To Report or not to Report? That Is the Question.

Which of the following would you report to the Medical Examiner or Coroner?

A 62 year-old woman with ischemic heart disease develops progressive heart failure subsequent to a hip fracture sustained 6 months prior. She never returned to baseline and dies while in the rehabilitation care facility.

A 45 year-old woman is hospitalized for a severe asthma exacerbation triggered after smoking crack cocaine. The urine drug screen is positive for cocaine metabolites. She develops anoxic encephalopathy, acute bronchopneumonia, and respiratory failure and expires on hospital day 7.

A 55 year-old man dies of multisystem organ dysfunction due to polymicrobial urosepsis after a brief hospitalization. Fifteen years prior, he sustained a spinal cord injury from a fall with resultant paraplegia. He developed a neurogenic bladder requiring intermittent catheterization and has had recurrent urinary tract infections ever since.

In each of these scenarios, natural disease seems to be the proximate cause of death; however; they all involve non-natural triggers and are all reportable. Deaths due to the acute or delayed effects of injury or intoxicants are reportable regardless of the interval of time that has transpired.  A whole host of complications disguised as chronic medical conditions have potentially non-natural causes. Examples of these include bowel adhesions, decubital ulcers, and seizures. It is important to not lose sight of the root cause of chronic medical conditions as this may preclude reporting of a death that should be reported. The temporal association of the effects of injury and intoxication will be the determining factor in the classification of the death as a homicide, suicide, or accident which is done by the Medical Examiner or Coroner. Clinicians certify only purely natural deaths.

Examples of other reportable deaths include:

  • Deaths occurring within 24 hours of hospital admission (clinical definition of sudden death)
  • Peri-procedural or therapy-associated deaths
  • Deaths of group home or institutionalized residents

Reporting deaths to the Medical Examiner or Coroner requires communication of key pieces of information. The Medical Examiner or Coroner will take jurisdiction and investigate certain deaths as mandated by state law.

For more information, see Chapters 3, 7, and 8 of Essentials of Death Reporting and Death Certification: Practical Applications for the Clinical Practitioner.

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