Certification of Death (Scotland) Act 2011 Implementation April 2015.
Death Certification - FOMA
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{ Death Certification Sara Zydowicz, DO Associate Medical Examiner District 9 Medical Examiner’s Office
Transcript of Death Certification - FOMA
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Death Certification Sara Zydowicz, DO Associate Medical Examiner District 9 Medical Examiner’s Office
Death certification
A final service to your patient Legal establishment of death
It provides complete information for the family and others who use the death certificate
Benefits may depend on the D.C.
A service to your community
The quality of our mortality databases depends on it
An accurate death certificate is of great potential use for research, statistics, public health decision making and policy setting, and law-making
Why you have to certify
FS 382.008 A death certificate with a
medical cause of death shall be filed and made available to a funeral home director within 72 hours upon receipt of a death certificate from a funeral home
Specifically, why me? “…a physician who treated the
decedent through examination, medical advice, or medication during the 12 months preceding the date of death.” Includes ED physicians Includes cross covering
physicians Includes consulting
physicians
“A death certificate isn’t like a degree from USC… it actually means something” –John Oliver
Yes
Florida Administrative code chapter 62B8-8.001(2)(g)
Administrative fines from $1,000-10,000
FS 382.026(8)
Misdemeanor criminal charge
Fine of up to $1000 per day of delinquency
Families may file complaints with State Medical Board
Are there consequences for not completing a death certificate?
Autopsy Service death certificate review
12 month period
590 certificates reviewed
88 amended
41 missing COD
7 had inaccurate COD
Medicolegal Death Investigation System *Reportable Deaths
Responsible for conducting death investigations
Certifying Cause of Death (COD) and Manner of Death (MOD) › Unnatural and unexplained
deaths › Homicides, suicides, drug-
related, unintentional injuries Approximately 20% of deaths in
the US each year are investigated Broad societal importance for
criminal justice system and public health › Evidence to convict guilty or
protect the innocent › Civil litigation › Public health and research
COD and
MOD
Scene and circumstances
Autopsy
Ancillary Studies
Article 20 of Articles of Eyre 1194 A.D.
“Custos Placitorum Coronoas”
“Keepers of the pleas of the crown”
‘coroner’ or ‘crowner’
Coroner’s duty was to determine MOD
Financially driven
Certain MOD contributed to the King’s coffers
Power to order inquests
This continued for about 600 years
Mind your Manners: History of Death Certification and MOD
Establishing the Medical Examiner
• Massachusetts (1877), New York City (1915)
• Appointed by agency
• Determine cause and manner of death
– Based on scientific rather than lay determination
– Skill, training, efficiency and equanimity
• Law required a physician, pathologist
• Medical examiner had authority to perform autopsy if necessary
*Provides for proper training and proper jurisdiction
Examinations, investigations, and autopsies.—(1) 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, for that purpose, make or have performed such examinations, investigations, and autopsies as he or
she shall deem necessary or as shall be requested by the state attorney:
(a) When any person dies in the state:
1. Of criminal violence.
2. By accident.
3. By suicide.
4. Suddenly, when in apparent good health.
5. Unattended by a practicing physician or other recognized practitioner.
6. In any prison or penal institution.
7. In police custody.
8. In any suspicious or unusual circumstance.
9. By criminal abortion.
10. By poison.
11. By disease constituting a threat to public health.
12. By disease, injury, or toxic agent resulting from employment.
(b) When a dead body is brought into the state without proper medical certification.
(c) When a body is to be cremated, dissected, or buried at sea.
(2)(a) The district medical examiner shall have the authority in any case coming under subsection (1) to perform, or
have performed, whatever autopsies or laboratory examinations he or she deems necessary and in the public interest to
determine the identification of or cause or manner of death of the deceased or to obtain evidence necessary for forensic
examination.
(b) The Medical Examiners Commission shall adopt rules, pursuant to chapter 120, providing for the notification of the
next of kin that an investigation by the medical examiner’s office is being conducted. A medical examiner may not retain
or furnish any body part of the deceased for research or any other purpose which is not in conjunction with a
determination of the identification of or cause or manner of death of the deceased or the presence of disease or which is
not otherwise authorized by this chapter, part V of chapter 765, or chapter 873, without notification of and approval by
the next of kin.
(3) The Medical Examiners Commission may adopt rules incorporating by reference parameters or guidelines of
practice or standards of conduct relating to examinations, investigations, or autopsies performed by medical examiners.
History.—s. 6, ch. 70-232; s. 26, ch. 73-334; s. 1, ch. 77-174; s. 1, ch. 87-166; s. 29, ch. 97-103; s. 3, ch. 98-253; s. 48,
ch. 2006-1.
FS 406.11
District 9 • Orange and Osceola
• Population of 1,523,771
• NOT including the 50 million tourists annually
• Covers 2,229 square miles
• 2018:
• 2083 cases
• ~1500 post mortem examinations
• Budget $5.6 million
• Per capita $2.82 tax contribution
• Generate over $290k in cremation approvals
District 9
First ‘green’ MEO in the
country
24/7
7 full time Forensic
Pathologists
Chief: Dr. Stephany
Deputy Chief: Dr. Utz
Associate: Drs Hansen, Giles,
Norford, Park, Zydowicz
7 Autopsy technicians
11-12 Investigators
11 Administrative staff
Neuropathologist
Forensic anthropologist
Forensic odontologist
Forensic toxicology
Drug surveillance
All MEO in Florida complete standard report for Medical Examiner’s Commission (MEC)
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Florida Drug Related Outcomes Surveillance and Tracking System (FROST)
Fentanyl analogues A.k.a. Frankenfentanyl
* 31 deaths in Orange county at a rate of 2.31 per 100k
* 75 death in Orange county at a rate of 5.56 per 100k
DEPARTMENT OF JUSTICE Drug Enforcement Administration 21 CFR Part 1308 [Docket No. DEA-476] Schedules of Controlled Substances: Temporary Placement of Fentanyl-Related Substances in Schedule I AGENCY: Drug Enforcement Administration, Department of Justice. ACTION: Temporary amendment; temporary scheduling order
SUMMARY: The Administrator of the Drug Enforcement Administration is issuing this temporary scheduling order to schedule fentanyl-related substances that are not currently listed in any schedule of the Controlled Substances Act (CSA) and their isomers, esters, ethers, salts and salts of isomers, esters, and ethers in schedule I. This action is based on a finding by the Administrator that the placement of these synthetic opioids in schedule I is necessary to avoid an imminent hazard to the public safety. As a result of this order, the regulatory controls and administrative, civil, and criminal sanctions applicable to schedule I controlled substances will be imposed on persons who handle (manufacture, distribute, reverse distribute, import, export, engage in research, conduct instructional activities or chemical analysis, or possess), or propose to handle fentanyl-related substances. DATES: This temporary scheduling order is effective February 6, 2018, until February 6, 2020. If this order is extended or made permanent, the DEA will publish a document in the Federal Register.
Emerging Technologies
Nicole Montalvo Reported missing 10/22/2019
The Todt family Discovered 1/13/2020
What happens when a body can’t be identified?
Nationwide 4400 unidentified bodies per year
1000 remain unidentified after 1 year
District 9 currently has 56 unidentified
Unidentified
Photographs
X-rays and CT scans
Fingerprints
Dental report
Anthropology report
DNA analysis for FBI or UNT
Forensic sketch
NCIC packet
Entry in to NaMUS
State Fatality Management FEMORS is a state-level asset of forensic specialists and equipment
FEMORS supports Florida Medical Examiners in mass fatality incidents under Department of Health (DOH), ESF-8 Mission Assignment
Activated members become temporary FDOH employees (for compensation, travel, liability and worker’s comp coverage)
FEMORS - Services
FEMORS Can Provide Aid For: Search and recovery Scene documentation Family Assistance Center Antemortem data collection Mobile Morgue Operations Forensic examinations Postmortem data collection DNA Acquisition Personal effects processing Remains identification Coordination of release of remains Records management Database administration Medical/psychology support Safety Officers and Specialists
DPMU Set-Up Example
Courtesy: DMORT
