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ADVISORY CONCERNING ELECTRONIC CIGARETTES, THE PRACTICE OF “VAPING,” “JUULING” AND USE OF OTHER ELECTRONIC NICOTINE DELIVERY SYSTEMS OR ENDS

Resources for Clinicians and Law Enforcement

What deaths must be reported to the county medical examiner?

Tenn. Code Ann. § 38-7-108 lists the following types of death which must be reported to and investigated by the county medical examiner of the county in which the death occurred:

Deaths due to violence or trauma of any type;

Deaths occurring suddenly in a person in apparent good health;

Sudden unexpected death of infants and children;

Deaths of prisoners or persons in state custody;

Deaths on the job or related to employment;

Deaths believed to represent a threat to public health;

Deaths where neglect or abuse of extended care residents are suspected or confirmed;

Deaths where the identity of the person is unknown or unclear;

Deaths in any suspicious/unusual/unnatural manner or found dead; and

Deaths in which the body is to be cremated.

 

Some examples of such types of deaths include:

 

Deaths due to vehicular crashes or falls;

Deaths due or related to acute overdose of legal or illegal drugs and/or alcohol;

Deaths of adults lacking a medical diagnosis which could reasonably result in death;

Deaths due to drowning;

Deaths due to thermal or chemical burns, or smoke inhalation;

Death by disease, injury, or toxicity resulting from employment

Deaths of prisoners or related to police intervention;

Deaths due to hypo– or hyperthermia;

Death of a fetus greater than 20 weeks gestation or weighing at least 350 grams resulting from maternal trauma or acute drug use;

When anatomic material suspected of being part of human body is discovered; and

Any death in which there is doubt as to whether the county medical examiner should be notified.

 

Deaths due or related to any of the above or any other non-natural event, regardless of the time elapsed between the injury and death. If death is related in any way to a single identifiable injury or poisoning event, the period of time between the non-natural event and the death is irrelevant. Examples of delayed deaths include:

* An elderly person who dies months after becoming bedridden from a fall

* A person who dies of bladder infection due to paralysis following a car crash years before

* A person who develops pneumonia as the result of lack of oxygen to the brain after choking on food.


Who should report these deaths?

According to TN Code Annotated 38-7-108(a) Any physician, undertaker, law enforcement officer, or other person having knowledge of the death a any person from violence or trauma of any type, suddenly when in apparent health, sudden unexpected death of infants and children, deaths of prisoners or person in state custody, deaths on the job or related to employment, deaths believed to represent a threat to public health, deaths where neglect or abuse of extended care residents are suspected or confirmed, deaths where the identity of the person is unknown or unclear, deaths in any suspicious/unusual/unnatural manner, found death, or where the body is to be cremated, shall immediately notify the county medical examiner or the district attorney general, the local police or the county sheriff, who in turn shall notify the county medical examiner. The notification shall be directed to the county medical examiner in the county in which the death occurred.


What if a body goes unclaimed in my hospital or healthcare facility?

If the body is identified, but the next-of-kin dose not assume responsibility to final disposition of the body, the facility may notify the state chief medical examiner after the body has been held for 96 hours after death. If the state chief medical examiner declines to direct the final disposition of the body within 72 hours of notification, the county medical examiner may have the body cremated.

If the identity of the person is unknown or cannot be ascertained, the county medical examiner should be notified.


If a person is referred to a regional forensic center, will an autopsy automatically be performed?

No. In some cases, cause and manner of death can be determined using an external examination of the body, x-rays, toxicology or other laboratory testing, and/or review of the medical history and circumstances surrounding the death.

 


In what circumstances is a treating physician obligated to sign a death certificate?

Tennessee law dictates that the “physician in charge of the patient’s care for the illness that resulted in death” complete and sign the death certificate, if the physician had treated the deceased within the four months prior to death. This holds true even if that physician was not physically present at the time of death.  Supervising physicians of nurse practitioners and physicians’ assistants are responsible for the death certificates of patients treated by these extenders.

Resources regarding medical certification of death are available at:

https://www.cdc.gov/nchs/nvss/writing_cod_statements.htm

https://netforum.avectra.com/public/temp/ClientImages/NAME/76bc59b3-9464-4ca8-8b2a-1f0624b22f99.pdf


Will an autopsy report automatically be sent to the  office or hospital of the treating physician? Who should the medical provider contact if they wish to inquire about an autopsy performed on one of their patients?

Copies of the autopsy report are available through The Office of the State Chief Medical Examiner at (423) 439-8403 or at https://www.tn.gov/health/health-program-areas/oscme.html. Autopsy reports are also available from the regional forensic center  where the autopsy was performed.  Autopsy reports are not automatically sent to treating facilities or physicians.

Autopsy reports are considered a matter of public record in Tennessee. If questions arise about information in the autopsy report, the forensic pathologist who performed the autopsy at the Regional Forensic Center should be contacted. 

Most autopsy reports are completed within 10 to 12 weeks, although obtaining and interpreting additional investigative or laboratory information may extend this time frame.  In some cases the forensic pathologist will have preliminary results within a day or two after the autopsy is performed.


What happens if a person dies in a medical institution and the family refuses to arrange for disposition of the body?

An undertaker may be summoned to take possession of a body If the next-of-kin or other responsible party refuse to do so within eight hours of notification of death. Tenn. Code Ann. § 68-4-101


How is a death scene investigated?

Death scene investigation is a collaborative process between law enforcement and the medical examiner and/or medical examiner investigator. A body falling under medical examiner jurisdiction should not be moved or disturbed without authorization of the county medical examiner.  The death scene as a whole, however, falls under the jurisdiction of the investigative law enforcement agency.

 

The National Institute of Justice publication Death Scene Investigation: A Guide for the scene investigator may be accessed at:

https://www.ncjrs.gov/pdffiles1/nij/234457.pdf