1. Dennis J. Wickham, MD Clark County Medical Examiner April 21, 2016 Role of the Medical Examiner and Death Certification

2. Objectives Provide an understanding of death investigation in Washington Provide an understanding of the function of the Clark County Medical Examiner Office Physician responsibility for reporting deaths to the Medical Examiner Physician responsibility for completion of death certificates Completing the Death Certificate

3. MEDICAL EXAMINER’S OFFICE

5. MEDICAL EXAMINER AND CORONER JURISDICTIONS IN THE UNITED STATES - 2002 DC State ME, mixed county ME and Coroners State ME, coroners in every county or district Mixed ME and Coroners Coroners in every county or district State ME, no coroners District ME, no coroners County ME, no coroners

6. Washington Death Investigation Systems Four Types - County Based Elected Coroners Elected Prosecuting Attorney/Coroners Medical Examiner - Home Rule Counties Medical Examiner - RCW 36.24.190 Jurisdictional Responsibility

7. Legal authority - Jurisdiction All Homicides, Suicides, Accidents Suddenly when in apparent good health (36 hrs.) Coroner’s Autopsy/Inquest Within one year of an accident Premature birth or Still birth Sexual Activity In Jail or Prison Diseases constituting a threat to Public Health Unclaimed Bodies Jurisdictional Responsibility

8. Duty to Report Jurisdictional Responsibility

9. Clark County deaths:3,428 Deaths reported:2,546 Jurisdiction assumed: 412 Autopsies performed: 314/356 External Examinations: 96 Deaths Certified only: 2 Clark County Statistics 2015

10. Jurisdiction Accepted Natural25% Accident50% Suicide19% Homicide 3% Undetermined 3% Clark County Statistics 2014

12. Death Investigation

13. Medical Examiner Investigator’s Role Document who is reporting the death Information about the decedent Circumstance concerning the death Medical History and Physician(s) Medications Apparent Trauma Scene Information/Body Location and Position/Drugs/Alcohol

15. Death Certificate Legal Record of the Death Filing: Within three days after the occurrence of the death is known Within 24 Hours if location of death is unknown Fetus – Less than 20 wks. gestation Certifier: Two days to certify cause of death without good cause for delay ***Filing of D/C Required Prior to Disposition*** Certify the Death

16. Who can certify a death Medical Examiner, Coroner, PA/Coroner Medical Examiner Investigator Attending Physician / Physician’s Associate Physician’s Assistant Advanced Registered Nurse Practitioner Fetal Death - Any of the Above Midwife Other person in attendance at the fetal death Certify the Death

17. Cause of Death The disease, injury, toxicity, or combination responsible for initiating the train of physiologic disturbances which produce death. Atherosclerotic Cardiovascular Disease Chronic Ethanolism Atherosclerotic Cerebrovascular Disease Adenocarcinoma of the Lung Chronic Obstruction Pulmonary Disease Hypertensive Cardiovascular Disease Diabetes Mellitus Certify the Death

18. Cause of Death Immediate Proximate Other Significant Conditions Conditions Contributing to Death But Not Resulting in the Underlying Cause Certify the Death

19. Cause of Death Immediate: Pneumonia Due to (or as a consequence of): Proximate: Blunt Chest Trauma Certify the Death

20. Other Significant Changes Cause of Death: Atherosclerotic Cardiovascular Disease Other Significant Conditions: Cocaine Intoxication Diabetes Mellitus Certify the Death

21. Mechanism of Death The pathophysiologic derangement set in motion by the cause of death that is incompatible with life. Ventricular Fibrillation Congestive Heart Failure Exsanguination Asphyxia Electrolyte or other Metabolic Disturbances Sepsis Certify the Death

22. Meaningless Terms Cardiac Arrest Cardiopulmonary Arrest Respiratory Arrest Sudden Death Certify the Death

23. Other Information Required Line 36:Autopsy? Yes/No Line 37:Autopsy Findings Available to Complete D/C? Yes/No Line 39:Females – Pregnancy? Line 40:Tobacco Use Contribute to Death? Yes/No Line 41:Date of Injury Certify the Death

24. Manner of Death Relates to how the death occurred Manners Natural Accident Suicide Homicide Undetermined Pending Certify the Death

26. Funeral Home starts recordEDRS sends notification to & assigns to certifier – certifier or ME. medical provider or ME. Funeral Director completesCertifier or ME completes Demographics & approvesthe Cause of Death section record.& approves record. Deputy Registrar reviews record & approves. EDRS sends email to Record is uploaded into Funeral Home to print database - certificates Burial Transit Permit printable by LHJ.

27. Assignment of Certifier

28. Assignment Notification Jay J. Jasper, A new death record has been started in the Washington State EDRS (Electronic Death Registration System) and assigned to your workgroup. Maize, Maggie M is the assigned medical certifier. If you are the assignee and believe this case has been incorrectly assigned to you please contact the individual below at the funeral home that started the record. Started By: Jason J. Jones, (999) 999-9999 Decedent Name: Yellow, Lily Date of Death: 10/12/2013 County of Death: Thurston Date of Birth: 99/99/9999 Sex: F Reported Age: Login to EDRS: https://test-fortress.wa.gov/doh/edrsqa2https://test-fortress.wa.gov/doh/edrsqa2

29. ME NOTIFICATION

30. Medical Certifier

32. Medical Certifier - Submit & Approve

33. Notification Choices

34. QUESTIONS