Medico legal Investigation System Coroner: Elected position held - - PDF document

6/17/2015 1 Office of the State Medical Examiner

Death Investigation and Certification

Mission Statement

The purpose of the Office of the State Medical Examiner (SME) is to bring trained medical evaluation to the investigation of deaths that are of concern to the public health, safety, and welfare of the State of Alaska. The SME investigates sudden, violent, unexpected, and suspicious deaths that occur in the state. In addition to determining the cause and manner of death, the SME works to provide accurate identification of decedents under their jurisdiction, and to notify the next‐of‐kin.

Medico‐legal Investigation System

 Coroner: Elected position held by the election winner (no forensic background required).  Coroner/Prosecutor: Usually an elected position in which the county prosecutor also serves as coroner.  Medical Examiner:

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Alaska is under a Medical Examiner’s system, not a Coroner’s system.

The SMEO covers all deaths for the entire state.

This includes deaths that occur “out at sea” or “over land” as long as the first port is made onto Alaska land. Example: Deaths on cruise ships.

State Medical Examiner’s Office

Office Hours: M-F 0730-1630 Investigator hours: 24/7 907-334-2200

6/17/2015 3 State Medical Examiner’s Office 1 ‐ Chief Medical Examiner 2 ‐ Deputy Medical Examiners 7 ‐ Investigators 5 ‐ Autopsy technicians 4 ‐ Administrative staff

Which deaths must be reported?

 AS 12.65.005 Duty to notify state medical examiner

 Unknown or criminal  Suicide  Accident  Poisoning  Commission of a crime  Suspicious  Unattended  Less than 24 hours after admit**  Associated with diagnostic or therapeutic procedure  Threat to public health  Foster home  Mental institution/treatment facility  State custody  Children under 18 **24 hours does not apply for non‐natural deaths as each must be reported regardless

2011 Fall related deaths

 31 fall related deaths in seniors  17 fall related deaths reported on the death certificate to the Bureau of Vital Statistics (BVS)  14 fall related deaths not reported to BVS  24 fall related deaths not reported to the SMEO

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Who is required to report a death?

AS 12.65.005 Duty to notify state medical examiner (a) Unless the person has reasonable grounds to believe that notice has already been given, a person who attends a death or has knowledge of a death, in addition to notifying a peace officer, shall immediately notify the state medical examiner… (c) The body of a person whose death has been or should be reported to the state medical examiner under this section may not be moved or otherwise disturbed without the permission of the state medical examiner.

1500‐1800 cases/year

reported to the SMEO

What happens when a death has been reported?

 Information gathering (circumstance, medical hx, demographics)  Scene investigation  Body examination  Rule out (foul play, trauma, suspicious circumstances)  Determine positive identification  Determine Jurisdiction  If No Jurisdiction Assumed release to funeral home/family and contact provider to sign DC

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SMEO categories for Deaths

 Once the SMEO investigator has gathered the pertinent information they will make a determination

• n SMEO jurisdiction.

 All reported deaths are reviewed by a pathologist within 24 hours verifying jurisdiction determination.  All deaths reported to the SMEO will fall into one of the following categories:

No Jurisdiction Assumed (NJA)

 Comfort One/Hospice  DNR in place  Typically elderly with a known terminal medical condition  The treating doctor will be signing the death certificate  Nothing unusual or suspicious (732 in 2014)

Consult & Inspection Cases

 Consult: investigation of a death, body is not brought into the Medical Examiner’s Office, deceased is released to family or mortuary. (165 in 2014)  Inspection: external examinations conducted on the deceased documenting all injuries, photographs, fingerprints, DNA card and toxicology specimens

• drawn. (225 in 2014)

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Autopsy Cases

Autopsy: “To see for oneself” A surgical operation performed on a dead body by a pathologist for the purpose of determining how the person died; the cause and manner of death. This includes both an external and internal exam documenting all injuries and natural diseases, photographs, fingerprinting, DNA cards, specimen draws for toxicology testing, and tissue samples for testing. (546 in 2014)

Level of Examination

 The level of the examination is determined by the pathologist.  The need for toxicology testing is determined by the pathologist.  The need for any additional testing is determined by the pathologist.  Law enforcement/medical staff/families can request additional testing but will not normally be performed unless it could change the manner or cause of death.

Toxicology Testing

 Toxicology testing is only performed on cases where it may impact the cause or manner of death.  All vehicle accidents are tested at the State Crime Lab (usually 3 months)  All other toxicology testing is performed out of state by a private company (usually 1 to 2 weeks up to 6 weeks)

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Cause & Manner of Death

Cause

The injury or disease process responsible for a death

Manner Natural Accidental Suicide Homicide Undetermined

Calendar Year 2014

 Total – 1673 deaths reported

 Accident – 337  Homicide – 37  Natural – 296  Suicide – 175  Undetermined – 81

When should the treating/attending physician sign the death certificate?

 The death is from probable natural causes  The decedent was under the physicians care and being seen/treated for the condition that most likely caused the death  No significant suspicion of foul play, accident, or suicide exist A patient being prescribed medications is considered under the care of the physician regardless of how long since they were last seen

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7 AAC 05.420. Physician’s Certificate

 Shall be signed within 24 hours after death by the physician in charge during the illness or condition that resulted in death or in attendance  If not in attendance … sign the certification, stating the facts and giving the apparent cause of death to the best of the person’s knowledge, this shall be sufficient unless the state medical examiner directs otherwise, or unless an official inquiry or inquest is determined to be necessary.

7 AAC 05.430. Cause of death entry

 When a physician is asked to complete a cause of death certification when he or she did not attend the deceased, the wording of the certification may be changed to so indicate, and the most probable cause or causes stated.

CONTACT INFORMATION:

Gary Zientek, MD Chief Medical Examiner Stephen Hoage Operations Administrator Office of the State Medical Examiner 5455 Dr. MLK Jr. Avenue Anchorage, AK 99507 Main: (907)‐334‐2200 Website: http://www.hss.state.ak.us/dph/sme/