Hospice and the Medical Examiner

Hospice and the Medical Examiner
Karen Gunson, MDOregon State Medical Examiner
Medical Examiner System
Can be Statewide, County or MunicipalAppointed Physician (usually Forensic Pathologist)Appointing Authority maybe Political Body or User GroupsOriginated with the Roman Legion
Coroner System
County BasedElected PositionVariety of Requirements depending on locationIn Rural Counties maybe Prosecutor or SheriffOriginated in England (Crown’s Man)
Medical Examiner’s Law
ORS 146Defines administrative relationshipsDefines ME jurisdictionAuthorizes ME to order autopsiesGives ME and DA control over scene of deathPhilosophical underpinnings: “Death is a medical problem”
Organization of ME System
State Medical Examiner and State Medical Examiner’s OfficeDeputy State Medical ExaminersCounty Medical ExaminersDeputy Medical Examiners
State Medical Examiner’s Office
Oversees the state death investigation systemSME appoints county/district medical examinersProvides advice and support to counties and agenciesSole provider of forensic autopsies and toxicologyCourt testimony
County Responsibilities
County ME responsible for local death scene investigationAppoints DME’s with the approval of the county DAState Office acts as the County ME in 14 counties
What ME does
Scene investigationLocation and notification of next of kinAutopsiesToxicology studiesCourt testimonyProvide information to family and communityDetermine cause and manner of death
Deaths Requiring Investigation
Apparently homicidal, suicidal or occurring under suspicious or unknown circumstancesResulting from the use of drugs, chemicals or toxic agentsOccurring while in state custodyApparently accidental or following an injuryBy disease, injury or toxin related to employment
Deaths Requiring Investigation, con’t
While not under the care of a physician during the period immediately previous to deathRelated to disease that might constitute a threat to public healthIn which a human body has been disposed of in an offensive manner
Notification of ME of Death
The ME shallbeIMMIDIATLY notified of all deaths requiring investigation andAll deaths occurring in persons admitted to a hospital for less than 24 hours however the ME may decline jurisdiction in these casesNo person having knowledge of a death requiring investigation shall intentionally or knowingly fail to make notification
Cooperation with Medical Examiner
All peace officers, health care providers, funeral home personnel, hospital personnel and correction facility personnel shall cooperate with the medical examiner’s investigation
For the purposes of ORS 146, hospice is considered to be a medical facility.
Medical Examiner Cases Under Hospice Care
Falls that contribute to death while in Hospice carePatients in Hospice care due to traumaIntentional medication overdoses either suicidal or homicidal