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Death Certificates, Simplified Karen Gunson, M. D. Jo. Ann Jackson, MBA Death Certificates, Simplified Karen Gunson, M. D. Jo. Ann Jackson, MBA

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

Medical Examiner Cases n n n n Apparently homicidal, suicidal or accidental Drug overdoses Medical Examiner Cases n n n n Apparently homicidal, suicidal or accidental Drug overdoses Deaths in custody Deaths on the job or resulting from employment Deaths occurring while not under the care of a physician in the immediate past In hospital less than 24 hours Suspicious or unusual deaths

Deputy Medical Examiner n n n Eyes and ears of the physician medical examiner Deputy Medical Examiner n n n Eyes and ears of the physician medical examiner at the scene of death Appointed by the county medical examiner and approved by the county district attorney Usually a police officer: city, sheriff or OSP Some are nurses or E. M. T. s Large counties have full time DMEs with national certification

County Medical Examiner Program n n n County Medical Examiner is in charge of County Medical Examiner Program n n n County Medical Examiner is in charge of local death investigation program Some will go out on scenes Most will view body in funeral home They appoint the Deputy Medical Examiners They communicate with the State Office via telephone, e-mail and written report

Definitions n Cause of Death: That natural disease or injury that sets in motion Definitions n Cause of Death: That natural disease or injury that sets in motion the events that lead to death n Manner of Death: Natural, Accident, Suicide, Homicide, Undetermined, Pending n Mechanism of Death: The final physiologic disturbance (i. e. . Cardio-respiratory Arrest)

Declaring Death and Death Certification n n In Oregon, there is no specific law Declaring Death and Death Certification n n In Oregon, there is no specific law on ‘pronouncement’ of death You do not have to witness the death or declare a person dead to sign the death certificate Only a physician, nurse practitioner or physician assistant can sign a death certificate Signing the death certificate is your final responsibility to your patient

What about Hip Fractures? (or any other injury) n n Did the hip fracture What about Hip Fractures? (or any other injury) n n Did the hip fracture hasten death? But for the hip fracture would this person have died at this time and place? Did the hip fracture contribute to death? Remember the definition of “Cause of Death” Cause of Death: That natural disease or injury that sets in motion the events that lead to death.

Injury Information n If an injury is cited as causing death or contributing to Injury Information n If an injury is cited as causing death or contributing to death, the injury information section must be completed even if the manner of death is natural (What? !? )

Helpful Hints n n “Undetermined Natural Causes” “Complications of…. . ” “Do I have Helpful Hints n n “Undetermined Natural Causes” “Complications of…. . ” “Do I have to fill out every line? ” “I don’t know how long between the event and death. ”

Questions Questions

Who can sign if not a ME case n n n ORS 432. 005(22) Who can sign if not a ME case n n n ORS 432. 005(22) “Medical certifier” means a physician, physician assistant or nurse practitioner licensed under the laws of this state or under the laws of Washington, Idaho or California who has treated a decedent within the 12 months preceding death. Death certificate must be signed within 48 hours of receipt ORS 432. 133(3) If working for federal government (IHS or VA), can be licensed anywhere

Query Forms n n Must be filled out by signing medical certifier Respond to Query Forms n n Must be filled out by signing medical certifier Respond to the query even if the response is “Unknown” so we know that the query has been addressed

Contacts Karen Gunson, MD State Medical Examiner 971 -673 -8200 Jo. Ann Jackson, MBA Contacts Karen Gunson, MD State Medical Examiner 971 -673 -8200 Jo. Ann Jackson, MBA Registration Manager 971 -673 -1160, Jo. Ann. [email protected] or. us Karen Hampton Vital Statistics and Systems Manager 971 -673 -1191, Karen. R. [email protected] or. us