What Say You? Say It Isn’t So!

Attention Clinicians (and curious Georges and Georgettes) !

What do you tell families when their loved one has passed and the death has been reported to the Medical Examiner or Coroner (ME/C)?
Do you:
1. Tell the family that by law the ME/C must accept all deaths reported to them?
2. Do you say to the family that an autopsy will be performed because the ME/C is mandated by law to perform one on all reported and accepted deaths?
3. Do you say to them that an autopsy will be performed by the ME/C even when the ME/C has not taken jurisdiction over the death and their loved one will not be transported to the Office of the ME/C?

Because health care providers assume the answer to the above questions is ‘yes’, families of patients who have died at the hospital in which the death is reportable or has been reported are being told that an autopsy will automatically be done by the ME/C, because “it’s the law”. Then, when the family calls the ME/C to find out the results of the autopsy, they are surprised (and sometimes angry) to learn that an autopsy was not done.

The Medical Examiner or Coroner has jurisdictional authority (as mandated by state law) over sudden and unexpected deaths, violent deaths (suspected or obvious homicidal , suicidal, and accidental deaths), unattended deaths, deaths of unknown or uncertain causes, deaths in which a non-natural cause cannot be ruled out, and deaths of the unclaimed and unidentified. These are the reportable deaths and also include deaths occurring within 24 hours of admission or deaths occurring after several days or more of hospitalization from non-natural causes.

The ME/C will not automatically assume jurisdiction over all deaths originating from a medical facility, particularly those due to natural diseases and their complications, and those in which injury or the toxic effects of medications or drugs did not play a part. This would also include deaths in which there may have been a history of some type of remote injury not connected with the current death circumstances OR deaths in which there was a history of some type of recent injury followed by a return to baseline health in the setting of stable chronic natural disease with lethal potential, like certain heart or lung diseases.

Contrary to popular belief of those practicing clinical medicine and many others:
1. The ME/C will not assume jurisdiction over all deaths reported to them. The ME/C will not certify (meaning complete the death certificate on ) deaths for which jurisdiction was not taken. These are the deaths that resulted from natural disease and these are the ones that are certifiable by clinical practitioners BY LAW. 1,2
2. The ME/C will not have an autopsy done on every case for which jurisdiction has been taken. The decision to do an autopsy is made on a case-by-case basis. Even without an autopsy, an external examination of the body, review of medical and other records, and review of results of any postmortem testing are done. Determination of the cause and manner of death with completion of the death certificate will follow. A family, specifically the next-of-kin, may request an autopsy to be done and must do so in a timely manner . The honoring of that request is at the discretion of the ME/C.
3. The ME/C will not perform an autopsy on cases for which jurisdiction was NOT taken. This should be a no-brainer. Why would an ME/C do an autopsy on a non-ME/C case? For a hospital death, if the family (again next-of-kin to be specific) wants an autopsy done then the hospital pathologist would perform the autopsy at cost to the family unless the cost is waived by the hospital, especially at a teaching hospital. Otherwise families are on their own with the option to seek the assistance of a private autopsy service.

Medical Examiners’ and Coroners’ Offices are government agencies and have a very important public health-oriented mandate of timely cause and manner of death determination, funded by us taxpayers. They work with limited resources, staff, and budget strategically applied in order to meet that mandate which involves the investigation of approximately 500,000 deaths out of the approximately 1 million deaths reported per year 3,4.

References:
1. Information For Physicians Who Sign (Certify) Death Certificates . Available at : https://www.tn.gov/content/dam/tn/health/documents/BME_Note112105.pdf.
2. The Ohio Revised Code 3705-16. Statements in facts of certificates-death certificate. http://codes.ohio.gov/orc/3705.16.
3. Hickman MJ, Hughes KA, Strom KJ, and Ropero-Miller JD. Medical Examiners’ and Coroners’ Offices, 2004. Available at: www.bjs.gov/content/pub/pdf/meco04.pdf.
4. Armstrong EJ. 2017. Essentials of Death Reporting and Death Certification: Practical Applications for the Clinical Practitioner.

Reserved just for you at: https://www.amazon.com/Essentials-Death-Reporting-Certification-Applications/dp/0998533408

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