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Office of the Chief Medical Examiner

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What is a Medical Examiner?

A medical examiner is a physician appointed by law to determine the cause and manner of death of persons who dies under specific circumstances as defined by law. Deaths under the jurisdiction of the medical examiner are called medical examiner cases. Law enforcement officials, physicians, hospitals, funeral directors, and others are required to report to the medical examiner any death they think might be a medical examiner case.

Which deaths must be examined and investigated?

The medical examiner is required by law to investigate and certify all deaths in the District of Columbia that occur by any means of violence (injury), and those that occur without explanation or medical attention, are related to drugs, of persons in custody, or which pose a threat to the public health. Deaths resulting from injuries or complications from injuries – no matter how long after the injury occurred – are still medical examiner cases and fall under the jurisdiction of the medical examiner.

What does “cause and manner of death” mean?

The cause of death is the medical disease, injury, or poison (alcohol, drug or toxic substance) that caused the physical death of a person. The manner of death is a description of the circumstances surrounding the death. Examples of manner of death are: natural, accident, suicide, homicide, undetermined, and pending.

What does “violent or unnatural” mean?

Violent or unnatural means the death was due or is suspected of being due to injury or any kind of poisoning.

If someone’s death appears to be natural, why is the medical examiner involved?

The medical examiner may take jurisdiction over an apparently natural death if: 1) the death was unexpected and no medical cause can be determined; 2) the decedent was not under the care of a physician for any disease which could reasonably be expected to cause death; or 3) the death might be a public health hazard. Deaths occurring under circumstances which are not clear, or to persons who are at risk for possible violence, may also be medical examiner cases. By law, the deaths of all DC wards including children and Mentally Retarded and Developmentally Disabled (MRDD) persons are medical examiner cases.

What kind of examination of the body does the medical examiner perform?

In some of the cases investigated and accepted, the medical examiner evaluates the medical history of the decedent and performs an external physical examination. The circumstances of the death and the external examination are used to determine the cause and manner of death. The remaining cases require a medicolegal autopsy. On all accepted cases, the medical examiner signs the death certificate.

Who decides which cases require a medicolegal autopsy? Why are medicolegal autopsies performed? Who performs them?

The medical examiner decides if an autopsy must be performed. The only exception to this procedure is in cases involving MRDD clients who are wards of the District and those receiving services through the D.C. Office of Disabilities – autopsies for this population are mandatory by law. Medicolegal autopsies are performed for several reasons: 1) to establish the cause of death when no reasonable diagnosis can be made from recent medical history, physical examination and/or circumstances surrounding the death; 2) to document internal injuries as well as external injuries; 3) to collect medical evidence such as tissue biopsies, body fluids and trace evidence; and 4) to reconstruct how the injury or injuries occurred. In the District, a physician specialist called a forensic pathologist or medical examiner performs the medicolegal autopsies and prepares the reports.

May a family refuse or object to a medicolegal autopsy?

Families may not refuse or object to a medicolegal autopsy for any reason -- be it religious or otherwise-- because autopsies are performed to answer medicolegal questions that are “in the public interest.” This means that the autopsy is needed to address a question of law or public health.

Do family members have access to the reports of the medical examiner? Who else may obtain an autopsy report?

The autopsy and toxicology reports are available to the legal next of kin (as defined by District law) of the decedent upon written request. These reports are also available upon request to the Mayor, law enforcement agencies or officials, and Fatality Review Committees/Boards. When others inquire, a brief statement of the cause and manner of death is released. Reports are available at the medical examiners’ office.

Is the CME involved if I want my loved one cremated?

By law, clearances by the CME shall be required for all deaths occurring in the District of Columbia for which cremations are requested regardless of where the cremation will occur.

How long does it take to obtain autopsy reports?

The length of time to receive an autopsy report varies on a case-by-case basis. In cases where an autopsy was not performed, a formal report is not provided. The OCME adheres to an established rule of priority for completing cases. Those that are a result of a homicide are completed within 60 days. For all other manners of death, the reports are completed within 90 days. However, cases that have very complicated circumstances require further investigation, or where additional testing is required, may take longer than the 60-90 day timeframe. The OCME will make an attempt to provide an estimation of time for case completion.

What does it mean if the death certificate reads "pending?"

When the medical or law enforcement investigation is incomplete, a case is placed in a pending status. The most common tests needed are toxicological examinations. The issuance of a final death certificate may also be delayed due to pending further investigations, such as review of medical records, or completion of fire and/or police reports. Funeral arrangements need not be delayed because the death certificate reads “pending.” The decedent can be buried or cremated after an autopsy even though the cause and manner of death are pending. Every effort is made to complete cases promptly so that the death certificate may be completed.

How do families obtain a death certificate?

The original death certificate is filed with the local health department by the funeral director of the organization making final disposition of the remains. Next of kin and others legally entitled to obtain the death certificate may obtain copies from the Registrar in the DC Department of Health Division of Vital Records.

What if families have questions about the medical examiner’s report or autopsy?

The next of kin may call the office and speak with the medical examiner. Families wishing to visit the office and speak directly with the medical examiner should make an appointment beforehand to make certain the doctor will be available.

What are the procedures for releasing unidentified or unclaimed remains?

A decedent or remains shall not be released to a family until positive identification has been made. This can be a lengthy process particularly when the remains are in a decomposed state. The Positive Identification Process is employed when bodies are unrecognizable due to decomposition and a positive identification becomes challenging. In such cases, the OCME uses fingerprinting, correct and precise descriptions of specific individual features such as tattoos, post-mortem x-ray comparisons, dental examinations and comparisons and DNA analysis. The OCME bears the costs of examinations, comparisons and analyses pertaining to positive identification of a decedent. These procedures are lengthy and may require ante mortem data for comparison, or procurement of specimens from living family members. Though rare, there are cases in which positive identification cannot be made and a body has to be released as a presumed identification.

By law all unclaimed decedents or remains are processed by the OCME for public disposition after 15 days. Public disposition refers to the process of either burial or cremation of unclaimed decedents or remains.

What does the medical examiner do that helps families and friends?

The medical examiner signs the death certificate with the cause and manner of death and produces autopsy reports. The benefits of a properly certified death certificate or autopsy report are legal and medical. The next of kin must have a properly completed death certificate and in some cases a certified copy of the autopsy report for legal purposes to claim insurance, receive government benefits, settle the decedent’s estate and pursue any legal actions they wish to initiate. Also, the criminal and civil courts require certified documentation of the cause and manner of death. Medical benefits include medical determination of the cause of death, recognition of unsuspected, unnatural causes of death, the identification of public health hazards to family and others, and sometimes the identification of a health condition that may be hereditary.

If there is personal property at OCME, how does a family member claim it?

A description of any property found on a person brought to the OCME is documented and is part of the case file. The legal next of kin can claim their loved ones’ personal property at the time of identification. A staff member would retrieve the property and the family member is then required to sign and receive a copy of a property receipt along with the property.

In a case where the family does not come to OCME for identification, a telephone call to the OCME will put them in contact with the staff member who can make arrangements to release the property according to OCME policy and procedures. Property can also be released to the funeral director who has been given authorization to receive the decedent’s remains for final disposition.


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