Medical Examiner’s Office: Continuous Improvement Can Strengthen Control Environment

The King County Medical Examiner’s Office (KCMEO) gathers high-risk items like cash, medication, and suspected illicit drugs during its death investigations. While the number of medication items KCMEO collected decreased since 2020, the number of suspected illicit drug items collected increased from about 200 items in 2020 to about 850 items in 2025. Similarly, the amount of US currency KCMEO collected increased from about $91,000 in 2020 to over $140,000 in 2025. We found that KCMEO implements some controls to prevent the loss or misuse of these items. However, KCMEO has not comprehensively assessed risk to further improve its safeguards, and there are some gaps in its ability to detect loss, theft, or misuse. Additionally, we found some inconsistency in practices to ensure its staff can safely handle drug evidence.

In our review of the staff who have decision-making authority over the King County Indigent Remains Program and providers that KCMEO partnered with for funeral and cremation services from 2021 to 2025, we found no indications of conflicts of interest. However, we identified gaps in controls to prevent and detect conflicts of interest. Representatives from local tribes spoke positively about working with KCMEO investigators, stating that, in their experience, investigators take time to work with them to ensure respectful services. Some investigators reported that better training and resources could help them feel more prepared for working with American Indian or Alaskan Native tribes and communities before they go out into the field.

We make recommendations for KCMEO to conduct a risk assessment and improve controls over high-risk items to detect the loss of items and better ensure staff safety. We also make recommendations so KCMEO can ensure that the selection of service providers is done fairly and ethically. Finally, we make recommendations to help ensure staff are prepared for working with tribes and communities.

KCMEO provides vital services to county residents through its death investigations, autopsies, and overdose surveillance work that inform public health and criminal legal processes. Its work involves risks that include collecting high-risk materials while conducting death investigations. Ensuring it has sufficient internal controls over its high-risk items helps protect staff from harm, safeguard evidence and property from being taken or damaged, and prevent King County from reputational, legal, and financial loss. It is also important that KCMEO services be as equitable as possible and ensure its staff are prepared to work with tribes and communities. A lack of appropriate attention to these risks could lead to families and communities having negative experiences with government officials.