For Primary or Attending Physicians/Funeral Directors
Physician’s Responsibility in Death Certification
Primary or attending physicians can certify only non-Medical Examiner, natural death cases. According to Florida Statute 382.008(3), as of July 1, 2013, all records on natural cases must be filed by the decedent’s primary or attending physician. This is the physician who treated the decedent through examination, medical advice or medication during the 12 months preceding the date of death.
The primary or attending physician shall list the cause of death in the following manner:
The Cause of Death is the disease which initiates the lethal chain of events, however brief or prolonged. In law this is the “proximate cause.” For vital statistics ICD-10 coding purposes, the cause of death is what should be coded. The mechanism of death must be considered only as a fatal complication of the underlying disease. In other words, the Mechanism of Death is the physiologic disturbance that is incompatible with life which was the result of the underlying disease. Examples are “bronchopneumonia,” “hemorrhage,” “embolism,” “cardiorespiratory arrest” or “renal failure,” etc. It must be due to an underlying cause, which must be listed on the death certificate.
Physician Responsibility for Death Reporting
Deaths falling within the categories outlined in Florida Statute 406.11 must be reported to the Medical Examiner. In deciding whether or not a case falls within the categories outlined in Florida Statute 406.11, one must also consider the background (including medical history) of the deceased, the age of the deceased, words to be used in the cause of death, the length of treatment by the doctor, the potential indication of trauma or injury, and finally, what will happen to the remains of the deceased after the funeral, i.e. disposition of the body. In each of these considerations there may be a reason that requires you to report the death.
Words:
The following is a list of words used by doctors which should signal that the death might come under the jurisdiction of the Medical Examiner. Some common mechanisms of death have been capitalized and made bold for emphasis.
- Asbestosis
- Aspiration Not Specified
- Cardiopulmonary Arrest, Not Specified
- Cervical or Head Trauma
- Coma, Not Specified
- Encephalitis
- Epidural
- Gangrene
- Hemothorax
- Intoxication or Overdose
- Injury, Chemical or Physical
- Mesothelioma Not Specified
- Paraplegia/Quadriplegia
- Peritonitis Not Specified
- Pulmonary Embolus
- Seizure
- Septicemia or Sepsis
- Shock, Not Specified
- Silicosis
- Subdural
- Sunstroke
- Tetanus
- Subarachnoid Hemorrhage
- Fracture
- Intracranial Hemorrhage
- Bronchopneumonia
- Hepatic or Renal Failure
Other terms which could raise a suspicion of trauma, accident, exposure to noxious chemicals or fumes, or disease resulting from occupational exposure require that the death be reported to the Medical Examiner.
The 24-Hour Rule: No such rule exists in the State of Florida. A person who dies from known heart disease within 24-hours of their hospital admission is generally not a Medical Examiner case. Conversely, if a trauma patient survives more than 24 hours in a hospital, it is a Medical Examiner case and must be reported. A death occurring after prolonged hospitalization will continue to be a Medical Examiner case if the initial admission was due to injury, criminal action, accident, drug overdose, drowning or other unnatural processes.
Fracture Cases: Falls resulting in ultimately fatal hip fractures must be reported to the Medical Examiner. Since the vast majority of these cases have underlying disease processes which precipitate a fracture of an osteoporotic hip, Medical Examiner involvement is generally one of recording the appropriate data. Fractures at other sites which may have contributed to the death of an individual require more direct investigation by the Medical Examiner Department in order to assess civil or criminal culpability.
Occupation Related Deaths: Besides injuries, deaths resulting from industrial hazards must be reported. These would include such things as benzene or radiation-induced leukemia, pneumoconiosis (asbestosis) and solvent-induced hepatic failure.
Public Health Interest: Any death in which there may be a threat to public health comes under Medical Examiner jurisdiction. This is generally restricted to deaths where an infectious disease of a highly contagious nature is suspected but NOT YET confirmed.
Child Abuse or Abuse of the Elderly: The State Attorney, the Department of Children and Families, and the Medical Examiner are concerned about alleged child and elder abuse. Such deaths must be reported to the Medical Examiner.
Inmate Deaths: All inmate deaths must be reported to and be investigated by the Medical Examiner by State Statute, regardless of the suspected cause of death.
WHEN IN DOUBT: When in doubt, please call the Medical Examiner Office.