well as the delivery of impartial forensic services for the community and the justice system.

“When I started at the OCME eighteen months ago, we instituted policy changes designed to streamline the completion of forensic studies, in order to help bring closure to the families of San Francisco,” said Chief Medical Examiner Christopher Liverman. “This milestone is confirmation that the policies, in conjunction with the city’s investment, are working.”

Since 2021, key OCME improvements include:

  • Increased efficiency of the issuance of reports, final death certificates, and decedent identification to provide expedient delivery of services, in accordance with NAME accreditation standards
    • 90% or more autopsy reports are now completed in 90 days or less
    • 90% or more of toxicology reports are now completed in 90 days or less
    • 90% or more of final death certificates are now completed in 90 days or less
    • In 90% of cases, decedent identification and notification to next of kin are completed in 24 hours or less
  • Increased staffing of key positions to meet rising workloads, balance casework, and better serve San Franciscans. New positions include 2 new assistant medical examiners, 3 new medical examiner investigators, 3 new forensic autopsy technicians, and 2 new forensic laboratory analysts.
  • Implemented new autopsy triage policy, modeled after other NAME-accredited medical examiner offices, to manage workload and prioritize the most critical issues
  • Implemented quality assurance review of case reports
  • Prioritized 60-day closure of homicide and suspicious cases to advance the mission of providing impartial, timely analysis to the justice system
  • Eliminated backlog of hundreds of cases, requiring more than a thousand toxicology tests

In addition, the Forensic Laboratory Division continued to achieve accreditation with the American Board of Forensic Toxicology, while increasing the scope and speed of testing, ensuring the impact of drugs in the community is understood and rapidly reported. OCME also recruits fellows and trains them as forensic autopsy technicians, a highly specialized position difficult to recruit nationwide, to support the completion of autopsies.

“National recognition that our Medical Examiner’s Office has met the highest standards of training has been a long-term goal that I’m proud to have collaborated with our City Administrator on,” said Supervisor Aaron Peskin, who held several hearings on the OCME. “This re-accreditation is a significant step towards a wholesale reform for this critical Department and restoring the public’s trust in the OCME.”

The Office of the Chief Medical Examiner is responsible for the investigation and certification of any sudden, unexpected, and violent deaths of legal or public health interest, including determining the cause, circumstances, and manner of death. OCME also provides useful reports, such as the monthly Accidental Overdose Reports and data to inform the Homeless Death Count, and conducts briefings to inform policymakers and public health officials and help improve outcomes. For more information, please visit OCME’s website.