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 Reportable Death Criteria Established by the State Medical Examiner
The office of the Chief Medical Examiner enjoys a close working relationship with the health care facilities and providers throughout the state. Sometimes there are questions regarding which deaths need to be reported to the Medical Examiner's Office. Tennessee State Law (38-7-108) states:
“Any physician, undertaker, law enforcement officer, or other person having knowledge of the death of any person from sudden violence or by casualty, or by suicide, or suddenly when in apparent health, or when found dead, or in prison, or in any suspicious, unusual, or other unnatural manner or where the body is to be cremated shall immediately notify the county medical examiner.
In the event such death occurs in a suspicious, unusual, or unnatural manner in a hospital, outpatient facility, nursing home, treatment resource, clinic, or other health care facility, the facility shall immediately notify the county medical examiner of the occurrence of such death. “
Due to the generalities in the state laws regarding reportable cases, we recommend that the following types of cases be reported to your county medical examiner in order that jurisdiction of these cases might be established.
- Death when not under the care of a physician for a potentially fatal illness. Generally, we would define "care of a physician" as an ongoing physician - patient relationship where the physician has treated the deceased. This treatment does not necessarily have any defined time restrictions.
- Death of a person when the attending physician, or his or her representative, is unavailable to sign the death certificate. (for example, out of state physician or physician on vacation)
- Death occurring suddenly when in apparent good heath when the cause of death has not been established by medical treatment.
- Death from violence of any type. All gunshot wounds, stab wounds, blunt trauma, fall related deaths, fire deaths, drowning, and motor vehicle collisions, regardless of the time elapsed from onset of incident to the time of death. (for example, if a person is shot with injury to the spinal column resulting in paraplegia then develops a urinary tract infection and sepsis at a later date, the death can be traced back to the injury and this is a reportable medical examiner case)
- Death related to an overdose of illegal drugs, alcohol or legal medications (including natural or herbal remedies).
- All deaths of children without a clear underlying natural cause of death. Any injuries in a child should alert you to contact our office for consultation, even when there is a natural disease present. Sudden infant death syndrome (SIDS) is a diagnosis of exclusion requiring a complete autopsy, and all suspected SIDS deaths must be reported to the medical examiner.
- Death occurring in a prison or of a prisoner.
- Death occurring on the job or related to employment.
- Death believed to present a public heath hazard.
- Death of a patient during or as a result of a diagnostic or therapeutic procedure, a medication error, or adverse, allergic, or toxic reaction to a therapeutic agent.
- Death of a nursing home or extended care resident when abuse, neglect, or overmedication is strongly suspected or confirmed as contributing to death.
- Death of a fetus of greater than 22 weeks gestation and the death is related to an act of violence, maternal substance abuse, or an accident.
- Death of a person from any cause when their identity is unknown or unclear.
- Death when cremation of the remains is to be performed.
Tennessee State Law does not contain a "24 hour rule". In other words, the death of any patient admitted to the hospital in the 24 hours preceding death does not have to be reported to the medical examiner unless the death satisfies the criteria outlined above. Also, the above criteria should serve as a guideline. If there are any questions regarding a death in your facility, you should feel free to contact our office for consultation. An investigator and a medical examiner are available 24 hours a day, 7 days a week and will be happy to assist you with any questions you might have. Acceptance of a case by the medical examiner does not mean that an autopsy will always be performed. These decisions are made by the medical examiner at his or her discretion.
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