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Hospital deaths
A. A patient admitted and/or brought to an emergency room should only be classified as a PROBABLE MEDICAL EXAMINER CASE if one of the following applies. (These classifications apply even when the patient lives for a prolonged period - up to days, weeks, months, even years in cases such as paralysis - before expiring.):
1. Any injury was sustained in the past that appears to be related to the death. This includes all drug overdoses, drownings, near-drownings, fractures, falls, head trauma, vehicular accidents, burns, electrical shock, gunshot, stab or blunt trauma wounds. Paralysis is generally due to such injury even if it occurred several years prior.
2. Poison or drug overdose is suspected by preadmission history or other source.
3. Suspicion of criminal abortion prior to admission is indicated.
4. Death of a fetus of over 20 weeks gestation if it was the apparent result of a traumatic event to the mother, i.e., auto accident, homicide, etc.
5. Death of an infant as a complication of maternal drug use.
6. When a person dies and has not been treated recently by a Florida-licensed physician.
- 1. When the DOA is an apparent natural death, the hospital should contact the deceased's local physician for signing of the death certificate. If there is no local physician but there is sufficient documentation by the Emergency Department staff of the natural cause of death by EKG, X-ray, CT scan or lab tests, then the admitting or attending physician at the hospital should sign the death certificate.
- 2. If the DOA has an out-of-state physician, the case should be referred to the medical examiner.
7. Surgical-related deaths when a person dies as a result of an operative mishap (accident) should be immediately reported to the medical examiner. Deaths resulting from normally expected risk of the procedure do not need to be reported.
8. Some hospitals have found it helpful to use a rubber stamp stating that the Medical Examiner's Office is to be notified if the patient dies. This is often stamped on the patient's admitting sheet. More often than not it will be necessary for this office to examine available medical information on a deceased patient who has been referred to this office. When a hospital patient is referred to Medical Examiner's Office, certain copies of medical records within the chart and any admitting specimens are to be sent with the body. Typically the medical records requested would include:
- E.R. records, including EMS Run Sheet if applicable;
- History and physical;
- Any and all consultations;
- Radiology reports;
- Lab reports; and
- First and last three days of doctor's progress notes and nurses notes.
9. There is no statutory provision regarding a "24 hour rule." Please advise all staff that may be involved with reporting deaths to the medical examiner that they should not call this office automatically on deaths that occur within 24 hours of admission. The medical examiner needs to be called only to report deaths that fall under medical examiner jurisdiction as the law sets forth. Once again, the reporting of deaths that are due to natural causes when the patient has a treating physician should no longer be reported to this office regardless of whether the death occurred within 24 hours of admission.
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Volusia County, Florida.
