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Much of the following is based on or adapted from information on the NYC Medical Examiner's office. Metropolis is assumed to be very similar in most respects to New York City and most, if not all, of the laws, rules, and regulations pertaining to NYC's ME's office will apply to Metropolis.
The Office of Chief Medical Examiner is a division of the Metropolis Department of Health and investigates cases of persons who die within Metropolis from criminal violence; by casualty or by suicide; suddenly, when in apparent good health; when unattended by a physician; in a correctional facility; or in any suspicious or unusual manner. The Office also investigates when an application is made for a permit to cremate the body of a person. (There is a mandatory 48 hour wait before a body is permitted to be cremated. This allows for an examination of the body to determine if further investigation into the death is warranted.)
The Office of the Chief Medical Examiner (OCME) is open 24 hours every day of the year and has more than forty medical examiners, an equal number of medicolegal investigators (MLI), more than twenty people in records, as well as staff in the various laboratories and Information Technology.
The OCME is located on New Troy Island. Each borough also has a medical examiner's office, located in one of the boroughs' larger hospitals. The Metropolis Medical Examiner System is one of the first formal ME systems in the United States, following the establishment of New York's ME system by only a few months.
The medical examiner is most often an appointed official. This has been part of a move toward professionalizing a job increasingly involved with advanced scientific techniques. In larger cities (for instance, New York City) and more populous counties, the post may be that of 'chief medical examiner', heading an office with M.E.s, deputy M.E.s, and forensic investigators on staff to handle individual cases. Ideally, the chief medical examiner is appointed on merit after an extensive testing and interview process and can only be removed from the post in the event malpractice or if criminal activities are uncovered. The M.E.'s office should be independent and apolitical in nature. In practice, the appointment and removal of a CME is often based on the local mayor's political needs and how well said CME gets along with the Mayor and senior politicos such as the District Attorney.
Duties of the M.E. always include determining the cause, time, and manner of death. This uses the same investigatory skills of a police detective in most cases, because the answers are normally available from the circumstances, scene, and recent medical records. In many American jurisdictions any death not certified by the person's own physician must be referred to the medical examiner. If an individual dies outside of their state of residence, the coroner or M.E. of the state in which the death took place issues the death certificate. Since the majority of deaths in the U.S. occur either in a hospital or under a doctor's care, only a small percentage of deaths require an autopsy to determine the time, cause and manner of death. However, approximately thirty percent of all deaths in a major city come to the attention of the medical examiner's office for various reasons.
Some deaths, such as celebrities or high profile cases, are referred to the chief medical examiner instead of the borough medical examiner. Police deaths and fire fighter deaths are also automatically referred to the chief medical examiner's office.
Deaths that occur in a hospital may be investigated over the phone through interviews with hospital personnel. Scene deaths (deaths that are called in by police officers or others) often require on-the-scene investigation.
The types of deaths that are investigated include:
The OCME maintains meticulous records related to cases that are investigated by their office. Access to these records is strictly controlled to ensure that confidentiality is maintained.
In some situations, these records can be made available to interested parties, including family members.
Investigation services are provided by a team of professional investigators. Service is provided 24 hours per day, seven days per week, 365 days per year.
The investigative staff performs scene responses and subsequent investigations to determine specifics surrounding deaths that occur in the county.
The investigative staff provides for the transportation of human remains to facilitate further examination. It also gathers evidence and specimens for further testing.
Note: because Metropolis uses MLIs (Medico-Legal Investigators) to do scene responses, it is rare for one of the medical examiners to be found at a crime scene. The role of the MLI is to establish time of death, tentative cause of death and related circumstances and to supervise the removal of the remains to the appropriate medical examiner's office. MLIs are physician assistants with extensive training in forensic investigation. Statistically, MLIs have a better than 95% success rate at determining cause and manner of death while on the scene. In the event of a drug related death, that rate climbs to better than 99 out of 100.
MLIs do not work for, or answer to, the police. By law, the medical examiner's investigator conducts an independent investigation to determine the identity of the dead and cause of death. The MLI is not responsible for determining who committed the crime - assuming a crime was committed. That is the purview of the police. Generally, the only contact a police officer will have with the actual body will be to determine if the victim is, in fact, dead. All other handling and examination of the body falls to the MLI.
MLIs undergo regular and extensive ongoing training to continually improve their assessment of death scenes. Such training includes lectures on blood spatter analysis, intimate partner abuse, SIDS, bullet wounds, how to testify in court, and natural disease pathology.
The OCME operates and maintains a state-of-the-art Toxicology Laboratory facility to provide the best scientific data related to the cases investigated.
The lab performs chemical analyses on samples obtained at both health care facilities and autopsy and performs chemical analyses on samples submitted by police agencies for criminal proceedings.
The autopsy is a surgical procedure that is performed to help establish the cause and manner of death. In most cases, the performance of an autopsy will not affect the viewing preferences of next-of-kin.
By law, religious preferences and/or wishes of the next-of-kin cannot prevent an autopsy from taking place in the event it is determined that one is needed. (Frequently it is not.) Aside from this, every effort will be made to take religious preferences, religious law, and the wishes of the next-of-kin into account in the handling of the body. For some groups, refrigeration of the body is forbidden; for others, all parts of the body that have been removed for examination (including blood) must be returned to the body prior to burial.
The autopsy section specifically:
Performs forensic autopsies to establish cause and manner of death.
Collects and documents evidence collection for legal proceedings.
Medical Examiner Office operations are often veiled in secrecy or misunderstanding. To assist the public, representatives of the Medical Examiner's Office are available through the Metropolis Speaker's Bureau.
Through this service, lecture series for specific audiences related to issues surrounding death and dying, violence, drugs, and other issues in the community are provided.
Additionally, the Medical Examiner's Office provides limited internship programs for qualified college students. The Metropolis Medical Examiner's Office also doubles as the Department of Forensic Medicine for the University of Metropolis's medical school.
The OCME works hard to ensure that in the event of a mass fatality incident, a rapid response can be made. The response is coordinated to mitigate the situation and return living conditions to normal as quickly and safely as possible for the people who live and work in Metropolis.
By working with a multitude of county and private agencies, plans are formulated and reviewed regularly to respond to and mitigate any mass fatality incident.
Regular training is held to ensure a level of responder awareness and safety is maintained for both traditional disaster scenarios as well as the threat associated with Weapons of Mass Destruction (WMD) / Nuclear, Biological, and Chemical (NBC) Agents.
More than 70,000 persons die in Metropolis each year. Each and every death is documented through a certificate of death - a legal document that is kept and safeguarded for perpetuity. The medical examiner's office is in charge of these. The vast majority of death certificates are filled out and signed off on by the decedent's personal physician or hospital personnel. Nearly all death certificates in Metropolis are filed through the Electronic Death Registration System (EDRS). This consists of an electronic form that must be completely filled out. Paper forms are used only in cases where the electronic forms are unavailable (as in loss of web access). The death certificate regarding a hospital death must be completed and filed with Health Department within 72 hours of the patient's death. Since most hospital deaths are fairly cut-and-dried, filling out the form is fairly simple.
Top section:
Decedent's legal name
Place of death
Date and time of death
Gender of decedent
Date last attended by a physician
Certifier signature
Next Section:
Cause of Death: the natural disease or traumatic injury which initiates the sequence of events resulting in an individual's death
Proximate Cause of Death: the disease or injury which represents the starting point in an unbroken chain of events, ending in death - for example, coronary artery disease, a gunshot wound to the chest, blunt force head trauma, lung carcinoma, etc..
Immediate Cause of Death: the complication or sequelae of the proximate cause of death, which is related to the proximate cause but does not represent an intervening cause of death ('intervening' cause of death= a disease or injury which initiates a new sequence of events leading to death)- for example, a myocardial infarct, pulmonary embolism, aspiration pneumonia, etc..
Note: 'cardiac arrest', 'cardiac failure', and 'respiratory failure' in and of themselves are not generally considered immediate causes of death as they do not actually give any information concerning what killed the decedent. Unless the body was disintegrated, everyone dies of 'cardiac arrest' or 'cardiac failure' - their heart stops.
Manner of Death: a classification of how the cause of death arose.
Six 'manner' classifications: Natural, accident, suicide, homicide, therapeutic complication, and undetermined.
Mechanism of Death: plausible physiological explanation(s) which links the cause of death to the cessation of vital functions
Examples:
#1: Cause of Death: Myocardial infarct
Due To: Coronary artery atherosclerosis
Manner of Death: Natural
#2: Cause of Death: Cerebral edema with herniation
Due To: Blunt Force Head Trauma
Due To: Fall from a height
Manner of Death: Accident
#3:Cause of Death: Bronchopneumonia
Due To: Prolonged immobilization and ventilator support
Due To: Traumatic head injuries
Due To: Gunshot wound to head
Manner of Death: Homicide
#4: Cause of Death: Acute pulmonary embolism
Due To: Fracture to right hip
Due To: Motor vehicle crash
Manner of Death: Accident
#5: Cause of Death: Radiation Poisoning
Due To: Kryptonite toxicity
Due To: Penetrating stab wound with kryptonite
Manner of Death: Homicide
Bottom section:
Autopsy
Pregnancy
Medical Examiner referrals
Tobacco use
Infant death
Signature
Events that require notifying the medical examiner: (If any of these terms appear as part of a cause of death, the case is immediately referred to the ME's office.)
|
Accident Adverse Reaction Asphyxia Aspiration At Work Assault Bite Blunt impact Burns Choke Contusion |
Crushed Cut Drowning Electrocution Explosion Exposure Fall Fire Fracture Gunshot Heat Stroke |
Hematoma Hemorrhage Homicide Hyperthermia Hypothermia Ingestion Injury Intoxication Intravenous Drug Use Laceration Misadventure |
Neglect Overdose Poisoning Sting Suffocation Suicide Therapeutic Complication Toxicity Trauma Wound |
For an overview on filling out a death certificate: Improving Cause of Death Reporting. This is an online instructional video for doctors.
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