Coronial System Research Articles

A Medical Examiner Wants Information. What’s Next?

Back to table of contents Previous article Next article Legal NewsFull AccessA Medical Examiner Wants Information. What’s Next?Moira WertheimerJ.D., R.N., C.P.H.R.M.Moira WertheimerSearch for more papers by this authorJ.D., R.N., C.P.H.R.M.Published Online:12 Jun 2017https://doi.org/10.1176/appi.pn.2017.6b10AbstractA young man is found deceased in a car in a nearby park, and there does not appear to be any foul play involved. A search of the victim’s car reveals some drug paraphernalia and an empty prescription bottle containing medicine that you prescribed. The medical examiner contacts you and requests the records of your last three visits with the patient and a list of all medications you prescribed. You are not sure if you are permitted to release the requested mental health information.Unfortunately, there may come a time in your psychiatry practice when one of your patients becomes a medical examiner (ME) case. When this happens, you may receive a request for information from the ME regarding your recent treatment and/or any medications you may have prescribed. The request may or may not come in the form of a subpoena, and often it may come via an email or telephone call. In addition, in some jurisdictions the request may come from a coroner as opposed to an ME. “Coroner” and “ME” are discrete titles (often used interchangeably) referring to individuals who complete somewhat similar roles, but they may have very different training and qualifications. Some jurisdictions may use a coroner system to investigate and determine a cause of death. The federal privacy laws discussed below do not distinguish between ME requests or coroner requests for information. For the purposes of this discussion, I am using the term ME. Under most state laws, the ME, typically a physician, is charged with impartially investigating and subsequently certifying the cause or manner and circumstances of the patient’s death, that is, homicide, suicide, accident, natural, or undetermined. As such, the ME may seek information from treating physicians to prepare a record of facts surrounding the patient’s cause of death. Keep in mind that an inquiry from the ME does not necessarily mean he or she is evaluating the treatment provided.As you know, federal and state privacy laws govern when and how protected health information (PHI) may be released absent specific patient consent, including PHI of a deceased patient. The Health Insurance Portability and Accountability Act (HIPAA) does not treat psychiatric information differently from other health information (except for heightened protection against disclosure of psychotherapy notes). As such, under HIPAA, a psychiatrist may disclose PHI to the ME to assist with identifying the deceased, determining the cause of death, and carrying out “other duties as authorized by law.” Similarly, 42 CFR Part 2, Confidentiality of Alcohol and Drug Abuse Patient Records, permits disclosure of PHI when requested by the ME.In addition to the federal HIPAA and Part 2 regulations, you must also determine whether your state’s privacy laws permit you to release the requested information. Many states’ privacy laws afford greater protection against disclosure than HIPAA or Part 2 protections. When there is a difference between federal and state confidentiality protections, deference should be given to the law affording greater protection against disclosure without patient consent. Please consult with your local attorney or risk management professional to determine whether you may release PHI in response to the ME’s request. ■This information is provided as a risk management resource and should not be construed as legal, technical, or clinical advice. This information may refer to specific local regulatory or legal issues that may not be relevant to you. Consult your professional advisors or legal counsel for guidance on issues specific to you. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, AG (“Al-lied World”). Risk management services are pro-vided by or arranged through AWAC Services Company, a member company of Allied World.Moira Wertheimer, J.D., R.N., C.P.H.R.M., is assistant vice president of the Psychiatric and Healthcare Risk Management Group of AWAC Services Co., a member company of Allied World. ISSUES NewArchived

Trends and Patterns in Unintentional Injury Fatalities in Australian Agriculture.

Agriculture is recognized internationally as a hazardous industry. This article describes the trends and patterns of unintentional farm fatalities in Australia. Data from the National Coronial Information System were analyzed to assess all unintentional farm fatalities for the 2001-2015 period. A secondary comparison with earlier coronial system data from 1989-1992 was also completed to ascertain historical changes. There was no statistically significant change in the rate of work-related fatalities per 100,000 workers in the 2001-2015 period. However, there was a significant curvilinear reduction in all cases of fatality (work and non-work related) per 10,000 agricultural establishments, which decreased from 2001 to 2009-2011 and then increased to 2015. The longer-term data from 1989-2015 revealed a reduction of 30% in work-related cases per 100,000 workers and a reduction of 35% in all cases (work and non-work) per 10,000 agricultural establishments. For both work-related and all cases, there was a statistically significant reduction from 1989 to 2005 and then no change thereafter. The longer-term reduction in farm fatalities ceased in the mid-2000s, and the rate has remained stable since. Fatal injuries continue to impose a significant burden on Australian farming communities, with the rate remaining relatively static for the past ten years. New evidence-based interventions targeting priority areas are required to reduce the incidence of fatalities in Australia agriculture.

Confirmation and certification of death

The duty of a doctor to a patient continues after the death of that patient. All GPs should have a good working knowledge of the processes around confirmation and certification of death. These processes involve the completion of detailed, and sometimes unfamiliar, paperwork. Knowledge of the process can help avoid unnecessary errors that can cause distress to families at a difficult time. The coronial system has issued guidance, and understanding of this guidance can aid smooth multidisciplinary working, reduce pressure on GPs and help bereaved relatives.

County Coroners and Their Role in the Heart of the Opioid Epidemic.

As drug- and opiate/opioid-related deaths continue to rise in the Midwest, we must look at how the type of death investigation in these areas is affected and taxed by the increase. Many states with a large rural component rely on a local coroner system, where death investigation lacks uniformity and requirements for coroner investigative personnel are extremely variable. This has mixed implications for communities and potentially affects law enforcement and prosecution, data collection, and public policy. Both coroner and medical examiner systems benefit from strong leadership, properly trained personnel, and fiscal support. However, operational differences amongst jurisdictions should be addressed so that all stakeholders ultimately receive optimal data. This paper discusses the coroner system of death investigation in one Midwest state (Ohio) in the context of the region's burgeoning opiate/opioid epidemic and suggests opportunities for improvement.

Prospective audit to evaluate the potential of the coronial system to increase solid organ donation

ObjectivesAnecdotal evidence suggests that organ donation from deceased donors referred to the Coroner/Procurator Fiscal (PF) could be increased if all followed best practice. The aim of this prospective audit was...

Deaths after police contact in England and Wales: the effects of Article 2 of the European Convention on Human Rights on coronial practice

AbstractThis paper examines the role of coroners in investigating and reporting on cases of death after police contact (DAPC) in England and Wales. It considers how Article 2 (the right to life) of the European Convention on Human Rights (ECHR) has affected coronial processes and practices. It argues that the effects of Article 2 represent an evolutionary shift in accountability processes surrounding cases of DAPC in England and Wales, but that this shift has in turn been mediated by aspects of institutional structure in the coronial system. It discusses how this shift demonstrates the dynamic relationship between the coronial system, state and society and how this has continued to evolve as a result of external demands.

The continuing implications of the ‘crime’ of suicide: a brief history of the present

AbstractThe long history of suicide as a criminal offence still has a significant contemporary effect on how it is perceived, conceptualised and adjudged. This is particularly the case within countries where suicide is largely determined within a coronial system, such as Australia, the UK and the US. This paper details the outcomes of a study involving semi-structured interviews with coroners both in England and Australia, as well as observations at inquests. It focuses around the widely held contention that the suicide rates produced within these coronial systems are underestimations of anywhere between 15 to 50 per cent. The results of these interviews suggest that there are three main reasons for this systemic underestimation. The first reflects the legacy of suicide as a criminal offence, resulting in the highest standard of proof for findings of suicide in the UK, and a continuing stigma attached to families of the deceased. The second is the considerable pressure brought to bear upon coroners by the family of the deceased, who, because of that stigma, commonly agitate for any finding other than that of suicide. The third involves the rise of ‘therapeutic jurisprudence’, wherein coroners take on the responsibility of the emotional well-being of the grieving families, which in turn affects the likelihood of reaching a finding of suicide. The conclusions drawn by the paper are also twofold: first – with respect to the stigma of suicide – it will take a lot more than simple decriminalisation to change deeply held social perceptions within the community. Second, given that suicide prevention programmes and policies are based on such deeply questionable statistics, targeted changes to coronial legislation and practice would appear to be required.

Consent for paediatric and perinatal postmortem investigations: Implications of less invasive autopsy

Abstract The majority of perinatal and paediatric deaths do not fall within the jurisdiction of the Coronial medicolegal system; the decision to consent to autopsy is a personal choice, made by parents on behalf of their child in order to better understand the circumstances of their death, to answer specific questions or to improve the process for others. Professionals seeking to obtain informed consent should understand the general autopsy process as well as the complete range of options available, with their advantages and disadvantages for specific clinical scenarios. This article summarises the principles of obtaining consent for perinatal or paediatric autopsy in the UK at the time of publication.

The Coronial System and Determining Manner of Death in Australia -An Overview

Death investigation in Australia was initially founded on the British coronial system. Today it continues to operate under a coroner-based service with each of the individual self-governing states and territories responsible for enacting and administering their own coronial legislation. This has led to some variation within Australia; however, there is broad similarity. Deaths reported to the coroner generally include those where the cause is unknown, there are violent/unnatural circumstances, the death is as a result of an anesthetic or medical procedure, the death occurred whilst held in care/custody, or the identity of the deceased is unknown. Coroners are legally qualified individuals who are appointed to administer the Coroners' Act, but have no medical training. They are required to investigate deaths to determine who a deceased person is, as well as, how, when, where and what caused them to die. This is an inquisitorial process with the purpose of determining the circumstances of death to serve the public interest. Their findings are presented in a written report that outlines the circumstances surrounding death in an attempt to indicate whether a death was natural or unnatural (due to external factors), and in the case of unnatural deaths, to outline the intent and external factors that led to death. Hence, the “manner of death” is presented as a narrative within the coroners' findings. The coroners use information obtained during their investigations to make recommendations about public health policy, justice, and the prevention of similar deaths in the future.

Scrutinising the Other: Incapacity, Suspicion and Manipulation in a Death Investigation

In common law countries like England, Australia, the USA and Canada, certain deaths come to be investigated through the coronial system. These include sudden, unnatural or suspicious deaths as well as those which appear to be the result of naturally occurring disease but the precise cause is unknown. When a reportable death occurs in Australia, a number of professional groups become involved in its investigation – police, coroners, pathologists and counsellors. While research has demonstrated the importance of training and education for staff in the context of criminal investigations – with its over-representation of vulnerable and marginalised populations – this is less likely to occur in the context of death investigations, despite such investigations also involving the over-representation of vulnerable populations. This paper, part of larger funded research on the decision-making of coronial professionals in the context of cultural and religious difference, explores the ways in which cultural and religious minority groups – in this case Islam, Judaism and Indigeneity – become differently positioned during the death investigation based upon how they are perceived as ‘other’. Our research raises three issues. First, positioning as ‘the other’ is dependent on the professional training of the staff member, with police and pathologists far more likely than coroners to be suspicious or ignorant of difference. Second, specific historical and contemporary events effect the Othering of religious and cultural difference. Third, the grieving practices associated with religious and cultural difference can be collectively Othered through their perceived opposition to modernity.

Forensic Investigation of mass disasters in Nigeria: A review.

This paper is to establish the present state of things in the country in terms of legal framework and the availability of personnel with a view to presenting an overview of proper mass disaster investigations. This is a retrospective review of mass disasters in Nigeria that occurred within the last 20 years. The study therefore reviews the state of the forensic investigation of the mass disasters as well as the efforts made to identify the victims of the disaster. The process of proper forensic investigation from the stage of evaluation of the scene and recovery process to the final identification of victims are presented to serve as a protocol for the country. The assessment of the present state of preparedness in Nigeria is also examined with a view to improving the practice to international standards. Data were retrieved from official documents from the aviation industry as well as Nigeria news reports. The standard protocols for disaster victim identification were retrieved from the guide released by the INTERPOL. The state of preparedness of the country and recommendations for improvement are presented. The Federal government and the states of the federation should without further delay put in place the process of reviewing the law of Coroner's system and provide the enabling environment for the proper forensic investigation. The training curriculum of the first responders should incorporate mass disaster investigations in order to produce efficient officers and personnel. A functional disaster victim identification (DVI) team is strongly advocated to incorporate different professionals involved in mass disaster management.

A Synopsis of the 1928 National Research Council's Bulletin on “The Coroner and the Medical Examiner”

The 1928 National Research Council (NRC) Bulletin on “ The Coroner and the Medical Examiner” is an often-referenced report because it compares the two system types and recommends that coroner systems be abolished and replaced with medical examiner systems. Copies of the Bulletin are difficult to find, so this article provides a synopsis of the Bulletin's content. The NRC Bulletin 64 was prepared under the auspices of the seven-member “Committee on Medicolegal Problems.” The report itself begins with a historical summary of the coroner system and discussion of the medical and judicial duties of coroners, along with the inadequacy of existing autopsy facilities. Next is a review of previous surveys of coroner systems in New York City, Cleveland, and Missouri. The Committee conducted its own surveys of the coroner systems in New Orleans, San Francisco, and Chicago. The Committee also studied the medical examiner systems in Boston, other parts of Massachusetts, and in New York City. Other sections deal with the comparative costs of the two systems, teaching of forensic medicine, medicolegal institutes, scientific publications, a summary of defects of coroner systems and advantages of medical examiner systems, and eight summary recommendations. We must remember that the historical Bulletin was written nearly a century ago, and there has been much improvement in medicolegal death investigation since that time, many improvements having their roots in the NRC Bulletin recommendations. The Bulletin's recommendations have been fulfilled to various extents in many parts of the United States.

Charleston, South Carolina: Reversion from a Medical Examiner/Coroner Dual System to a Coroner System

The death investigation system for the state of South Carolina is a coroner system. The state has 46 counties and each has one elected lay coroner. The educational requirement is a high school diploma. Many physicians and legislators have repeatedly attempted to change the state and large counties’ death investigation systems to medical examiner systems. Due to the politically strong coroners, these attempts have been largely unsuccessful. In 1972, Charleston County converted to a medical examiner/coroner dual system. This system was constantly challenged until it reverted back to a coroner system in 2001. The establishment of the dual system, hurdles and road blocks confronted, and reasons for the ultimate reversion are discussed.

Coroner Duties that Differ from Typical Medical Examiner Duties

State death investigation laws were reviewed to determine which duties coroners have that go beyond death investigation and are not typical duties of medical examiners. Twenty-four states have statutes giving coroners one or more other such duties. Those duties include acting as the sheriff and/or being in charge of the jail when the sheriff is unavailable, serving as public administrator, providing ambulance services, supervising the sanitary conditions at penal institutions, performing clinical rape examinations and mental commitments, attending judicial executions, filling in as a county commissioner, and operating small claims courts and issuing warrants. Colleagues in many states reported that these statutory duties have actually been performed, although rarely. If a state or local jurisdiction were considering transition from a coroner system to a medical examiner system, any legislative change would need to consider whether the medical examiner would assume all duties of the coroner, or whether other solutions would be needed to carry out the tasks that are not related to death investigation. Legislation to change from coroner to medical examiner systems would need to ensure that any such essential services unrelated to death investigation are transitioned to other officials.

New York State: Fee-for-Service Forensic Pathology in a Multiple Coroner System

Having served as a board-certified forensic pathologist in the southern tier of New York for over 23 years, the author has received cases from over a dozen rural New York State coroner counties. While some coroners are physicians, none of them is a pathologist, and most are not in the medical profession. Some are appointed by their county legislature, whereas others are elected. Levels of coroner training and experience in death investigation, terms of office, multiple coroners per county, and turnover of coroner staff are all challenges for the consultant forensic pathologist. Functioning as an autonomous independent contractor, a forensic pathologist can bring standardization, medical knowledge, and reliability to the determination of cause, mechanism, and manner of death, even when resources are less than optimal. As fewer hospital pathologists perform autopsies, and as community hospitals opt to close their morgues entirely, regional centers emerge to absorb the workload. In such a setting, the forensic pathologist must establish a working relationship with an institution such as a regional hospital to support an adequate physical plant for an autopsy service. Until such time as adequate manpower and financial resources are available, a coroner-based death investigation system is still a necessary complement to the medical examiner system in New York State. There are both drawbacks and advantages to such a practice for the independent forensic pathologist. Yet the citizens of this area of New York State are served by a death investigation system that is functional and meets basic needs.

PRILOG POVIJESTI SUDSKE MEDICINE I MRTVOZORSTVA U GRADU BJELOVARU

This review analyses historical sources on the development of forensic medicine and the coroner system in the town of Bjelovar over the past two centuries. The development of these two professional fields in the context of public health was regulated through a number of bylaws, such as Normativum Sanitatum from the time of the Habsburg Monarchy. Coroner examinations were performed by physicians, surgeons, and laymen using special instructions such as the famous booklet by nobleman and county medical officer Vilim Peičić from 1914. Forensic autopsy was performed by surgeons, primary or secondary hospital physicians in case of sudden or suspicious in-hospital deaths, whereas outpatient forensic autopsies were performed by county or town medical officers and district physicians at the request of investigating authorities (police, court, or general attorney's office). This historical review should serve as the basis for further historical research into this field in Croatia so as to obtain deeper insight into the development of forensic medicine and the coroner system, two professions that have always been a vital factor in public health.

Coronial autopsy in a rural setting

ObjectivesTo determine the precise nature of the non-homicide coronial autopsy. Design and settingRetrospective analysis of coronial autopsies between 2005 and 2011 in a rural setting on the Mid North Coast of New South Wales. ResultsA total of 1446 autopsies were performed during the 7 year study period. There were 1428 (98.75%) coronial and 18 (1.25%) hospital autopsies. Death in the coronial cases was attributed to natural causes in 829 (58%) of the cases, accidental causes in 321 (22.5%) of the cases, suicide in 244 (17%) of the cases and no apparent cause (indeterminate) in 34 (2.5%) of the cases. Acute myocardial ischaemia constituted 66.7% of the natural causes. Road traffic and other motorised vehicle-related accidents were responsible for 60.7% of deaths in the accidental group. The 2 main types of death in the suicide group were hanging (36.5%) and drug overdose (31.5%). In 34 deaths, the cause remained unclear, however, because of lack of suspicious circumstances and negative histology and toxicology, they were presumed to be due to natural causes. ConclusionsThe hospital autopsy has almost completely disappeared. On the other hand, coronial autopsies are on the rise. General Practitioners appear reluctant to issue death certificates in certain situations where there are no suspicious circumstances and the Coroners feel obliged to ask for autopsies. Currently, there is a severe shortage of pathologist and the additional coronial works adds to the burden on those pathologists who engage in such work. The coronial system needs to think about the role of the autopsy in these circumstances. Furthermore, additional resources from the various stakeholders are required for the increasing educational role of the coronial autopsy in undergraduate and postgraduate teaching.

Los sistemas de investigación de la muerte innatural: coroners y medical examiners

Unnatural death is investigated by authorities in a special way because of legal reasons. There are two main models to this purpose; the one is based in Common Law tradition, the coroner system, and the other in the crime investigation. The paper goes into details of the coroner system and also of its transformation, the medical examiner system. Finally, several considerations are made about death investigation in Spain.

Cardiac Arrest 2012

Cardiac Arrest 2012

Consensus Conferencing in Forensic Toxicology for the Coronial System

Consensus Conferencing in Forensic Toxicology for the Coronial System