Death Investigation Guidelines
Criteria for Reportable Deaths
After a death is reported to the Medical Examiner's Office, the Medical Examiner will determine whether the office will assume jurisdiction and responsibility for signing the death certificate. In order to make this decision, an investigation is performed. Investigation may include a review of Medical records (the office can review records, by law, without family permission), interviews, an investigation at the place of death, clarification of prescriptions, etc. If jurisdiction is assumed, a forensic pathologist will determine if an autopsy will be performed. The law allows Medical Examiners to perform autopsies, without family permission or signature on a consent form. In certain deaths, the pathologist will sign a death certificate based on the decedent's medical records, without an autopsy. An example of this situation would be an elderly person who falls and sustains a hip fracture; the patient becomes hospitalized, a surgery is performed to repair the fracture, and postoperatively the patient develops pneumonia and dies. Because the chain of events that lead to death is well documented in records, and no foul play is suspected, the Medical Examiner signs the death certificate without performing and autopsy, even though the office assumed jurisdiction.
Deaths which may come under the jurisdiction of the Spokane County Medical Examiner are defined by state statute (RCW 68.08.010) and include, but are not limited to the following criteria:
- Persons who die suddenly when in apparent good health and without medical attendance within 24 hours preceding death
- Circumstances which indicate death was caused in part, or entirely, by unnatural or unlawful means (i.e. accident, traffic, suicide, homicide), or when death occurs within one year following a bad accident.
- Suspicious circumstances
- Unknown or obscure causes
- Deaths caused by any violence whatsoever, whether the primary cause or any contributory factor in the death
- Contagious disease which may be a Public Health hazard
- Unclaimed, indigent decedents
- Premature and stillborn infants, where suspicious circumstances are present
A Typical Investigation
A typical sequence of events in a Spokane Medical Examiner Death Investigation
- Death is pronounced at the scene by paramedics.
- Law enforcement is contacted; they secure the scene and perform an initial investigation. Law enforcement contacts the Medical Examiner Investigator on duty.
- The Medical Examiner Investigator arrives on scene and determines the circumstances surrounding death. He/she takes custody of the decedent's personal property and medications. The body is examined, and photographed, then sealed in a body bag with a tamperproof seal, in front of witnesses. The investigator speaks to family members and provides a Medical Examiner Pamphlet, the pamphlet answers typical family questions.
- If not at the death scene, next-of-kin is located and informed of the death.
- The Medical Examiner Transport service takes the body to the secure Medical Examiner autopsy facility. The body is "signed in" with witnesses and placed in a large refrigerated room to retard decomposition.
- If an autopsy is to be performed, the body is weighed, and taken to the examination room; the evidence seal on the body bag is broken in the presence of witnesses. After the autopsy, the body is respectfully covered, and the funeral home the family has selected is contacted to allow for pick-up of the body and transportation to the mortuary.
- The cause of death and manner of death are listed on the death certificate, the funeral home files the certificate with the local office of the State Vital Records Department. If the death certificate cannot be accurately completed on the day of autopsy, due to a need for further testing, the death certificate is completed as "pending" so that no disposition delay need occur.
- Microscopic slides and additional test results are analyzed and the autopsy report is completed.
- The Medical Examiner Investigators and Staff are available at all stages of this process to discuss findings with family members and assist families as needed.