What happens when a Medical Examiner (ME) declines a case?

When a Medical Examiner Declines a Case

When a medical examiner declines a case, it means they have determined the death does not fall under their jurisdiction or require their investigation, resulting in the responsibility for death certification returning to the treating physician or primary care provider.

Reasons for Case Declination

Medical examiners (MEs) and coroners have specific jurisdictional authority to investigate certain types of deaths. When they decline a case, it typically occurs for the following reasons:

1. Death falls outside jurisdictional criteria:

   • Natural deaths with established medical history
   • Deaths where the cause is clearly established
   • Cases where no suspicion of criminal activity exists

2. Resource allocation considerations:

   • ME offices must prioritize cases that require forensic investigation
   • Limited resources necessitate focusing on deaths requiring medicolegal scrutiny

3. Statutory limitations:

   • Each state has specific laws defining which deaths fall under ME jurisdiction
   • Deaths not meeting these criteria are declined

What Happens After Declination

When an ME declines a case, several processes are triggered:

• Death certification responsibility: Returns to the treating physician or primary care provider
• Medical records: Become the primary source for determining cause of death
• Family notification: Next of kin are informed that the ME will not be investigating
• Funeral arrangements: Can proceed without ME involvement
• Organ/tissue donation: May proceed if appropriate and previously authorized 1

Implications of Case Declination

The declination of a case by an ME has several important implications:

For Healthcare Providers

• Death certificate completion: The attending physician becomes responsible for completing the death certificate
• Documentation requirements: Medical records must clearly document the cause and circumstances of death
• Communication with family: Healthcare providers may need to explain the natural cause of death to family members

For Families

• Faster release of remains: Without ME investigation, funeral arrangements can proceed more quickly
• Less invasive process: No forensic autopsy will be performed
• Private autopsy option: Families retain the right to request a private autopsy if desired

For Legal/Administrative Purposes

• Insurance claims: Can proceed based on the treating physician's death certification
• Estate matters: Legal proceedings can move forward without waiting for ME findings
• Public health statistics: Death will be categorized based on treating physician's determination

Common Pitfalls and Considerations

• Premature declination: Sometimes MEs may decline cases that actually warrant investigation
• Communication gaps: Failure to properly document the declination can create confusion
• Incomplete information: MEs may decline based on initial information but reconsider if new facts emerge
• Jurisdictional variations: Standards for accepting/declining cases vary significantly between jurisdictions 2

Special Circumstances

Hospital Deaths

In hospital settings, MEs may decline cases when:

• Death occurs from known natural disease
• Medical care was appropriate and death was expected
• No allegations of negligence or malpractice exist 3

Genetic Testing Considerations

In cases where postmortem genetic testing might be beneficial:

• Even if the ME declines the case, they should consider reaching out to the family if a genetic cause is suspected
• The ME should maintain policies regarding sample collection that might be needed later 4

Remember that ME practices vary significantly by jurisdiction, and what constitutes grounds for declination in one location may differ in another. When in doubt about reporting requirements, healthcare providers should consult with their local ME office for guidance.