RHODE ISLAND OFFICE OF THE STATE MEDICAL EXAMINER: PATHOLOGY IN THE PUBLIC INTEREST

Medicine and Health Rhode Island,  Sep 2005  by Laposata, Elizabeth A

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"We provide answers to sudden unexpected violent death in the community. "

"We protect the public health and safety."

"We preserve evidence for the government and far families. "

"We stand ready to help families through their grieving process. "

Rhode Island General Law Title 23 Chapter 4 and Title 23 Chapter 1-1 establishes the Medical Examiners Office in the Department of Health and mandates that it investigate all deaths in Rhode Island that are sudden, unexpected, unexplained, or involve injury. Medical doctors with postgraduate training in anatomic pathology and subspecialty training in forensic pathology lead the investigation. Forensic pathology directs its efforts to the examination of living or dead persons to provide an opinion concerning the cause, mechanism, and manner of disease, injury, or death; the identification of unknown persons; the significance of biological and physical evidence; and the correlation and reconstruction of wounds, wound patterns, and wound sequences. The forensic pathologist aids public health, public safety, quality assurance, medical education, and the administration of justice.1 Our goal is to develop strategies to prevent injury, disease, and death - to have the dead help the living.

HISTORICAL ORIGINS

The office of medical examiners originated in 9tn Century England in the office of the "Crowner" (hence, the term coroner).2 The King dispatched the "Crowner" to "investigate" death scenes and determine whether the King could claim or tax the deceased subjects belongings. When coroner laws came to the American British colonies, coroners were elected officials (usually not even medical doctors). The first move toward a medical examiner system occurred in 1860 when Maryland legislated the presence of a physician at the death scene. Modern death investigation systems evolved from a decentralized, local coroner practice to the current medical examiners system, led by physicians trained in forensic pathology.

How DEATHS ARE REPORTED IN RHODE ISLAND

In Rhode Island, the Office of the State Medical Examiner investigates any death involving injury (whether minor or major, recent or remote), as well as death that is sudden, unexpected at that time, or unexplained. Specific reportable deaths and occurrences established by Rhode Island law are listed in Table 1.

To report a death, call the Medical Examiner Office hotline [401-222-2948], in operation 24 hours a day, 365 days a year. Anyone having knowledge of a possible unnatural death may report it. Usually, physicians and law enforcement personnel are the primary reporters. However, funeral directors or relatives occasionally report concerns about a potentially non-natural death.

INITIAL CALLS AND CLASSIFICATION OF THESE CALLS

Medico-legal investigators staff the office around the clock to assess potential jurisdiction as outlined in Table 1, respond to the death scene if required, supervise the transport of the deceased to the Medical Examiners Office and prepare an initial narrative report. There are three potential outcomes of the initial call: jurisdiction accepted; jurisdiction accepted In Absentia (meaning absent the body); and jurisdiction declined.

If the Medical Examiner accepts jurisdiction, a full medico-legal death investigation will occur; and the Medical Examiner must sign the death certificate. If a reportable death is under Medical Examiner jurisdiction, no further manipulations of the body or examinations should be conducted and all lifesaving medical devices and/or resuscitative or therapeutic items must be left in place. The deceased is transported to the Medical Examiners Office. The cause of death will be determined to a reasonable degree of medical certainty and findings entered on the death certificate. In most but not all cases, an autopsy is performed. For example, a death due to hanging may require only an external examination, but only if the scene investigation reveals no evidence of foul play and the decedent's medical, psychiatric and social history provides evidence of potential motive and means for suicide. Further, the external examination of the body must show nothing suspicious or the potential for another mode of death. The Medical Examiner determines on a case-by-case basis whether the case requires an external examination only, a limited or full internal examination, or other procedures and testing to certify the cause and manner of death.

With "Jurisdiction accepted In Absentia" the Medical Examiner has determined that a postmortem examination was not required to determine the cause of death. This occurs when the scene investigation and interviews of witnesses, families, and others and discussions with law enforcement reveal no need for an autopsy. Typical cases include elderly persons with probable natural disease processes who die at home, or traumatic deaths after prolonged hospitalization due to non-homicidal injury. These cases usually have sufficient diagnostic testing results and hospital records to determine the cause of death. In these situations, all records are reviewed by the Medical Examiner. The deceased can be released directly to the funeral home, and the funeral director obtains the death certificate from the Medical Examiner.