1. Medical Examiner Referral System
Ashlee Davis
Funeral Home/ Medical Examiner Liaison

2. NJ Sharing Network 7, 000,000 People In Our DSA 54 Hospitals
3 Level I Trauma Centers
5 Level II Trauma Center
6 Transplant Centers
Good Morning, I’m Ashlee Davis
I’m apart of NJ Sharing Network. We are the designated OPO for northern & central New Jersey. Just to give you a little background about NJ Sharing Network…
In NJ we have over 7 million people within our designated service area. That also includes 3 Level I trauma centers, 5 Level II trauma centers, as well as 6 transplant centers. Share the state w/ Gift of Life, who serves the southern parts of NJ, as well as PA & Maryland.

3. Funeral Home/ Medical Examiner Liaison
700 + Funeral Directors

4. Medical Examiner vs Coroner
13 ME Offices in NJ Sharing Network’s Designated Service Area
Based upon Medical Examiner criteria, all deaths are reported and investigated (referrals that were called in from the hospital and have been determined to be an ME’s case).
My role with the network is Funeral Home/Medical Examiner Liaison. Along side my partner, we interact with over 700 Funeral Directors throughout NJ as well as the tristate, but we are also involved with the Medical Examiner offices within New Jersey.
There are 13 ME offices in NJ. Unlike Georgia, we do not operate on a coroner system. All offices operate under one Chief Medical Examiner, the additional staff includes pathologist, autopsy assistants, investigators, & office staff. NJ is unique, we don’t have a centrally located ME Office, we have both State & County operated offices. There is no uniformity within the 13 Medical Examiner Offices. This makes the job more difficult as it necessary to interact with each office individually. ..

5. New Jersey’s Medical Examiner Offices
.. In my role, I would follow up and coordinate between the Sharing Network and the Medical Examiner’s Office for donation. Based upon Medical Examiner criteria, all deaths are reported and investigated This would apply to the referrals that were called in from the hospital and have been determined to be an ME’s case. Unlike, the hospitals who are mandated by law to contact their OPO, Medical Examiner’s are not required.

6. Potential Donors
At the Regional Medical Examiner’s Office which consists of: Essex, Hudson, Passaic, & Somerset Counties, there were a total of _______5128_____ deaths within the four counties alone and a high number of those deaths, were deaths outside of hospitals and those families would not have the opportunity to donate and if they were designated First Persons, their wishes would go unfulfilled.

7. Total Reported Deaths To Regional Medical Examiner
5,128 Deaths Reported
Within One Medical Examiner Office’s (4 Counties)

8. Why the Need for ME Referrals?
Honor the wishes and the “legally binding document” of those who have registered with the Motor Vehicle Commission (MVC).
Give families the same opportunity as those whose loved ones die in hospitals.
ME cases can be sudden deaths, young, unnatural, violent. This option of gifts help in the bereavement process.
Why the need for ME Referrals?
We want to honor those who may have died at home or any place outside a hospital, and it was their wishes to become a donor. Another point, we’re able to give families the same opportunity as those whose loved ones died in a hospital. ME cases are young, unnatural, & usually violent. This option of gifts helps in the bereavement process. Along with also helping recipients, there is a greater need for OA grafts, fresh tissue, & specialty grafts your recipients. I believe everyone here can attest that you have had at least one donor family tell us how our involvement has helped them tremendously in their bereavement process.
Myself also being a funeral director, I was able to see firsthand when the families would come back to visit me at the funeral home and share their recipient letters. organs & tissues are shared locally within the community first.

9. Rough Beginnings Began in 2009 by ME/FH Liaison Wendy Rothschild
We rely on medical investigators for additional information w/ hospital deaths and even more w/ ME cases when there is no chart
Too many follow up phone calls( It was a learning process for our staff, carte blanc w/ ME offices…One investigator would be out on a scene, we’ll call you when he/ she gets back…never called back…
Not the right time, too soon after the death, initially investigators thought they had to approach families( It was outside the comfort zone for investigators in terms of approaching a family from a criminal & documentation perspective. Some investigators’ previous background was medical or law enforcement… they aren’t trained on end of life discussion…
Interferes with timing of criminal investigation( Mainly our issue as we have to recover in a period of time)
Medical Examiners and staff were concerned about ‘legality’ of sharing personal information with OPO, whereas one is not FPC

10. Rough Beginnings
We rely on medical investigators for additional information
Too many follow up phone calls
Not the right time, too soon after the death
Interferes with timing of criminal investigation
‘Legality’ of sharing personal information with OPO (Not FPC)

11. Anatomical Gift Act
The anatomical gift act absolves everyone who makes a referral from legal liability. Our relationships with our Mes and OPOs is HIPPA exempt, we both share confidential information regularly regarding potential donors. In response to Medical Examiners and staff concerned about ‘legality’ of sharing personal information with OPO, whereas one is not FPC(first person consent)
AN ACT concerning anatomical gifts, revising parts of the statutory law and supplementing
Title 26 of the Revised Statutes.
BE IT ENACTED by the Senate and General Assembly of the State of New Jersey:

12. How did we get here?
ME offices are not mandated to report deaths to Sharing Network
Keep ME apprised of outcome of case whether consented or no consent
Offer Heart Pathology Report, DRAI (attending physician), pictures, blood, bile, urine, share results of our serologies
ME aware tissues & organ go back to their communities, and transplant centers within their counties, (community service) Made them aware of the burn centers in our area with St. Barnabas
Rapid Response to concerns
Ongoing education with Medical Examiner & their staff on uses of all tissues, and how recovery of heart valves are life saving, especially for children. DTA used for dialysis portals, SV used for cardiac bypass.
Ensure to work with OPO staff to make process smooth for ME office & staff
If this is something your OPO would like to do, you must first have a relationship with ALL staff. Be visible throughout all offices, nothing is more true than out of sight out of mind… If you can identify one champion in the office or even better a Doctor advocate…you’re in the door…You must establish the groundwork….we the OPO are very small within their world, its our duty to make them apart our mission.
Synergy- the interaction or cooperation of two or more organizations, substances, or other agents to produce a combined effect greater than the sum of their separate effects.
MOST IMPORTANTLY WE GOT HERE BECAUSE OF COMMUNICATION & UNDERSTANDING THAT THE MEDICAL EXAMINER’S OFFICE HAS THEIR OWN JOB, whose duty it is to investigate deaths and injuries that occur under unusual or suspicious circumstances, to perform post-mortem examinations, sometimes give families a peace of mind.

13. Keep ME apprised of outcome of case whether consented or no consent
Offer Heart Pathology Report, DRAI (attending physician), pictures, blood, bile, urine
Rapid Response to concerns
Ongoing education with Medical Examiner & their staff
Ensure to work with OPO staff to make process smooth for ME office & staff
Synergy

14. We provide the investigators w/ a pocket card to take on scenes…Due to tissue processors changing criteria we ask that our ME refer all deaths, and use the pocket card as an outline.
CAPS are put on at different times, age limits change……..

15. Medical Examiner Referral Process
Currently Participating: 6 out of 13 ME Offices (DSA)
All deaths outside of a hospital can be referred
MI investigates a death and determines that it should be brought into the ME office for a View or Autopsy
If decedent fits given criteria, ME staff will call Sharing Network, or ME Liaison
Network will handle the referral, same process as we currently do for hospitals
Network representative or ME Liaison will keep the MI informed about the status of the referral: NOK contact, consent, tissue requested, recovery time, etc.
If the decedent is FPC and notification is made, authorization for transportation will be obtained from the family and relayed to the appropriate ME office.
If there is no consent then the body remains in the morgue.
If ME has allowed the Network to recover before autopsy has been performed, we will return the donor to the ME office or the FH if no autopsy is being done.

16. Currently Participating: 6 out of 13 ME Offices (DSA)
All deaths outside of a hospital can be referred
MI investigates a death
ME staff will call Sharing Network
Network will handle the referral, same process as we currently do for hospitals
ME Liaison will keep the MI informed about the status of the referral: NOK contact, consent, tissue requested, recovery time, etc.
If there is no consent then the body remains in the morgue.
If ME has allowed the Network to recover before autopsy has been performed, we will return the donor to the ME office or the FH if no autopsy is being done.

17. NJ Medical Examiner Referrals
The Referral process began in 2009, we started recording data in 2012….. Although the numbers are >>>>>>>>>>>>the goal was to give families an opportunity to donate & give the ME staff the opportunity to participate in our life saving mission…..

18. Jamal “Mally” Gaines

20. 2017 5K

21. Questions??
Ashlee C. Davis linkedin.com/in/adavislfd Funeral Home/Medical Examiner Liaison Licensed Funeral Director/ Embalmer