Hospice and the Medical Examiner Karen Gunson MD

Hospice and the Medical Examiner Karen Gunson, MD Oregon State Medical Examiner

Medical Examiner System • Can be Statewide, County or Municipal • Appointed Physician (usually Forensic Pathologist) • Appointing Authority maybe Political Body or User Groups • Originated with the Roman Legion

Coroner System • County Based • Elected Position • Variety of Requirements depending on location • In Rural Counties maybe Prosecutor or Sheriff • Originated in England (Crown’s Man)

Medical Examiner’s Law • • • ORS 146 Defines administrative relationships Defines ME jurisdiction Authorizes ME to order autopsies Gives ME and DA control over scene of death Philosophical underpinnings: “Death is a medical problem”

Organization of ME System • State Medical Examiner and State Medical Examiner’s Office • Deputy State Medical Examiners • County Medical Examiners • Deputy Medical Examiners

State Medical Examiner’s Office • Oversees the state death investigation system • SME appoints county/district medical examiners • Provides advice and support to counties and agencies • Sole provider of forensic autopsies and toxicology • Court testimony

County Responsibilities • County ME responsible for local death scene investigation • Appoints DME’s with the approval of the county DA • State Office acts as the County ME in 14 counties

What ME does • • Scene investigation Location and notification of next of kin Autopsies Toxicology studies Court testimony Provide information to family and community Determine cause and manner of death

Deaths Requiring Investigation • Apparently homicidal, suicidal or occurring under suspicious or unknown circumstances • Resulting from the use of drugs, chemicals or toxic agents • Occurring while in state custody • Apparently accidental or following an injury • By 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 death • Related to disease that might constitute a threat to public health • In which a human body has been disposed of in an offensive manner

Notification of ME of Death • The ME shall be IMMIDIATLY notified of all deaths requiring investigation and • All deaths occurring in persons admitted to a hospital for less than 24 hours however the ME may decline jurisdiction in these cases • No 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 care • Patients in Hospice care due to trauma • Intentional medication overdoses either suicidal or homicidal