A behind-the-scenes struggle between Ontario coroners and forensic pathologists could lead to a major overhaul of the way deaths are investigated in the province, The Canadian Press has learned.

Rank-and-file coroners allege a review of the system — which includes recommendations from a yet-to-be-released consultant's report — is a thinly veiled power grab by forensic pathologists.

Coroners fear being shut out of death investigations in favour of forensic pathologists — physicians who conduct autopsies to determine the cause of death but have little experience in dealing with the public.

"This forensic pathologist-driven review seeks to reduce the coroner system to rubble," Dr. Susan Aitken, a part-time coroner from Stittsville, Ont., recently wrote to her colleagues.

Coroners called to a death scene try to determine what killed the person. They are instrumental in liaising with grieving relatives or in making recommendations aimed at improving public safety.

Pathologists say if they run death investigations, there would be little need for coroner involvement.

According to the Ontario Coroners Association, the changes under consideration involve having pathologists designated as coroners.

They in turn would appoint civilian examiners — such as former police officers — to respond on their behalf to death scenes.

Ostensibly, the KPMG review — which began last December — was to explore "cost-saving and other efficiencies" as the government seeks to rein in spending.

The government will only confirm that a theme arising out of the completed review involves "expanding the role of forensic pathologists in the death-investigation system" but has kept the final KPMG report tightly under wraps.

"Even criminals standing trial have a say on who sits on their jury," is how Dr. Natalie Mills, a part-time coroner in Rockland, Ont., described it.   

Coroners are fiercely proud of the system. They say making wholesale changes or adding another layer of examiner is pointless.

In a letter to Community Safety Minister Madeleine Meilleur last week, Aitken accused the pathologists of setting out to "sabotage" the current system.

"We see the erosion of morale and the loss of confidence in the system occurring before our very eyes," Aitken wrote in the letter obtained by The Canadian Press.

"The people of Ontario will be blindsided by the proposed changes and will not understand how drastically different and less responsive the pathology-run system is likely to be."

Meilleur refused to discuss the report, saying no decisions have been made.

Dr. Michael Pollanen, the province's chief forensic pathologist, did not respond to a request for comment on the proposed changes.   

Dr. Andrew McCallum, the province's chief coroner, also refused to discuss the recommendations.

"We have a highly effective death investigation system in Ontario," McCallum said in an email to The Canadian Press. "(We) believe that we have the ability to find a place for all of the professionals in the system."

In most provinces, coroners are physicians. The others, among them Alberta, use a U.S.-style medical-examiners system in which death investigators may have legal, medical, or law-enforcement backgrounds but are not necessarily doctors.

Currently, about 300 coroners in Ontario — many small-town doctors who do the work on the side — carry out about 18,000 investigations each year for about $400 per case. About one per cent involve homicides.

In addition, 150 licensed pathologists do 6,000 autopsies annually, according to government figures.

The KPMG report comes in the aftermath of the public inquiry into forensic pathology in Ontario — prompted by the discredited work of pediatric forensic pathologist Dr. Charles Smith, whose opinions and evidence ruined lives and led to several wrongful convictions.

Dr. Alan Drummond, of Perth, Ont., a part-time coroner for almost 20 years, stressed the issue for coroners is not money, but why a well-functioning system needs to be remade.

"It looks like a solution to a problem that doesn't exist."