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Communications with the Coroner
by: LAWRENCE M. SHUER
Those of us who work here occasionally have a patient who expires during hospitalization. Sometimes there is a question as to when it is necessary to contact the coroner to report the death. In fact, in the last year or so we have had two instances in which the coroner felt we were derelict in notifying the coroner's office. For this reason I believe it is important to review the criteria with you so that you are familiar with the circumstances under which a call to the coroner is required.
The coroner is a county peace officer who acts under the authority of California law. Certain specific laws define the coroner's powers and give him/her the right and duty to investigate certain classes of deaths.
Failure to notify the coroner's office in such instances is a misdemeanor. If you aren't sure whether a death is reportable, please call the coroner's office to receive direction. The coroner will gladly inform you whether an inquest is required. If it isn't, all you need to do is document in the chart that the coroner has released the case.
The situations in which deaths should be reported to the coroner are as follows:
1. Known or suspected homicide.
2. Known or suspected suicide.
3. Accident (whether the primary cause or only contributory, and whether the accident occurred immediately or at some remote time).
4. Injury (whether the primary cause or only contributory, and whether the injury occurred immediately or at some remote time).
5. Grounds to suspect that the death was caused in any degree by the criminal act of another.
6. No physician in attendance (no history of medical attendance).
7. The deceased was not attended by a physician in the 20 days prior to death.
8. The physician is unable to state the cause of death. (The physician must be genuinely unable, not merely unwilling.)
9. Poisoning (food, chemical, drug, therapeutic agents).
10. All deaths due to occupational disease or injury.
11. All deaths in operating rooms or following surgery or a major medical procedure.
12. All deaths in which a patient has not fully recovered from an anesthetic, whether in surgery, recovery room or elsewhere.
13. All solitary deaths (unattended by physician, family member or any other responsible person in the period preceding death).
14. All deaths in which the patient is comatose throughout the period of physician attendance, whether at home or in hospital.
15. All deaths of unidentified persons.
16. All deaths in which the suspected cause is Sudden Infant Death Syndrome.
17. All deaths in prison, jails or of persons under the control of a law enforcement agency.
18. All deaths of patients in state mental hospitals.
19. All deaths in which there is no known next of kin.
20. All deaths caused by known or suspected contagious diseases constituting a public health hazard, including AIDS.
21. All deaths due to acute alcoholism or drug addiction.
A physician usually must sign the death certificate. If the deceased does not have a doctor in attendance who can determine the cause of death, the responsibility for that determination and filling out the certificate falls upon the coroner. If the physician last in attendance is not and will not be available within a reasonable period of time to sign the death certificate, he/she may designate an assistant or associate to sign the certificate in his/her absence, provided that the person signing the certificate has access to the attending's medical record. The coroner has the ultimate authority as to whether an autopsy is required.
The coroner will usually release the body if the cause of death is quite apparent and none of the above criteria fit. By law, the medical and health section data and the physician's certification must be filled out within 15 hours of the death or by the coroner within three days after examination of the body.
Stanford Hospital & Clinics has a specific section in its Administrative Manual that deals with the "Death of Patient." A copy of the manual is available on all nursing units and can be a handy reference. The section details the protocol for dealing with the patient after death and contains instructions for contacting the coroner, including the telephone number.
If the coroner feels an inquest is not required, it is our practice to request that an autopsy be performed here by our Pathology Department. We are a teaching hospital and care for patients with very complex disease processes. We believe we have much to learn by examining patients who have expired under our care and we hope to use this knowledge to benefit future patients. The Administrative Manual is quite helpful in describing the process of obtaining an autopsy here.
I also wish to remind you to ask families if they would consent to donate tissue from the deceased to help with the medical care of others. While organ donations are valuable gifts, the tissue banks are quite in need of bone, skin, corneas, etc. (See my column "The Gift of Life" Volume 22, #8 Aug/Sept 1998, http://www-med.stanford.edu/shs/update/archives/aug98/shuer.html.)
I hope that it is infrequent in your practice that you face situations requiring this knowledge. However, because of the concerns expressed by the coroner's office, I felt compelled to refresh your knowledge of this issue.
Please contact me at should you have questions regarding these matters.
