Policies and Procedures
Deaths Occurring in Emergency Rooms
Duties of the Last Attending or Covering Physician (FL Statute Sec 382.008(3))
Because a death occurs in the emergency room, there is no strict requirement that it be reported to the Medical Examiner. Clearly, if any reporting criteria are present (see Criteria for Reportable Deaths) deaths should be reported for clearance or investigation by the Medical Examiner. If a firm clinical diagnosis has been established while the victim was in the emergency room and no reporting criteria are present, the attending licensed physician can certify death.
Some hospitals have the policy whereby no emergency room physician will certify death if the patient has not been under previous care by a member of the hospital staff. In such instances, the criterion for reporting is that of sudden death in a person without supportive past medical history. If there is supportive past medical history from a private physician not a member of the hospital staff, that private physician should certify death. If the physician is unavailable, the medical examiner staff will view the body and provide a means for certification.
If death is reported to the Medical Examiner's Office, it is incumbent upon emergency room personnel to supply any information to the Medical Examiner's investigator in order that the Medical Examiner can review the clinical findings and render accurate certification. An autopsy will not necessarily be performed if the investigation does not warrant it.
The Practicing Physician and the Medical Examiner
The Medical Examiner's responsibilities do not revolve solely around certifying criminal deaths or serving in the prosecution of criminals. In practice, and as provided by several Florida Statutes, the Medical Examiner may inquire into all deaths impartially and solely to prepare a record of facts which are available to anyone whose lawful purpose requires them, whether these be criminal or civil, whether these serve the public or the individual. Furthermore, the Medical Examiner is charged with certifying causes of death which are reasonably accurate and acceptable for purposes of vital statistics.
When there has been no physician in attendance, there obviously is no one other than the Medical Examiner who can legally sign the death certificate. The Medical Examiner thus has clear authority to proceed in these deaths. When there has been previous medical attention, the attending physician may be required to provide the Medical Examiner with copies of medical records and other pertinent information that would assist the Medical Examiner in determining whether further investigation is needed. Prior records and history form the basis of sufficient legal grounds for the Medical Examiner to authorize further investigation including an autopsy. The Medical Examiner will make the decision to accept or reject jurisdiction of a case based on the sum of the facts learned from the physician, and the circumstances of the death.
It is important to bear in mind that any query by the Medical Examiner or investigators into the manner or mode of medical treatment is done to ascertain whether there are sufficient grounds for the Medical Examiner to proceed, and not to judge or evaluate the adequacy or propriety of any particular treatment. Deaths where the Medical Examiner finds are not within the jurisdiction of the office will be referred to the physician whose responsibility it is to sign the death certificate.
Physician Responsibility in Reporting Deaths
Duties of the Last Attending or Covering Physician (FL Statute Sec 382.008(3))
If an attending physician is quite satisfied that the death is outside the jurisdiction of the Medical Examiner, the Medical Examiner need not be notified and the body can be released to a funeral home. If, in the opinion of the attending physician, criteria have been met which require the reporting of the death to the Medical Examiner, the physician shall report the death immediately by telephone to the Medical Examiner's Office (255-4003). This number is monitored 24 hours a day. Frequently physicians/medical personnel notify the Medical Examiner of every death to relieve themselves of any responsibility for the determination of jurisdiction. Familiarity with the death reporting criteria will reduce unnecessary phone calls. Whenever a question exists, qualified Medical Examiner investigative personnel will make the assessment quickly and expeditiously.
The attending physician, upon learning that the Medical Examiner's Office has accepted the jurisdiction of the death, may report this to the family, make them aware that the body will be removed to the Office of the Medical Examiner, and that there is a probability a postmortem examination will be conducted. In those instances in which the Medical Examiner accepts jurisdiction, the body will be transported to the Office of the Medical Examiner by a transport service. There should be no removal of clothing or effects, or handling the body in any manner by persons not authorized by the Medical Examiner.
If an attending physician wishes to attend the autopsy, this request should be made to the Medical Examiner. Every effort will be made to accommodate such requests.
Organ Donation
A potential organ donor is a patient who has suffered an injury to the brain resulting in brain death. Such a potential organ donor will generally be maintained on respiratory and hemodynamic support until the Organ Procurement Agency has an opportunity to assess donor potential. Once this is established by the Procurement Coordinator of the Organ Procurement Agency, it is necessary that the Medical Examiner Investigator be notified of the potential donor so that an assessment of the circumstances of the injury can be made by the Medical Examiner Investigator and a determination made whether or not organ or tissue procurement authorization can continue. Once an assessment has been made and all concerns of local law enforcement agency have been answered, then organ procurement authorization can continue. Generally, the only instances where the Medical Examiner will obstruct organ procurement is in homicidal deaths, particularly of infants or children where there may be hidden injury. Each death must be evaluated on its own merit. Every effort will be made by the Medical Examiner to ensure there is maximum utilization of organs for donation. If the donation is obstructed by the Medical Examiner, the Organ Procurement Agency will be provided an explanation.
Funeral Home Personnel and the Medical Examiner
The funeral home employees need to be aware of the types of death that should be reported to the Medical Examiner.
Whenever it becomes apparent that a death should be reported, it is incumbent upon the funeral home personnel to report the death to the Medical Examiner at once. Medical Examiner notification must be done before embalming. Such deaths should be reported even though the deceased's physician may have agreed to certify death. Early reporting will prevent needless disruption or inconvenience to the family and the funeral director. Funeral home personnel should not assume that a hospital, nursing home, etc. has already notified the Medical Examiner in such instances, but should notify the Medical Examiner directly for assessment.
When death comes under the jurisdiction of the Medical Examiner, funeral personnel may not remove a body from the place of death, without permission of the Medical Examiner. It is not acceptable practice to make a removal of the body on the verbal opinion of the family that the doctor will sign the death certificate. The doctor should be contacted directly in order to learn whether or not the death will be certified. In addition to his/her own observations, funeral home personnel should inquire of both family and physician whether there was any accident or injury associated with the death.
In some instances family physicians will be willing to certify death because the cause of death is consistent with the previous medical condition even though the physician did not visit or attend the patient recently before death. In these cases, the Medical Examiner's Office does not need to be contacted.
The relationship between the Duval County Medical Examiner and the practicing physician can be mutually beneficial. The cooperation of physicians whose patients have become Medical Examiner cases is frequently instrumental to the Medical Examiner in making an accurate certification of the cause of death. This is particularly true in supplying medical and psychological history and medical records. The Medical Examiner is able to provide physicians with an accurate determination of the cause of death when an autopsy is performed. Many Duval County physicians have expressed confusion as to their duty to the Medical Examiner. The purpose of this section is to clarify that duty.