When 2-month-old Nathan Tiffany died in Spirit Lake, Idaho, in August 1999, a coroner sent his body to Spokane's forensic pathologist. The autopsy showed no signs of abuse. His death was classified as Sudden Infant Death Syndrome.
One year later, Michelle Tiffany confessed to suffocating her infant son.
The case illustrates "how difficult this job can be, even if you have a forensic pathologist performing it," said Dr. Robert West, Kootenai County's coroner and a retired general surgeon.
In Idaho and Washington, coroners are not required to have any medical training. Yet they are tasked with determining the cause of death and deciding when autopsies are needed.
"It's astounding," West said. "Considering the stakes in the death investigations, the requirements are relatively lax -- not just in Idaho, but across the country."
Coroners in both states rallied this year to defeat two bills that sought to increase oversight, saying it was unnecessary. In Idaho, a bill died that would require coroners to order autopsies in all SIDS deaths.
"Autopsy is just one part of" death investigations, said Erwinn Sonnenberg, president of Idaho's Coroner Association. "Crime scene investigation is just as important."
A recent report from the Idaho Child Mortality Review Team cited incomplete coroner reports on SIDS deaths as one of the biggest obstacles to the reviews.
In Washington, a bill died in the Senate that would have required coroners and medical examiners to report suspicious child deaths to the Department of Health and Human Services.
"I don't believe that coroners have the training necessary to make the close calls on many child deaths," said Rep. Mary Lou Dickerson, D-Seattle, the bill's sponsor. "They could be used car salesmen or prosecutors."
In Washington, records on one-fourth of SIDS deaths lacked important information about the death scene, according to a recent state report.
That creates data gaps in both states' statistics on child fatalities.
In Washington, the state's six largest counties, including Spokane, rely on medical examiners. Poorer rural counties continue to use coroners.
"We have a patchwork, county-by-county system," said Dr. Sally Aiken, Spokane's medical examiner. "Small counties can send the bodies here and we can do an autopsy. But we can't do an investigation at the scene."
Currently, Idaho and Washington each operate two separate reviews of child death.
In both states, teams from Child Protective Services review the deaths of children recently engaged with state services.
Also, teams from both states' health departments produce reviews of all childhood deaths.
In Washington, the Department of Health stopped funding the reviews last year and several counties may be forced to quit tracking the deaths.
Spokane County's Regional Health District will absorb the costs of the reviews but plans to hold fewer meetings this year.
The data provides the most comprehensive picture available of why the county's children are dying.
The county report found that nearly a third of Spokane County's 94 child deaths in 2001 were preventable, from abuse to accidental drownings and shooting circumstances.
In 2000 and 2001, the review found at least 22 children had died of abuse or neglect.