PUBLIC HEALTH & EDUCATION

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Forensic Medical protects the health and safety of citizens its serves through the investigation of sudden and unexpected deaths and from deaths occurring in health care facilities. Forensic Medical performs substantially more autopsies than are performed in all the hospitals in the communities it serves. On average, between one-third and one-half of all autopsies performed reveal natural causes of death rather than deaths due to physical or chemical injury. These findings are submitted to the appropriate federal, state and local agencies, which then use the data to determine how to best utilize limited public resources for the protection of the public.

Forensic Medical provides information to the medical community through participation in hospital morbidity and mortality conferences, child death review boards and public health forums. Forensic Medical goals are to heighten the early identification of communicable diseases and the prevention of child abuse and decrease preventable child deaths. Forensic Medical pathologists actively participate in local and state multidisciplinary child fatality review teams. Additionally when a death results from a defective consumer product, malfunctioning medical equipment or industrial accidents, we report these to the proper authorities to assist in making our communities safer.

All Forensic Medical facilities are regional forensic centers and as such serves counties by providing continuing education to county medical examiners, justices of the peace, law enforcement, death investigators and district attorneys through seminars covering all aspects of forensic science.

In the Nashville NAME accredited forensic center, Forensic Medical trains Vanderbilt and Meharry Medical Schools’ pathology residents in forensic science.

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FORENSIC FACILITY MANAGEMENT

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• Provide the services/operation of a medical forensic center
• Provide a transition plan for assuming contracted responsibilities
• Develop and maintain mass casualty and mass disaster plans
• Provide expert consultation about morgue planning and new medical examiner facilities
• Recruit and staff with forensic pathologists and support personnel – provide effective and efficient forensic pathology services by motivating a team of professionally skilled employees who consistently meet high quality standards
• Provide training for autopsy technicians
• Establish autopsy standards that fulfill the legal requirements of the facility/state/county/city
• Set guidelines that fulfill the needs of the law enforcement agencies that interact with the facility

Forensic Medical is a professional company who provides effective and efficient medical examiner and forensic pathology services. Our company recognizes that recruitment and retention of high-quality personnel is critical to establishing a forensic medical practice that is above reproach, and has established a team management approach of professionals who consistently meet high quality standards in their quest to provide the services and operation of a forensic pathology service organization.

Our staff can provide a transition plan for assuming contracted responsibilities from a previous contractor. Through our experience we can provide expert consultation about morgue planning and construction of new medical examiner facilities. Our staff has been integral in the development of mass casualty and mass disaster plans and have been involved in both tabletop and hands-on disaster training.

Our staff has developed forensic investigation and autopsy standards that fulfill the legal requirements of state and county agencies and provided training in death investigation and autopsy technical services as well as set guidelines that fulfill the needs of the law enforcement agencies that interact with our facilities.

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FORENSIC AUTOPSIES

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In Tennessee, a medicolegal or forensic autopsy may be ordered by a county medical examiner, the state medical examiner, or by the appropriate district attorney’s office. County medical examiners are physicians appointed to the post who are responsible for certification of cause and manner of death in cases of unusual, unexpected, or unnatural deaths, which include homicides, suicides, accidents, and deaths in otherwise healthy people. Many such cases may require an autopsy for accurate and complete determination of the cause of death. Once the decision has been made to order an autopsy, the county medical examiner then refers the decedent to a regional forensic center in which the autopsy will be performed by a board-certified forensic pathologist. By law, facilities performing forensic autopsies in the state of Tennessee must be accredited by the National Association of Medical Examiners (NAME), which assures that nationally-accepted standards for our investigations are being satisfied. Forensic Medical Management Services, PLC oversees the Metropolitan Nashville Davidson County Office of the Medical Examiner and in that role provides medicolegal autopsy services to over fifty counties in Tennessee. When the autopsy has been concluded, a death certificate will be completed by the forensic pathologist to accompany the body to the funeral home. Frequently, additional testing or information will need to be provided in order for a final determination of cause and manner of death to be made. In such circumstances, an initial death certificate reflecting the pending status of the case will be issued, followed by a delayed certification of death indicating the final results of the autopsy and death investigation. Performance of a forensic autopsy will not hinder or delay a funeral, including open-casket services. After the autopsy and all ancillary testing have been concluded, a formal autopsy report will be issued. This process usually takes several weeks to complete. A certified copy of the autopsy report can be provided after a written request with payment has been received. This can also be requested and paid for by clicking here. Although the written autopsy report is considered a matter of public record, photographs taken during the autopsy and death scene investigation are not, and will not be released without an order issued by the court.

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MEDICAL EXAMINER SERVICES

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Cases that are within Medical Examiner Jurisdiction include “deaths under suspicious, unnatural, or unusual circumstances” (TCA 38-7-108). This includes deaths caused by any type of violence or trauma, suddenly when in apparent health, deaths of infants and children, deaths related to employment or job injuries, persons in jail or custody, deaths believed to represent a public health threat, or deaths caused by abuse or neglect. This means that if any discrete injury, drug use, or any other external event contributes in any way to death, the case should be reported to the Medical Examiner’s Office. The following list represents the most common types of deaths that will fall under medical examiner jurisdiction: Any type of homicidal violence (gunshot wounds, stab wounds, blunt trauma from beating, strangulation, etc.)

• Suicidal injuries (gunshot wounds, overdose, etc.)
• Blunt trauma from motor vehicle collisions
• Overdose from prescription medication or illicit drugs, no matter the duration of hospitalization
• Trauma from falls (including subdural hematomas and hip fractures)
• Sudden death in persons with no known medical history
• Sudden death in children or infants, even those with known medical history
• Any indication or suspicion of neglect or abuse
• Any person in custody or incarcerated
• Any of the above types, regardless of the time elapsed between the traumatic event and death (e.g. sepsis from decubitus ulcers due to quadriplegia from gunshot wound 15 years prior)

Anyone may report any death to the Medical Examiner’s Office by calling 615-743-1800 or by paging 1-800-216-0107. We generally make a determination of jurisdiction at the time the death is reported; however, some complex or unusual cases may require more time (perhaps several hours) before a determination of Medical Examiner jurisdiction is made. The reporting individual will need to have the following minimum information about the deceased: Basic demographic information, reason for admission to hospital or emergency facility, length of hospital stay, any known medical history, and any known history of or suspicion of trauma, overdose, suicide, falls, or foul play. Medical examiner investigators may request additional or more detailed information.

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PRIVATE & HOSPITAL AUTOPSIES

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Private or family requested autopsies may be obtained for decedents who would not otherwise require autopsy by statute. Although families may request an autopsy for many reasons, some of the most common circumstances include:

• To better understand the natural disease or disease process that caused death
• To provide information about possible inherited or genetic diseases, allowing other family members to seek testing and/or treatment
• To investigate possible medical treatment complications
• To assist in civil proceedings regarding the death

Private autopsies may only be ordered by the legal next-of-kin or by other individual with the appropriate legal authority to do so. According to family request, the autopsy examination may include complete examination of all organ systems or may be limited to a specific area of concern. A completed and signed authorization for autopsy with full payment must be received prior to the remains being transported to our facility for examination. Ancillary studies including toxicology and histology may be performed at the discretion of the consulting forensic pathologist. A final autopsy report typically takes several weeks to complete. All autopsies are performed by experienced forensic pathologists who are either board certified or board eligible by the American Board of Pathology. Autopsy will not preclude viewing of decedent’s remains after preparation by a funeral director. In most circumstances, the autopsy procedure can be completed and the decedent released to the funeral home for final disposition within 24 hours. Hospital Autopsies Family members and/or hospital staff may feel postmortem examination is necessary when a patient dies while in the care of a hospital or other medical facility. If the hospital does not offer autopsy services, or if the family desires the examination be performed by a third party, Forensic Medical provides professional autopsy services by experienced forensic pathologists. Hospital ordered autopsies require the following: Autopsy authorization signed by the legal next-of-kin, hospital administrator, and a witness. The family’s desire regarding extent of the examination (limited to a specific anatomic area of interest or complete postmortem examination.) The consulting forensic pathologist must have access to the decedent’s medical records in order to render accurate and fully informed opinions regarding the cause of death and any potential contributory factors. The treating physician will typically contact the forensic pathologist before the autopsy with specific questions or concerns that he or the family would like addressed by the examination. The pathologist will provide a written preliminary report of the gross diagnoses within 48 hours after the autopsy. Forensic Medical abides by all Joint Commission on Accreditation of Healthcare Organization standards established for hospital autopsies. The autopsy report, when complete, becomes part of the decedent’s medical record at the facility where the patient died, and the family may obtain a copy of the autopsy report from that facility or from the primary care provider. Forensic Medical typically does not provide a copy of the autopsy report directly to the family. The hospital, by signing the authorization for autopsy, accepts financial responsibility for the autopsy fee. In general, the autopsy examination is completed within 24 hours after the body arrives where the examination is to occur.

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EXPERT CONSULTATION TESTIMONY

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• Exhumation autopsy

• 2nd autopsy
• Expert witness

Forensic Medical is staffed by physicians who are certified by the American Board of Pathology in both Anatomic and Forensic Pathology and who hold faculty appointments at large teaching hospitals in Nashville, Tennessee. In addition to performing more than 6000 postmortem examinations each year, including medicolegal, private, and hospital-requested autopsies, the Medical Examiners of Forensic Medical Management Services, PLC also routinely provide expert medicolegal consultation services. These may concern a wide array of cases, including performing second autopsies and exhumation autopsies, evaluating non-lethal injuries, and reviewing medical records and autopsy reports prepared by other physicians.

Requests for expert witness consultation services may be accepted from other physicians, family members of the deceased, attorneys, insurance companies, and law enforcement agencies from across the country. Consultation services are tailored to each situation, and as such may range from making a simple explanatory phone call to offering complex expert witness testimony in both civil and criminal cases.

For more information, contact us at contact@forensicmed.com.

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