Report Of Death

This chapter has been confined to those issues relevant to the assessment of living patients. However, another important responsibility of the emergency physicians is that of notifying the local law-enforcement agency or medical examiner or coroner of a death that constitutes a medical examiner or coroner case.

Statutory language identifies those deaths that require an investigation by a medical examiner/coroner of the circumstances of the death. This enables one to determine whether an autopsy is necessary, which can then be carried out under the same statutory authority. Such deaths are generally those of individuals who die suddenly while not under the immediate care of a physician and any death associated with some type of injury, and usually include a category of any suspicious or unusual death. It should be emphasized that the length of time a patient has been in hospital, or the age of an injury associated with the underlying cause of death, is not a factor in determining whether the death should be reported to the medical examiner/coroner.

For example, the death of a person who sustained paraplegia from a gunshot wound of the back remains a medical examiner case despite the many medical procedures and complications that result from such an injury—even when many years have passed and the victim has died of a complication of paraplegia, such as a chronic urinary tract infection. The evidence of gunshot injury together wtih the medical treatment and any other intervening events leading up to the eventual death need to be assessed by the medical examiner/coroner. If a chain of events exists, leading from the gunshot wound to the immediate cause of death, then the manner of death would be determined to be homicide. BIBLIOGRAPHY

Carmona R, Prince K: Trauma and forensic medicine. J Trauma 29:1222, 1989. DiMaio DJ, DiMaio VJM: Forensic Pathology. New York, Elsevier, 1989.

DiMaio VJM: Gunshot Wounds: Practical Aspects of Firearms, Ballistics and Forensic Techniques. New York, Elsevier, 1985. Goldsmith MF: U.S. forensic pathologists on a new case: Examination of living persons. JAMA 256:1685, 1986. Jones NL: Atlas of Forensic Pathology. Igaku-Shoin, 1996.

Maryland Statute Health—General §5-704. Child Abuse and Neglect—Reporting of Abuse or Neglect—By Health Practitioner, Police Officer, Educator or Human Service Worker. Mason JK: Forensic Medicine: An Illustrated Reference. Chapman and Hall, 1993.

Mittleman RE, Goldberg HS, Waksman DM: Preserving evidence in the emergency department. Am J Nurs 83:1652, 1983. Mittleman RE, Stevens EC, Sorouon R: Obtaining saliva samples from bitemark evidence. Law Enforcement Bull November, 1980. Parrish RF, Ing R: Medical Examiner and Coroner Jurisdictions in the United States. American Academy of Forensic Sciences, 1988. Smialek JE: Forensic aspects of penetrating trauma, in 12th National Trauma Symposium, March, 1990. Spitz WU, Fisher RS: Medicolegal Investigations of Death Investigation, 3d ed. Charles C Thomas, 1993.

Wetli C, Rao V, Ivatury R, Cayten CC: Gene: The Textbook of Penetrating Trauma. Baltimore, Williams and Wilkins, 1995, pp 1084-1097.

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