Since California became a state, each County has had a coroner. The Coroner was an elected official (often the Sheriff) who was charged with determining cause and manner of death in specific cases.
In 1848, under the treaty of Guadalupe Hidalgo, the part of Mexico called Alta California became part of the United States. Two years later, California became a state including, among its original counties, Los Angeles County. The County seat was located in a town founded in 1777 and originally known as El Pueblo del Rio de Nuestra Senora la Reina de Los Angeles de Porciuncula.
The first Coroner of Los Angeles County, Alpheus P. Hodges, was also the Mayor of the City of Los Angeles. During the administrative transition from Mexican law to United States law, it was difficult to police an area such as Los Angeles, which had no rail or telegraph connection with the rest of the country. The homicide rate between 1847 and 1870 averaged 158 per 100,000, which was about ten to twenty times the rate in New York.
Coroner’s cases were recorded in a ledger book, with each case given one line. Frequent causes of death included “consumption” (tuberculosis),” apoplexy” (sudden death with loss of consciousness) and “dropsy” (accumulation of excess fluid in the body). In 1850 all of the top ten causes of death were infectious diseases.
The Coroner’s job was not at first a full-time job. In 1852 the duties of Coroner and Public Administrator were merged. The Coroner, who reported to the County Clerk, determined the cause of death based on the available information. In difficult cases the Coroner summoned an inquest jury, took testimony, and reported the jury’s verdict.
The Ft. Tejon earthquake (estimated magnitude 7.9) in 1857 is the most recent earthquake on the southern section of the San Andreas Fault. The recorded death toll was only two, as the County was sparsely populated.
A smallpox epidemic in 1863-64 decimated the Native American population of Los Angeles County, which had no natural immunity to the disease. In 1871, racial tensions led to the China Riots, in which 19 died. In 1905 Los Angeles County required formal death certificates to replace the often incomplete records kept by local churches and courts.
In 1906, the District Attorney called for elimination of the Coroner’s jury, saying, “A Coroner’s verdict binds no one. It cannot be used in court and might just as well be written in mud.” Coroner-elect Dr. Roy Lanterman asked for a clerk and a detective to help with the overwhelming workload of the Coroner. The first public morgue in Los Angeles County was established during Dr. Lanterman’s tenure.
In 1911 the Coroner’s office acquired its first permanent home in room 902 of the Old Hall of Records, located at 220 N. Broadway in Los Angeles. The inquest was the main way of determining cause, manner and responsibility for death. Autopsy was reserved for cases where the cause of death was unknown or where poisoning was suspected.
By the 1920s the Old Hall of Records was running out of space. The Coroner, as well as other County agencies dealing with criminal cases, moved to the new Hall of Justice at 211 W. Temple in Los Angeles in 1926. The Coroner’s office, located in room 100, was equipped with facilities for scientific processing of cases, including autopsy tables, embalming tables, refrigeration, an inquest room, and a viewing room.
The worst multi-fatality incident in the history of Los Angeles County occurred on March 12, 1928 when the St. Francis Dam broke. Although the number of deaths is unknown, it was estimated at more than 400. In response to this disaster, the California State Legislature in 1929 updated the dam safety program and created the State Board of Registration for Civil Engineers.
With the discovery of penicillin in 1928 and streptomycin (for tuberculosis) in 1944, infectious diseases began to move out of the list of the top 10 causes of death. At the same time, with increased use of the automobile came an increase in motor vehicle deaths.
World War II was a period of rapid growth for Los Angeles County. In 1942 a toxicology laboratory was administratively transferred from the Health Department to the Coroner. The number of Coroner’s cases was about 5500 per year. In 1954 the Model Postmortem Examinations Act was created, leading to a spurt in conversions from elected coroners to physician medical examiners.
1956 was an important year for the Coroner’s office. In that year, an amendment to the Los Angeles County Charter required that the Coroner be a certified pathologist. The Coroner’s office was separated from the Public Administrator’s Office. The Board of Supervisors appointed Dr. Theodore Curphey as the first Chief Medical Examiner-Coroner in 1957. Dr. Curphey had previously been the Chief Medical Examiner of Nassau County.
In 1959 the American Board of Pathology recognized forensic pathology as a specialty, allowing forensic pathologists to become board certified. In the late 1950s, Edwin Shneidman, Norman Farberow and Robert Litman developed the technique of psychological autopsy in collaboration with Los Angeles County Coroner. This technique is used internationally to determine manner of death in equivocal cases.
Dr. Curphey retired from his position in 1966 and Dr. Thomas Noguchi, a staff pathologist at the Coroner’s office, became the Chief Medical Examiner-Coroner. During Dr. Noguchi’s tenure, the Coroner’s office established positions for specialists in the investigation of forensic deaths (Coroner’s investigators), and also established a forensic pathology fellowship for training pathologists in the subspecialty of forensic pathology.
In 1972 the office moved to the Forensic Science Center, located at 1104 N. Mission Rd. in Los Angeles on the grounds of LAC+USC Medical Center. This office contains offices, autopsy rooms, an in-house toxicology laboratory, and an electron microscopy laboratory (opened in 1973).
In 1983 Dr. Noguchi left the Coroner’s office for an academic position at the University of Southern California. Dr. Ronald Kornblum, former Chief Medical Examiner-Coroner of Ventura County, became Acting Chief Medical Examiner-Coroner and was appointed to the permanent post in 1987. Dr. Kornblum, a nationally-recognized expert on chokehold deaths, presided over an office with a dramatically increased workload (over 17,000 cases in 1990-91). In the late 1980s anthropologist Dr. Judy Suchey, in collaboration with the Coroner’s office, developed the Suchey-Brooks system of skeletal aging. This is currently a standard system used in forensic identification of skeletons.
Upon Dr. Kornblum’s retirement in 1990, the Board of Supervisors appointed an acting Chief Medical Examiner-Coroner, Dr. J. Lawrence Cogan, and a Director, Ilona Lewis, as heads of the Department. Dr. Cogan was responsible for medical matters and the statutory functions of the Coroner, while Ms. Lewis was responsible for all other Department functions. During this period the Coroner’s office developed its first Department wide computer system.
In 1992, Dr. Lakshmanan Sathyavagiswaran, who was the Chief of Forensic Medicine at the Coroner’s office, was appointed permanent Chief Medical Examiner-Coroner. Upon Ilona Lewis’ retirement in 1993, Anthony T. Hernandez was appointed Director.
The ensuing years saw increasing computerization of the Department, including a major computer upgrade in 2000, an Internet site, participation in the State’s Electronic Death Registration System in 2008, and a multi-year program to digitize the Coroner’s case files. The Coroner’s office physically expanded to include adjacent office buildings at 1102 N. Mission Rd. and in the County Hospital’s Old Administration Building.
In March 2012, the Director, Anthony T. Hernandez, retired and Dr. Sathyavagiswaran was appointed Chief Medical Examiner-Coroner/Interim Director. Upon Dr. Sathyavagiswaran’s retirement in 2013, the Board of Supervisors established a single department head, the Chief Medical Examiner-Coroner. Dr. Mark Fajardo, previously Chief of Medicine at Riverside County Coroner, was appointed to this position in August 2013.
Los Angeles County Coroners
1850-51 Alpheus P. Hodges, M.D.
1852 Rafael (Ralph) C. Guirado
1853 Joseph Stillman Mallard
1854-55 Thomas A. Mayes
1856 Q. A. Sneed
1857 James Brown Winston, M.D.
1858 A. Cook
1859 Henry A. Miles
1860-61 H. P. Swain
1862-65 J. S. Griffin, M.D.
1866-67 J. L. Smith
1868-69 Vincent Gelcich, M.D.
1870-73 Joseph Kurtz, M.D.
1874-75 N. P. Richardson
1876-77 Joseph Kurtz, M.D.
1878-79 J. Hannon
1879-84 Louis Hubert Nadeau, M.D.
1885-86 Andrew McFarland, M.D.
1887-90 J. M. Meredith
1891-93 William Amasa Weldon, M.D.
1893-95 Horace Getchell Cates, M.D.
1895-99 George Walter Campbell, M.D.
1899-1902 L. T. Holland, M.D.
1902-07 John Henry Trout, M.D.
1907-08 Roy Stanley Lanterman, M.D.
1908-20 Calvin Hartwell
1920-21 F. T. Williams
1921-45 Frank Albert Nance
1945-53 Ben Harlan Brown
1953-57 E. A. Winstanley
Chief Medical Examiner-Coroners
1957-66 Theodore Joslyn Curphey, M.D.
1966-83 Thomas T. Noguchi, M.D.
1983-90 Ronald Kornblum, M.D.
1990-92 J. Lawrence Cogan, M.D. (Acting)
1992-2013 Lakshmanan Sathyavagiswaran, M.D.
2013-2016 Mark A. Fajardo, M.D.
2016 Lakshmanan Sathyavagiswaran, M.D.
2017- Jonathan Lucas, M.D.
1990-93 Ilona Lewis
1993-2012 Anthony T. Hernandez
2012-13 Lakshmanan Sathyavagiswaran, M.D. (Interim)