N.C. OCME Guidelines
- The county medical examiner is an officer of the State of North Carolina, charged with the duty of investigating and certifying specified categories of human deaths in North Carolina. A medical examiner's authority derives from Article 16 of Section 130A of the North Carolina General Statutes. His/her primary purpose is to detect,analyze, and document the medical aspects of certain types of deaths so that deaths can be better understood scientifically, legally, and socially.
- The following types of deaths in North Carolina are to be reported to a medical examiner:
- Unknown, unnatural or suspicious circumstances
- In police custody, jail or prison
- In state-operated mental health facilities
- Poisoning or suspicion of poisoning
- Public health hazard (such as acute contagious disease or epidemic)
- Deaths during surgical or anesthetic procedures
- Sudden unexpected deaths not reasonably related to known previous disease
- Deaths without medical attendance
The medical examiner (ME) has discretion as to whether he/she believes a given death is or is not within his/her jurisdiction. Note, however, that every death that is due to or might reasonably have been due to a violent or traumatic injury or accident is to be investigated by the medical examiner. This includes all murders, suicides, accidents, poisonings, etc. Note that every death due to a violent cause is to be investigated, regardless of the duration of survival (including hospitalizations) of the decedent after his/her injury. If there is any question as to whether or not a given death should be investigated by he medical examiner, please call the Office of the Chief Medical Examiner (OCME) for consultation. The toll free number is 1-800-672-7024.
- A death will be reported to a medical examiner by any person who has knowledge of the death or who finds the dead body. Usually this will be a law enforcement agency, rescue squad, State Highway Patrol, funeral home, emergency room or private physician. The medical examiner should make a rapid initial evaluation of the reported death to ascertain whether he/she should assume jurisdiction over the case. The medical examiner should tell the reporting party promptly what to do with the dead body. The body should not be removed from the scene of death until the medical examiner has authorized the removal. If an ME plans to go to the scene to view the body this should be made clear to the notifying agents and the ME should respond promptly. Law enforcement officials may authorize removal in emergency situations.
The ME should make arrangements with law enforcement agencies, funeral homes, and hospitals in the area to facilitate the prompt disposition of the dead body. The medical examiner may direct that a body be removed from the scene to a more convenient repository for detailed examination at a more convenient time. Most cases will not require the medical examiner's presence at the scene of the death, and the law does not require a scene visit. The ME should make a special effort, if at all possible, to visit the scene of all homicide deaths, and to such other scenes of death as may contribute to a better understanding of the case. If the medical examiner does not visit the scene, the information about the scene, how the body was found, etc., must be obtained from law enforcement, EMS personnel or others having such direct knowledge.
The medical examiner's jurisdiction attaches at death (this includes the determination of brain death) or upon the finding of a dead body. The ME has no jurisdiction over living persons. The place where death is pronounced or where a dead body is first found determines jurisdiction. The ME's geographic jurisdiction ordinarily extends to the borders of the county in which he/she is appointed to serve but is not necessarily limited to that county should it prove expedient to take jurisdiction in a death in an adjacent county. Note that the medical examiner's jurisdiction is determined by the place where the body is found, not necessarily by the place where the cause of death was inflicted.
The ME should relay findings to the appropriate law enforcement agencies at the place where the cause of death was inflicted if it is determined to be different from the county of death. He/she should also determine, based on investigation, where and when death actually occurred. (This may NOT be the same place where death was pronounced or the body found.) It is not the ME's job to pronounce people dead. For the purposes of our system, pronouncement of death occurs when the first person decides that an individual is dead.
The ME must personally view every dead body over which he/she assumes jurisdiction. The body should be critically inspected, including the back, both before and after removal of clothing. The ME must be alert for signs of violence, trauma, poisoning, etc. Obtaining a medical and social history of the decedent to help explain the cause and manner of death is a basic part of the investigation. He/she must be satisfied that any signs of injury are consistent with the history presented, and that when the death is thought to be from natural causes that no discordant evidence of injury is present. Consultation with law enforcement agencies is to be obtained in all relevant deaths. In some instances a ME may be asked to investigate a death after a body has been buried or cremated. Viewing of the body will, of course, be impossible and the investigation will be limited to a historical review of the circumstances of death and whatever observations about the body were made at the time. The ME should indicate that the body was not viewed and why, but go ahead and send in a report of investigation and prepare a ME death certificate.
The medical examiner has the authority to order an autopsy when, in his/her opinion, it is advisable and in the public interest. This power is to be used judiciously. If in doubt as to the advisability of ordering an autopsy, consultation is to be sought from the OCME or from the Regional Pathologist. In the event of a difference of opinion between a ME and a regional pathologist, the OCME may be contacted to resolve the issue.
Medical Examiners should order an autopsy on:
- all homicides and suspected homicides
- suspected drug related deaths, illicit or prescription
- hit and run accidents
- victims alleged to have been lying in the roadway or on railroadtracks before being struck
- pilots and crew in aircraft crashes, private and commercial
- sudden unexpected deaths where the decedent does not have a well-documented illness that would explain death (All such deaths in young adults, children, and infants, including SIDS cases, should be autopsied. Deaths in the elderly should be considered on a case by case basis.)
- suspicious or contested suicides
- accidental deaths where the observable injuries do not appear sufficient to explain death or seem inconsistent with the alleged "accident"
- possible public health hazard when the autopsy is the most expeditious means of determining whether in fact a hazard exists
- law enforcement insistence
- badly burned (charred) bodies
- badly disfigured bodies when identification may be an issue, especially if there are multiple fatalities
- skeletonized remains
- badly decomposed remains
- any death where there is a reasonable suspicion that trauma (external force) may have been the cause or a contributing cause and an autopsy will settle the issue.
- apparently natural deaths in known alcoholics and drug abusers
- deaths of travelers, vacationers, convention attendees, workers, students, and other strangers from afar should be carefully evaluated before a decision NOT to autopsy is made.
- ME authorized autopsies are performed by assigned contracted pathologists located throughout the state, and at the OCME in Chapel Hill. The ME should telephone the regional pathologists before dispatching a body for autopsy and discuss the case with the pathologist, arrange a convenient disposition of the body, and coordinate transportation. When indicated, the ME should promptly report findings and those of the pathologist to the appropriate law enforcement agency.
- The ME must make a record of his/her findings and of the circumstances of the death on the "Report of Investigation" form and on such diagrams, etc., as may be needed to completely document the case. These records are to be sent to the OCME within 14 days of notification of the death. The ME should keep a copy of all documents for his/her records.
- As the official" document of a public official, the medical examiner's Report of Investigation reflects on the medical examiner, the medical profession, and on the medical examiner system. Examiners should try to make it as legible as possible, complete, and relevant. This report may be the only record (other than the death certificate) prepared in connection with this death. The findings of an ME investigation may be critical to the resolution of a variety of legal and social issues. Medical abbreviations may pose problems for many non-medical people who read the reports.
- The ME Report of Investigation and the autopsy report once received and reviewed at the OCME are public records.
- The ME must complete the "Medical Examiner Certificate of Death" on every case over which he/she assumes jurisdiction. ALL copies of the certificate are to be forwarded to the local Registrar of the County of death, usually through the funeral home handling the final disposition of the body. A death under ME jurisdiction CANNOT be certified on a non-medical examiner death certificate.
- If the cause and/or manner of death is not known or for some other reason the death certificate diagnoses cannot be immediately completed, the certificate should be marked as pending" and forwarded as noted above. A supplemental death certificate can be filed later with the local registrar. Please bear in mind that the completion and filing of the death certificate is often crucial to families of decedents in order to settle estates, collect insurance and resolve other death-related matters. Medical examiners should do all they can to insure that no unnecessary delays occur in generating this important document.
- Only rarely would any medical examiner take custody of the property or valuables of a decedent. Wallets, jewelry, and the like can be transferred to the possession of law enforcement officers, funeral directors, or family members. It should be noted on the investigation report what disposition is made of any personal effects especially the more valuable personal property. Please exercise caution regarding the leaving of valuables with a body that is put in an unsecured morgue facility.
- Bodies should be released only to the next of kin or their agents.
- In the event of a disaster involving multiple deaths, please contact the OCME by telephone as rapidly as possible and practical. Our toll-free number, 1-800-672-7024, is in operation 24 hours/day.
- Should there be reported to you as a medical examiner the death of any person likely to generate widespread public interest or arousal, please inform the OCME promptly by telephone.
- Specimen collection kits are provided to all ME’s and contain detailed instructions inside the kit. Draw specimens for toxicology BEFORE the body is embalmed on all ME cases that will not be autopsied. Try to obtain two specimens per case: a blood specimen from subclavian or femoral sites and a specimen from the eye (vitreous) or bladder (urine). The specimen kit has two vials for collection one with and one without preservative. The vials are clearly marked. Avoid using the vial without preservative for collection of blood specimens. Only use cardiac as a last resort and avoid thoracic punctures. The pathologist should draw the blood specimen if an autopsy is to be performed. Send the labeled sample in the vials provided in the sample collection kit to the Toxicology Laboratory of the OCME in Raleigh. Complete the toxicology request form and send it in the kit with the specimen. Advice on toxicology problems can be obtained from one of the OCME pathologists or from the Chief Toxicologist at 1-800-672-7024.
- The medical examiner does not need to submit bills for his/her services. Payment is set in motion when a properly completed Report of Investigation is received. ME's will not be paid for an investigation unless the report is submitted.
- The OCME recommends that medical examiners direct all requests for copies of ME, autopsy, and toxicology reports to the OCME. The same applies to insurance forms" received for subjects of ME cases. The OCME can return the forms to the appropriate insurance companies with a copy of your reviewed Report of Investigation. There is generally no charge to requesting parties for copies.
- As a public officer, the ME may, and should upon request, release to the news media the cause and manner of death that is entered on the death certificate and Report of Investigation. Care should be taken to insure that such information is conveyed to the next of kin BEFORE it is released to the press. This information may be relayed personally by the Medical Examiner or through law enforcement officers. The alcohol test results may also be released. Homicides are a bit different. Consult with the appropriate law enforcement agency or District attorney's office concerning what may be released about a suspected homicide, and whether or not you should refer inquiries to them.
- The staff members at the OCME are available for assistance at any time. The toll-free number is 1-800-672-7024. When OCME staff are not in the office, after regular work hours and on weekends, a North Carolina Memorial Hospital operator will connect a caller with the on-call OCME Medical Examiner.
- In certain non-ME deaths, the Medical Examiner's permission is necessary before a body can be cremated or buried at sea. The following deaths do not need ME permission:
- deaths that are already medical examiner cases
- occur in a licensed hospital or nursing home
- under the care of a licensed hospice
- an infant less than 24 hours old
- where the body is being donated to the Commission of Anatomy ora medical school
While emergency department deaths are generally considered as not having occurred in the hospital for cremation authorization purposes, they will not require ME permission if the patient is being transferred from another licensed hospital or nursing home at the time of death.
In all other instances the medical examiner should view the body, ascertain that a valid death certificate exists or will be filed that does not bear a cause of death that requires further investigation, and fill out an authorization for cremation form. The person(s) requesting permission for cremation/burial at sea should pay the $50 fee directly to the medical examiner. A death that would not otherwise be a ME case should not be made one just because cremation or burial at sea is desired or requested.
- When a death falls into medical examiner jurisdiction and permission for organ donation from next-of kin or through organ donation card has been obtained, the ME's permission is also required before harvesting. Medical Examiners should allow donation unless, in their judgement, examination of the organ to be harvested will be critical in determining the cause and/or manner of death. Donation may be permitted even in cases of homicide. If in doubt, consult the OCME. The body will still have to be examined by the medical examiner and in those cases where autopsy is appropriate, one should be performed following harvesting.
- Please read and understand the relevant North Carolina General Statutes and the Administrative Rules. They expand on some operating policies and procedures of the North Carolina Medical Examiner System.