Helpful Resources
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"Brochure: What the Physician Should Know Before Signing The Death Certificate"
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"Florida Department of Health: Physician Information"
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"Florida Department of Health: Physician Information"
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FAQ's
When does a case fall under the jurisdiction of the Medical Examiner?
In the case of an unexpected or possibly unnatural death, an investigation into the circumstances surrounding the death by the Medical Examiner’s Office is legally required to determine the cause and manner of death and to establish the identity of the deceased before a medical examiner can sign the death certificate. The types of deaths that fall under Medical Examiner jurisdiction are specified in Florida Statute 406. The Medical Examiner’s Office has no jurisdiction over deaths other than those specified by the statute
Florida Statute 406.11 specifies a dozen categories of death cases that fall under medical examiner jurisdiction and must be reported to the Medical Examiner’s Office. These are:
• 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
The majority of these have to do with traumatic deaths or death occurring while under the custody of the State. The deaths of patients who have been involuntarily committed (“Baker Acted”) or those who are mentally disabled and in a State-run facility are considered “in custody” deaths, and the Medical Examiner’s Office will assume jurisdiction.
Of the natural death cases, the issues of “unattended” deaths and deaths occurring “suddenly, when in apparent good health” seem to cause the most confusion about jurisdiction.
“Unattended by a physician” means there was no doctor/patient relationship in existence at the time of death. An “attended” death does not require the doctor to be physically at the patient’s bedside, only that a doctor/patient relationship exists (see Attorney General’s Opinion 94-103). Both AGO 94-103 and F.S. 382.11 hold that, if the patient was last treated by a physician within the 30 days prior to death, that patient is considered to be under that doctor’s care. Enrollment in a Hospice program is considered “attended”.
Additionally, if the patient has a current prescription from a physician for a disease that might have caused death, the patient is considered to be “attended.” Therefore, unless there is an injury that directly results in death or contributes to the death (see above), these deaths do not fall under medical examiner jurisdiction.
“Suddenly, when in apparent good health” means a person has no known disease that might cause death, and has died suddenly. Those who have hypertension, diabetes and/or arteriosclerotic cardiovascular disease (to cite the most frequently encountered) are not “in good health”, no matter how “well-controlled” their disease may be. Sudden cardiac deaths in this patient population are common. If the circumstances of their terminal event are not suspicious for foul play and are consistent with sudden cardiac death, these deaths would not be medical examiner cases.
When do I need to report a death to the Medical Examiner’s Office?
Pursuant to F.S.S. 406, the medical examiner’s offices in each of Florida’s 24 medical examiner districts investigate all unexpected/unattended deaths and deaths due entirely to or contributed to by trauma. Under certain circumstances, a District Medical Examiner’s Office is compelled by statute to assume jurisdiction and issue the death certificate. There has been some confusion as to what cases fall under medical examiner jurisdiction and must be reported.
Most deaths that occur in Districts 5 & 24, which includes Marion, Lake, Citrus, Sumter, Seminole, and Hernando Counties, that are due to traffic accidents, homicides and other types of obvious trauma are reliably reported to the Medical Examiner’s Office by law enforcement. However, in some cases the Office must depend on physicians, hospitals, and other medical facilities to report deaths that occur under the care of a physician where trauma, drug overdose, or other injurious event contributed to the death. Statute 406 (specifically 406.12) compels any person in the District who becomes aware of a case falling under medical examiner to report the case to the Medical Examiner’s Office in the district in which the death occurred,
If a patient’s death is directly due to trauma, the death would automatically fall under medical examiner jurisdiction. In cases where trauma contributed to the death, many physicians are unaware of the medicolegal approach to the determination of the manner of death when both natural and unnatural causes of death coexist. A simple rule of thumb states that if an unnatural cause of death (trauma, drug overdose, electrocution, drowning, etc.) plays a contributory role in the death, then the manner of death is unnatural (i.e., accidental, suicidal or homicidal), and, therefore, the case falls under the jurisdiction of the medical examiner. Hip fractures are typical contributors of death.
In some cases trauma may have been present but did not contribute to the death. For example, if a person falls and fractures a hip and during the healing process suffers a deep venous thrombosis and then a pulmonary embolism, the death is related to the traumatic hip fracture and, therefore, is accidental and falls under medical examiner jurisdiction. However, a case involving a pathologic hip fracture due to metastatic carcinoma would be considered a natural death since no trauma was involved. If a person who had a hip fracture dies due to a natural disease process unrelated to a hip fracture (or any other antemortem trauma), the death would be considered natural and would not fall under medical examiner jurisdiction.
In complicated or confusing cases, the Districts Five and twenty-four Medical Examiner Office can be an excellent resource for information regarding death certification. If you or your staff have any questions regarding Statute 406 or a particular case, please feel free to call the Office at 352-326-5961.
Which Medical Examiner’s Office should I notify?
The state of Florida is divided into 24 medical examiner districts. The place where a person dies or where a deceased’s body is found or is brought ashore from water determines the geographic jurisdiction.
The Districts 5 & 24 Medical Examiner’s Office serves only Citrus, Hernando, Lake, Marion, Seminole, and Sumter Counties.
Can my patient’s family have an autopsy performed if the death does not fall under the jurisdiction of the Medical Examiner?
The Districts 5 & 24 Medical Examiner’s Office does not perform autopsies on the bodies of individuals whose deaths do not fall under Medical Examiner jurisdiction as defined by Florida Statute 406.11.
If the next of kin wishes to pursue a private autopsy, he or she can consult with their local hospital or funeral home for a recommendation of a private pathologist who will perform the autopsy for a fee determined by that pathologist. To avoid a conflict of interest the Districts 5 & 24 Medical Examiner’s Office, is not in a position to recommend any particular private pathologist or organization that perform private autopsies.
When is a patient’s treating physician required to sign the death certificate?
F.S.382.008 states that, for non-medical examiner cases, the patient’s “physician in charge of the decedent’s care for the illness or condition which resulted in death or the physician in attendance at the time of death or immediately before or after death” is charged with signing the death certificate “to the best of his or her knowledge and belief”. Occasionally, a physician who has the responsibility of signing a death certificate on a non-medical examiner case declines to do so. Many people are under the mistaken assumption that these deaths then become Medical Examiner’s cases by default. This is incorrect. F.S. 382.008 is clear that the patient’s physician remains responsible for signing the death certificate in non-ME cases.
Please also take note of Sections 8 and 9 of F.S.382.026 Penalties--
(8) Except where a different penalty is provided for in this section, any person who violates any of the provision of the chapter, or the rules and regulations of the department, or who neglects or refuses to perform any of the duties imposed upon him or her there under, commits a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083
(9) In addition to any other sanction or penalty authorized by law, the department may impose a fine which may not exceed $1000 for each violation of this chapter or rules adopted there under. Each day that a violation continues may constitute a separate violation.
Sudden, natural deaths frequently occur at home. Many times the patient’s physician responsible for signing the death certificate does not know his or her patient has died until the funeral home brings the death certificate. for completion and signature. Understandably, these physicians may have questions about the circumstances immediately surrounding their patient’s death. Because the responding Law Enforcement agencies typically report these deaths to the Medical Examiner’s Office, we can provide information on the circumstances of death in these cases. Each of the physicians in the Medical Examiner’s Office signs literally hundreds of death certificates every year (the majority of which are natural deaths). We can, therefore, often be helpful to the clinician pondering the appropriate wording on a challenging case. Please feel free to contact this office if we can assist you in any regard.
What should I list as the cause of death on my patient’s death certificate?
The term “cause of death” is defined as “the injury, disease or combination of the two responsible for initiating the train of physiological events, brief or prolonged, which produced the fatal termination.” Below is a list of diagnoses which are insufficient when listed alone on a death certificate. These conditions do not actually represent causes of death, but rather they are pathophysiologic mechanisms resulting from an underlying disease or event. That underlying disease or event should be listed as the cause of death on the death certificate. For example, the term “cardiac arrest” is not an appropriate cause of death. If the death was due to heart disease, then the appropriate certification of the death might be “Atherosclerotic cardiovascular disease” or “Hypertensive cardiovascular disease.”
Terminal Sequelae that Cannot Stand Alone on a Florida Death Certificate
Aspiration
Bronchopneumonia
Cardiogenic shock
Cardiac arrhythmia
Cardiac dysrhythmia
Cardiorespiratory arrest
Cardiac failure
Cardiac arrest
Encephalopathy
Gastrointestinal hemorrhage
Hemorrhage
Hemorrhagic shock
Hepatic failure
Intracranial hemorrhage
Liver failure
Metabolic acidosis
Multisystem failure
Paraplegia
Pneumonia
Pneumocystis pneumonia
Pulmonary embolus
Pulmonary thromboembolus
Quadriplegia
Ruptured viscus
Renal failure, acute or chronic
Respiratory failure
Respiratory arrest
Sepsis
Septic shock
Shock
In the case of an unexpected or possibly unnatural death, an investigation into the circumstances surrounding the death by the Medical Examiner’s Office is legally required to determine the cause and manner of death and to establish the identity of the deceased before a medical examiner can sign the death certificate. The types of deaths that fall under Medical Examiner jurisdiction are specified in Florida Statute 406. The Medical Examiner’s Office has no jurisdiction over deaths other than those specified by the statute
Florida Statute 406.11 specifies a dozen categories of death cases that fall under medical examiner jurisdiction and must be reported to the Medical Examiner’s Office. These are:
• 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
The majority of these have to do with traumatic deaths or death occurring while under the custody of the State. The deaths of patients who have been involuntarily committed (“Baker Acted”) or those who are mentally disabled and in a State-run facility are considered “in custody” deaths, and the Medical Examiner’s Office will assume jurisdiction.
Of the natural death cases, the issues of “unattended” deaths and deaths occurring “suddenly, when in apparent good health” seem to cause the most confusion about jurisdiction.
“Unattended by a physician” means there was no doctor/patient relationship in existence at the time of death. An “attended” death does not require the doctor to be physically at the patient’s bedside, only that a doctor/patient relationship exists (see Attorney General’s Opinion 94-103). Both AGO 94-103 and F.S. 382.11 hold that, if the patient was last treated by a physician within the 30 days prior to death, that patient is considered to be under that doctor’s care. Enrollment in a Hospice program is considered “attended”.
Additionally, if the patient has a current prescription from a physician for a disease that might have caused death, the patient is considered to be “attended.” Therefore, unless there is an injury that directly results in death or contributes to the death (see above), these deaths do not fall under medical examiner jurisdiction.
“Suddenly, when in apparent good health” means a person has no known disease that might cause death, and has died suddenly. Those who have hypertension, diabetes and/or arteriosclerotic cardiovascular disease (to cite the most frequently encountered) are not “in good health”, no matter how “well-controlled” their disease may be. Sudden cardiac deaths in this patient population are common. If the circumstances of their terminal event are not suspicious for foul play and are consistent with sudden cardiac death, these deaths would not be medical examiner cases.
When do I need to report a death to the Medical Examiner’s Office?
Pursuant to F.S.S. 406, the medical examiner’s offices in each of Florida’s 24 medical examiner districts investigate all unexpected/unattended deaths and deaths due entirely to or contributed to by trauma. Under certain circumstances, a District Medical Examiner’s Office is compelled by statute to assume jurisdiction and issue the death certificate. There has been some confusion as to what cases fall under medical examiner jurisdiction and must be reported.
Most deaths that occur in Districts 5 & 24, which includes Marion, Lake, Citrus, Sumter, Seminole, and Hernando Counties, that are due to traffic accidents, homicides and other types of obvious trauma are reliably reported to the Medical Examiner’s Office by law enforcement. However, in some cases the Office must depend on physicians, hospitals, and other medical facilities to report deaths that occur under the care of a physician where trauma, drug overdose, or other injurious event contributed to the death. Statute 406 (specifically 406.12) compels any person in the District who becomes aware of a case falling under medical examiner to report the case to the Medical Examiner’s Office in the district in which the death occurred,
If a patient’s death is directly due to trauma, the death would automatically fall under medical examiner jurisdiction. In cases where trauma contributed to the death, many physicians are unaware of the medicolegal approach to the determination of the manner of death when both natural and unnatural causes of death coexist. A simple rule of thumb states that if an unnatural cause of death (trauma, drug overdose, electrocution, drowning, etc.) plays a contributory role in the death, then the manner of death is unnatural (i.e., accidental, suicidal or homicidal), and, therefore, the case falls under the jurisdiction of the medical examiner. Hip fractures are typical contributors of death.
In some cases trauma may have been present but did not contribute to the death. For example, if a person falls and fractures a hip and during the healing process suffers a deep venous thrombosis and then a pulmonary embolism, the death is related to the traumatic hip fracture and, therefore, is accidental and falls under medical examiner jurisdiction. However, a case involving a pathologic hip fracture due to metastatic carcinoma would be considered a natural death since no trauma was involved. If a person who had a hip fracture dies due to a natural disease process unrelated to a hip fracture (or any other antemortem trauma), the death would be considered natural and would not fall under medical examiner jurisdiction.
In complicated or confusing cases, the Districts Five and twenty-four Medical Examiner Office can be an excellent resource for information regarding death certification. If you or your staff have any questions regarding Statute 406 or a particular case, please feel free to call the Office at 352-326-5961.
Which Medical Examiner’s Office should I notify?
The state of Florida is divided into 24 medical examiner districts. The place where a person dies or where a deceased’s body is found or is brought ashore from water determines the geographic jurisdiction.
The Districts 5 & 24 Medical Examiner’s Office serves only Citrus, Hernando, Lake, Marion, Seminole, and Sumter Counties.
Can my patient’s family have an autopsy performed if the death does not fall under the jurisdiction of the Medical Examiner?
The Districts 5 & 24 Medical Examiner’s Office does not perform autopsies on the bodies of individuals whose deaths do not fall under Medical Examiner jurisdiction as defined by Florida Statute 406.11.
If the next of kin wishes to pursue a private autopsy, he or she can consult with their local hospital or funeral home for a recommendation of a private pathologist who will perform the autopsy for a fee determined by that pathologist. To avoid a conflict of interest the Districts 5 & 24 Medical Examiner’s Office, is not in a position to recommend any particular private pathologist or organization that perform private autopsies.
When is a patient’s treating physician required to sign the death certificate?
F.S.382.008 states that, for non-medical examiner cases, the patient’s “physician in charge of the decedent’s care for the illness or condition which resulted in death or the physician in attendance at the time of death or immediately before or after death” is charged with signing the death certificate “to the best of his or her knowledge and belief”. Occasionally, a physician who has the responsibility of signing a death certificate on a non-medical examiner case declines to do so. Many people are under the mistaken assumption that these deaths then become Medical Examiner’s cases by default. This is incorrect. F.S. 382.008 is clear that the patient’s physician remains responsible for signing the death certificate in non-ME cases.
Please also take note of Sections 8 and 9 of F.S.382.026 Penalties--
(8) Except where a different penalty is provided for in this section, any person who violates any of the provision of the chapter, or the rules and regulations of the department, or who neglects or refuses to perform any of the duties imposed upon him or her there under, commits a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083
(9) In addition to any other sanction or penalty authorized by law, the department may impose a fine which may not exceed $1000 for each violation of this chapter or rules adopted there under. Each day that a violation continues may constitute a separate violation.
Sudden, natural deaths frequently occur at home. Many times the patient’s physician responsible for signing the death certificate does not know his or her patient has died until the funeral home brings the death certificate. for completion and signature. Understandably, these physicians may have questions about the circumstances immediately surrounding their patient’s death. Because the responding Law Enforcement agencies typically report these deaths to the Medical Examiner’s Office, we can provide information on the circumstances of death in these cases. Each of the physicians in the Medical Examiner’s Office signs literally hundreds of death certificates every year (the majority of which are natural deaths). We can, therefore, often be helpful to the clinician pondering the appropriate wording on a challenging case. Please feel free to contact this office if we can assist you in any regard.
What should I list as the cause of death on my patient’s death certificate?
The term “cause of death” is defined as “the injury, disease or combination of the two responsible for initiating the train of physiological events, brief or prolonged, which produced the fatal termination.” Below is a list of diagnoses which are insufficient when listed alone on a death certificate. These conditions do not actually represent causes of death, but rather they are pathophysiologic mechanisms resulting from an underlying disease or event. That underlying disease or event should be listed as the cause of death on the death certificate. For example, the term “cardiac arrest” is not an appropriate cause of death. If the death was due to heart disease, then the appropriate certification of the death might be “Atherosclerotic cardiovascular disease” or “Hypertensive cardiovascular disease.”
Terminal Sequelae that Cannot Stand Alone on a Florida Death Certificate
Aspiration
Bronchopneumonia
Cardiogenic shock
Cardiac arrhythmia
Cardiac dysrhythmia
Cardiorespiratory arrest
Cardiac failure
Cardiac arrest
Encephalopathy
Gastrointestinal hemorrhage
Hemorrhage
Hemorrhagic shock
Hepatic failure
Intracranial hemorrhage
Liver failure
Metabolic acidosis
Multisystem failure
Paraplegia
Pneumonia
Pneumocystis pneumonia
Pulmonary embolus
Pulmonary thromboembolus
Quadriplegia
Ruptured viscus
Renal failure, acute or chronic
Respiratory failure
Respiratory arrest
Sepsis
Septic shock
Shock