Medical Examiner District 23

A death certificate must be completed by a doctor for all deaths before final disposition of the deceased can occur. When the person has a family doctor and dies from natural causes (i.e. the result of a disease), the doctor can complete the death certificate. But, if the person is not under the care of a physician or the death appears to be suspicious or unusual (i.e. the result of injury), the medical examiner must be notified to begin an investigation and make sure the death certificate is completed

State statute dictates the types of cases in which the medical examiner will become involved. The specific statute reads as follows:406.11 Examinations, investigations, and autopsies. In any of the following circumstances involving the death of a human being, the medical examiner of the district in which the death occurred or the body was found shall determine the cause of death and shall make or have performed such examinations, investigations, and autopsies as he shall deem necessary or as shall be requested by the state attorney when any person dies in the state:

• Of criminal violence. By accident. By suicide.
• Suddenly, when in apparent good health.
• Unattended by a practicing physician or other recognized practitioner.
• In any prison or penal institution.
• In police custody.
• In any suspicious or unusual circumstance.
• By criminal abortion.
• By poison.
• By disease constituting a threat to public health.
• By disease, injury, or toxic agent resulting from employment.
• When a dead body is brought into the state without proper medical certification.
• When a body is to be cremated, dissected, or buried at sea.

The district medical examiner shall have the authority in any case coming under any of the above categories to perform, or have performed, whatever autopsies or laboratory examinations he deems necessary in the public interest.

In many cases when there is a death, at least two jurisdictions are involved. The police or law enforcement agencies involved have jurisdiction over the scene and its associated physical evidence. The medical examiner is responsible for the body of the deceased and any physical evidence/property in direct contact with the body. With the exception of life-saving efforts that may be attempted by fire / rescue and law enforcement officials, the body may not be touched or moved by anyone (including law enforcement officials) without permission of the medical examiner or his representative. Therefore, forensic death investigators from the Medical Examiner's Office respond to most non-natural death scenes before the decedent is removed from the scene. Forensic Investigators will document the pertinent details and collect information about the circumstances of death. The decedent will then be transported to the Medical Examiner's Office, where he / she will be placed in refrigeration until examination.

The forensic autopsy is an internal and external examination of the body after death using surgical techniques to determine the presence of an injury and / or to identify any disease that may have caused or contributed to the death. It is performed by a forensic pathologist, a medical doctor specially trained in this type of procedure who is able to recognize diseases or patterns of injury, collect evidence and investigate the circumstances surrounding the death. This examination may be comprehensive or may be limited to a particular organ or system.

The autopsy room is regarded as a special place for gathering medical knowledge. An air of dignity and respect for the decedent is maintained at all times. Small samples of each organ are taken for microscopic examination to look for disease such as malignancy or infection. Specimens may be taken as evidence in criminal related deaths. Other tests that may be performed include testing for drugs, chemicals, or toxic substances. The final report may take many weeks to prepare due to detailed studies that may be performed. If this is the case, the death certificate will be issued with 'pending' as the cause of death while the medical examiner awaits the results of these tests.

The autopsy report becomes a permanent part of the decedent's medical record.

The completed report, unless withheld pending criminal investigation, is available to the family and the findings may be discussed at length with your physician or with the pathologist.

The performance of an autopsy should not in any way affect a funeral or viewing of the body. Funeral directors and pathologists have been working together for many years so that the body can be readily embalmed and prepared for the service.After the examination, the body can be released to the funeral home of the family's choice regardless of the pending status of the cause or manner of death. The family is required to sign a release giving the funeral home permission topick-up the remains from the medical examiner's office.

Often people have loved ones who pass away, and they do not understand why an autopsy wasn't performed. The primary reason is that it did not fall under the medical examiner's jurisdiction, meaning that it was an apparent natural death with an attending physician to sign the death certificate. Sometimes, however, despite this, family members feel that a death is suspicious in nature and an autopsy should have been done. For such people, bear in mind that the death was thoroughly investigated by local law enforcement, or the medical examiner investigator and no suspicion was found. All of the circumstances related to death indicate that the death was indeed natural and therefore, falls upon the attending physician to sign the death certificate. Keep in mind that hearsay or "gut feelings" do not make evidence of suspicion. There needs to be some physical or sustentative evidence to support suspicious claims. Furthermore, the Medical Examiner's Office will not become involved in a non-Medical Examiner case unless Law Enforcement or the State Attorney's Office agrees that it should. If you would like an autopsy to be performed on your loved one and the Medical Examiner's Office does not do one, the legal next of kin has the right to hire a private pathologist to perform any examinations the family wishes.

The Medical Examiner has the discretion to perform whatever examinations he deems necessary on a case by case basis. On deaths by apparent natural causes without an attending physician or traumatic deaths where the decedent has been hospitalized for a certain period of time, a forensic autopsy is not necessary. In such cases, medical records from the hospital or doctor's office will be used in conjunction with an external examination of the deceased todetermine cause and manner of death.

Copies of autopsy reports are provided upon request. Autopsy reports can be requested by written letter which must include the name of the decedent and the date of death. Attach a self-addressed, stamped envelope to: The Office of the Medical Examiner, 4501 Avenue A, St. Augustine, Florida 32095

Please Note: Autopsy reports for homicides cannot be provided through our office. These records may be obtainablethrough the State Attorney's Office after the criminal investigation has concluded.

Contact your funeral home or contact the Office of Vital Statistics either at the St. Johns County Vital Statistic Office (or county in which the death occurred) or at the State Vital Statistic Office

Personnel from the medical examiner's office are not permitted to recommend a funeral home to families. Funeral homes are listed in the phone book. Contacting other family members and friends can usually result in some guidance for the family

Each county has a social services indigent burial services for those who are unable to afford funeral arrangements. Be prepared to provide financial, insurance, etc. information when appealing to this service. You may contact them:

• St. Johns County Social Services (904) 209-6140
• Putnam County Social Services (386) 329-0218
• Flagler County Social Services (386) 586-2324

Other Important Phone Numbers

• St. Johns County (904) 209-3250 (ext. 1001)
• Putnam County (386) 326-3200
• Flagler County (386) 437-7350
• State of Florida (904) 359-6900
• Social Security Administration 800-772-1213