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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 the Public

Main Office - Nashville

Office of the State Chief Medical Examiner
Andrew Johnson Tower - 7th Floor
710 James Robertson Parkway
Nashville, TN 37243
Telephone: 844-860-4511
Fax: 615-401-2532
Health.OSCME@tn.gov

Satellite Office - Johnson City

Office of the State Chief Medical Examiner
William L. Jenkins Forensic Center
Box 70431
Johnson City, TN 37614
Telephone: 423-439-8409
Fax: 423-439-8810



What is a county medical examiner?

Each of the 95 counties in Tennessee has a county medical examiner. The county medical examiner is a medical doctor who is responsible for the investigation of deaths which occur suddenly and unexpectedly in people in otherwise good health.

The county medical examiner also investigates deaths due or related to any type of trauma, no matter how long the interval between the time of injury and death, possible or confirmed drug overdoses, suspicious or unnatural deaths, and deaths of incarcerated individuals or people in state custody.



What is a county medical examiner investigator?

Many county medical examiners have medicolegal death investigators who respond to death scenes and perform investigations. Medicolegal death investigators must be a licensed emergency medical technician, paramedic, registered nurse, physician’s assistant, or a person registered by the American Board of Medicolegal Death Investigators.


What is a forensic pathologist?

A forensic pathologist is a medical doctor with specialized training in pathology and determining cause and manner of death. Forensic pathologists direct death investigations and perform autopsies.


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.


Where are forensic autopsies performed in Tennessee?

All autopsies ordered by the county or state medical examiner or by a district attorney must be performed in one of the five regional forensic centers in the state. The regional forensic centers are staffed by board-certified forensic pathologists and must be accredited by the National Association of Medical Examiners (NAME).

There are five forensic centers in the state of Tennessee with NAME accreditation: William L. Jenkins Forensic Center (Johnson City); Knox Regional Forensic Center (Knoxville); Hamilton County Forensic Center (Chattanooga); Forensic Medical Management Services (Nashville); and West Tennessee Regional Forensic Center (Memphis).


What is cause of death?

The cause of death is the anatomic or physiologic abnormality which set into motion the chain of events leading to death.


What is manner of death?

The manner of death describes the circumstances under which death occurred. In Tennessee, deaths are classified as follows:

 

Natural: death is due exclusively to natural causes; no external factors caused or contributed to death in any way;

Accident: death is due to an unintentional injury or poisoning;

Homicide: death at the hands of other(s); or

Suicide: death by one’s own hand.

A fifth classification of manner of death is “Could not be determined”,  is used when there is inadequate information to choose a manner of death, or when there are two or more equally compelling manners of death. Any death due to non-natural causes and deaths of people with no known natural disease process to account for death must be reported to the county medical examiner of the county in which the death occurred.


If someone’s death appears to be natural, why might the medical examiner be involved?

The medical examiner may take jurisdiction over an apparently natural death if:

The death was unexpected and no medical cause can be determined;

The decedent was not under the care of a physician for any disease which could reasonably be expected to cause death;

The death might represent a public health hazard; or

The body cannot be identified by conventional methods.


What kind of examination of the body does the medical examiner perform?

In some of the cases investigated and accepted, the medical examiner evaluates the medical history of the decedent and performs an external physical examination. The circumstances of the death, the external examination, and ancillary testing may be used to determine the cause and manner of death. The remaining cases require a medicolegal autopsy.


What is a medicolegal autopsy? Why is an autopsy performed?

An autopsy is the external and internal examination of a deceased person to determine the extent of injury or disease process, and to determine cause and manner of death. In most cases, the autopsy will not delay funeral planning or disfigure the body.


Who is authorized to order a forensic autopsy?

The county medical examiner or his or her investigator(s) when designated to do so by the county medical examiner, deputies, district attorneys, and the state chief medical examiner are authorized to order an autopsy.  The county medical examiner or death investigator will use information obtained from family members or friends of the deceased, law enforcement, and the death scene to determine whether the death falls under medical examiner jurisdiction. If the county medical examiner or death investigator concludes that an autopsy is warranted in order to determine cause and manner of death, the body will be transported to one of the five regional forensic centers for an examination by a forensic pathologist.


What happens if the family objects to an autopsy?

The medical examiner has the authority under Tennessee law to order an autopsy.  If the family has objections to an autopsy, the legal next-of-kin may discuss them with the County Medical Examiner or Regional Forensic Center where the body has been taken.


Who is considered the next-of-kin?

If a person is married at the time of their death, their spouse is the legal next-of-kin. This is true even if the spouse has been estranged. If there is no spouse, the order of succession is: adult child, parent, adult siblings, adult grandchildren, and grandparents.


Will the family be billed for a forensic autopsy?

No. Forensic autopsies are paid for by the county ordering the investigation and the state.


How do I get a copy of the autopsy report?

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 in which the autopsy was performed.

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 additional investigative or laboratory information may extend this time frame.


Who should the next-of-kin contact if they have questions about the autopsy or autopsy report?

Questions should be referred to the forensic pathologist who performed the autopsy.


How do I get a copy of the death certificate?

Death certificates can be requested through the Tennessee Office of Vital Records at (615) 741-1763 or at https://www.tn.gov/health/health-program-areas/vital-records.html. The office of vital records or health department in the county in which the death occurred can also issue a certified death certificate. Neither the Regional Forensic Centers nor the Office of the State Chief Medical Examiner issues death certificates.


If the next-of-kin has questions the manner of death determination, what can they do?

If the next-of-kin has a concern about the manner of death determination, they should contact the medical examiner who certified the death.  If the manner of death is suicide and the next-of-kin disagrees with the determination, they have specific options per new legislation passed in 2017.  This change to the Tennessee Code Annotated can be found under the “2017 Legislative Updates” tab on the left hand side of the main page.  A form to begin this process can be accessed here.


If we have no money for burial to whom can we turn for assistance?

If a body is unclaimed, the expense of burial is to be paid from the sale of property found with the body, or, if there is none, from the county treasury. Honorably discharged veterans may be interred by the Department of Veterans Services.


Are we required to use a funeral home or have a body embalmed?

Burials in Tennessee do not require the use of a funeral home or embalming. If the body is to be buried out-of-state, laws and regulations will differ. Prior to burying a body on private property the county or city zoning authority should be contacted to ensure compliance with local zoning regulations.


Why is the Office of the Chief Medical Examiner a part of the Department of Health, and not a part of the Department of Safety and Homeland Security, or the Tennessee Bureau of Investigation?

In Tennessee, the medical examiner system is organized under the authority of the Commissioner of the Department of Health.  The reason the Office of the Chief Medical Examiner is organized under the Department of Health is because suspicious, unusual, or unnatural deaths may be the first sign or symptom of a public health threat that could affect the public welfare.  In addition, a separation between the medical examiner system from law enforcement or the judicial system ensures an independent medical investigation free of bias.


If the next-of-kin has a concern about the manner of death determination...

A form to begin this process can be accessed here.


Why is the medical examiner involved if I want my loved one cremated?

By law, approval by the medical examiner shall be required for all deaths occurring in the county for which cremation permits are requested, regardless of where the cremation will occur.