� Page 1 Office of the Chief Medical Examiner INFORMATION for Family & Friends What is a Medical Examiner? A Virginia city or county medical examiner is a physician appointed by law to determine the cause and manner of death of persons who die under specific circumstances spelled out 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 that they think might be a medical examiner�s case. Which deaths must be examined and investigated? The medical examiner is required by law to examine and 1nvestigate deaths that (1) occur when the decedent was not under the care of a physician; (2) are sudden and unexpected; (3) are due to violence of any kind; and (4) occur where violence might be suspected or violence cannot reasonably be ruled out. The medical examiner decides if a death must then become a medical examiner�s case. What do �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. Deaths are classified by manner as natural, accident, suicide, homicide, undetermined, and pending. 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 �violent or unnatural� mean? Violent or unnatural means the death was due�or is suspected of being due�to injury of any kind or 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 (1) if the death was unexpected and no medical cause can be determined; (2) if the decedent was not under the care of a physician for any disease which could reasonably be expected to cause death; or (3) if 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 prisoners are medical examiner cases. -------------------------------------------------------------------------------- Page 2 What kind of examination of the body does the medical examiner perform? In about half of the cases accepted and investigated, the medical examiner evaluates the medical history of the decedent, performs an external physical examination, obtains body fluids for toxicologic testing, and investigates the circumstances of the death with law enforcement officials to determine the cause and manner of death. The remaining cases require a medicolegal autopsy. On all 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. Medicolegal autopsies are performed for several reasons: (1) to establish the cause of death when no reasonable diagnosis can be made from medical history, physical examination, and 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 Virginia, specialist physicians called forensic pathologists perform the medicolegal autopsies and prepare the reports. May a family refuse a medical autopsy? Families may not refuse a medicolegal autopsy because they 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. Do family members have access to the reports of the medical examiner and the pathologist? The report of an investigation by a medical examiner (CME 1 report), the report of the autopsy (CME 10 report), and laboratory reports are available to the legal next of kin of the decedent upon written request. When others inquire, a brief statement of the cause and manner of death is released. Reports are available from the district offices in Richmond, Fairfax, Roanoke, and Norfolk. How long does it take to obtain reports? The length of time to receive a report varies on a case-by-case basis and by district office. Some reports are available upon receipt by the district office of the city or county medical examiner�s report of examination and investigation and after laboratory results are reviewed. In cases where an autopsy was not performed, this is usually about four weeks. In other cases, an autopsy, additional studies, and further investigation may be necessary. If an autopsy was performed and extensive laboratory tests were required, the report will usually be available in eight to twelve weeks. However, complicated cases may take several months to resolve. The district office can usually give an estimate of the time required for the completion of an individual case. -------------------------------------------------------------------------------- Page 3 What does it mean if the death certificate reads �pending?� When the medical or law enforcement investigation is incomplete, a case is placed in pending status. The most common tests needed are analyses for drugs and medication and forensic science tests. The issuance of a final death certificate may also be delayed pending further investigation, such as a review of medical records or a police report. 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 in the local health department by the funeral director or 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 city or county of death or at the Division of Vital Records in Richmond, Virginia. What if families have questions about the medical examiner�s report or autopsy? Next of kin may call the district office and speak with the office staff or pathologist. Families wishing to visit the office and speak directly with the pathologist should make an appointment beforehand to make certain the pathologist will be available. 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 on a medical examiner case. The benefits of a properly certified death certificate are legal and medical. Next of kin must have a properly completed death certificate to claim insurance, receive government benefits, settle the decedent�s estate, and pursue any legal actions they wish to initiate. The medical benefits include a medical determination of 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 might be hereditary. The criminal and civil courts also require documentation of the cause and manner of death. -------------------------------------------------------------------------------- Page 4 Where do families write or call? The addresses and phone numbers of the district offices are as follows: Central District 400 East Jackson Street Richmond, Virginia 23219 (804) 786-3174 Fax (804) 371-8595 E-Mail: OCME_CENT@vdh.state.va.us Northern Virginia District 9797 Braddock Road, Suite 100 Fairfax, Virginia 22032 (703) 764-4640 Fax (703) 764-4645 E-Mail: OCME_NOVA@vdh.state.va.us Tidewater District 830 Southampton Avenue, Suite 100 Norfolk, Virginia 23510 (757) 683-8366 Fax (757) 683-2589 E-Mail: OCME_TIDE@vdh.state.va.us Western District 6600 Northside High School Road Roanoke, Virginia (540) 561-6615 Fax (540) 561-6619 E-Mail: OCME_West@vdh.state.va.us �