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Medical Examiner's Office

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1. What types of death fall under the medical examiner's jurisdiction?

Iowa Code 331.802 clearly defines which cases fall under the jurisdiction of medical examiners. Medical examiner cases include sudden, unexpected, violent or unnatural deaths, and other deaths "affecting the public interest." Deaths which are outlined in 331.802 must be reported to and investigated by medical examiners. Any death in which the manner of death is not natural or any death in which the decedent was not seen by a physician with 30 days when the decedent had a diagnosed terminal or bedfast conditions must be reported to and investigated by a medical examiner. These deaths must occur in Muscatine County.

2. What is the difference between a medical examiner and a coroner?

In Iowa, the County Medical Examiner must be a licensed physician, appointed by the Board of Supervisors in each county and approved by the Iowa State Medical Examiner. His/her official responsibility is to investigate any death that is described in Iowa Code 331.802(3). A coroner is an elected official and does not have to be a licensed physician. Iowa does not utilize the coroner system, however Illinois does.

3. What is the difference between a medical examiner and medical examiner investigator?

A County Medical Examiner (CME) is a physician licensed within the State Iowa and appointed by their respective County Board of Supervisors to conduct investigations necessary to determine the cause and manner of death of individuals who die under violent, sudden, and unexpected circumstances (Iowa Code 331.802 (3)). CME-I's are trained death investigators who assist the CME in performing these duties. Often conducting the preliminary investigation at the scene. Our Investigators are members of the Iowa Office of the State Medical Examiner, and the Iowa Death Investigators Association. They have received training thru Saint Louis University and participate in yearly continuing education classes.

4. If a death appears natural, why is the Muscatine County Medical Examiner Department involved?

The medical examiner may take jurisdiction over an apparent natural death if the death (1) if the death was unexpected, (2) if the cause of death was uncertain, (3) if the decedent was unattended by a physician, (4) if death might be due to a virulent or contagious disease, and/or (5) if the manner of death is not clear.

5. What is an autopsy?

Medical examiner autopsy is a detailed medical/surgical examination of a person's body and individual internal organs after death. The function of the autopsy is to identify and document the presence or absence of diseases and/or injuries that can explain an individual's death. Diseases and injuries are interpreted in the context of an accompanying investigation of the patient's circumstances of death, the medical history, and toxicology testing. The cause and manner of death are determined by congruence of investigative, historical and autopsy information.

A medical examiner autopsy is performed or supervised by a forensic pathologist (a pathologist with specialized training and board certification in the practice of autopsy pathology and medicolegal death investigation). Muscatine County uses primarily the University Of Iowa's Decedent Care Center for its autopsies, but will also use the Iowa Office of the State Medical Examiner in Ankeny. The forensic pathologists at University of Iowa's Decedent Care Center are members of the Iowa Office of the State Medical Examiner.

6. When and why is an autopsy needed and who determines this?

An autopsy may be ordered by the medical examiner based upon his/her medical opinion that an autopsy is needed to assist in determining the cause and manner of death. In some cases an autopsy may be required by law due to the circumstances surrounding the death. Even when the cause of death may appear to be obvious, such as in a gunshot wound, an autopsy can provide details necessary for determining the manner of death and information required for insurance purposes and legal proceedings.

7. May a family refuse an autopsy ordered by the medical examiner?

No. Forensic autopsies are done to answer medicolegal questions that are deemed in the "public's interest" or to address a question of law. The Muscatine County Medical Examiner recognizes that an individual's religious beliefs may be contrary to the performance of an autopsy. Both entities are open for discussion to try to accommodate the family's wishes and to fulfill the legal obligation presented by your loved one's death. Please contact the Muscatine County Medical Examiner's office and share your concerns.

8. Who pays for the autopsy?

There is no cost to the family for an autopsy that is ordered by the Muscatine County Medical Examiner.

9. Does an autopsy affect funeral services?

Generally, an autopsy does not delay funeral services or prevent the option of embalming and viewing the decedent.

10. How do I choose a funeral service provider?

Iowa law prohibits the Muscatine County Medical Examiner Office from recommending a funeral service provider. We however will contact the funeral home of your choice.

11. Where will the autopsy take place?

The Muscatine County Medical Examiner Office primarily utilizes the University of Iowa Hospitals and Clinics Department of Pathology Autopsy Service in Iowa City, IA, as its primary autopsy consulting service. On rare occasions, an autopsy may occur at the Iowa Office of the State Medical Examiner in Ankeny, IA. The medical examiner investigator in charge of the case will be able to inform you where the autopsy will occur.

12. Who may obtain copies of the autopsy report?

The information contained within an autopsy report is confidential and treated as a medical record. The final report is available to the immediate and legal next-of-kin (power of attorney, spouse, adult child, parent, adult sibling, grandparent, guardian, in that order) and to those with written permission from the immediate and legal next-of-kin. Others who may receive copies of the autopsy report include treating physicians, law enforcement agencies and county attorneys investigating the death. The cause and manner of death are public records and can be released unless release of such information will jeopardize an investigation or pose a clear and present danger to the public safety or the safety of an individual (Iowa Code 22.7(41)).

13. How may I obtain a copy of the autopsy report?

The final autopsy report is available at a cost of $20, made payable to the Muscatine County Medical Examiner's Office, but only to the immediate and legal next-of-kin (power of attorney, spouse, adult child, parent, adult sibling, grandparent, and guardian). Final autopsy reports will only be provided to persons who are legally entitled to the report. You may obtain a copy of the final autopsy report by contacting the Muscatine County Medical Examiner Department at 563-263-5828, on our website, or by mailing a completed Autopsy Report Request Form, or by printing and scanning a completed copy of the Autopsy Report Request Form and email it.

Requests for a copy of the final autopsy report from someone other than those who are legally entitled (e.g., an insurance company, a private attorney) must be submitted on company letterhead, include a release of information form signed by the legal next-of-kin and must include a $20 check made payable to the"Muscatine County Medical Examiner Department"

14. Who can request that a forensic autopsy be performed?

County Medical Examiners, County Attorneys, and the State Medical Examiner have the statutory authority and obligation to request that a forensic autopsy be performed in cases where death is suspected to have arisen from violent, suspicious, and unexpected circumstances (Iowa Code 331.802 (4)).

15. How long does it take to receive a copy of an autopsy report?

It generally requires at least 6 weeks for the autopsy report to be available. However, this may be extended if additional testing is ordered by the forensic pathologist. The issuance of the death certificate may or may not be affected by any delay in the autopsy report. Every effort is made to accurately complete the death certificate as soon as possible.

16. What is a death certificate and how do I obtain a copy?

The death certificate is an official, legal document and vital record that is signed by a licensed physician. It includes the decedent's demographic data and states the cause and manner of death. The death certificate provides legal proof that death has occurred. The death certificate is needed to settle the estate of the deceased and provides information to public health agencies at the local, state, and federal levels to track statistical trends in health. These statistics are used to alert government health agencies of trends in natural and infectious diseases, risky behaviors, and unsafe equipment and vehicles which contribute to deaths.

17. I would like to have my loved one's organs / tissues donated. Will medical examiner involvement keep this from happening?

The Muscatine County Medical Examiner Department notifies the Iowa Donor Network of reported deaths. We fully support organ, tissue, and eye donation and work closely with Iowa Donor Network and Iowa Lions Eye Bank.

18. How do I get the personal effects of my loved one?

Personal property that was held by the medical examiner investigator will usually be returned to your funeral service provider when it is no longer needed for the investigation. Please contact your funeral service provider in order to collect your loved one's belongings. If law enforcement retained any personal property, you will need to contact the appropriate agency directly.

19. What is the best way to dispose of my loved one's leftover prescription medication?

Prescription medications belong to the individual they were prescribed to. Upon the death of that individual, these medications may be confiscated and disposed of by the Muscatine County Medical Examiner Department (based on the type of medications). The department disposes of medications in accordance with FDA guidelines. Disposal options are available to families. These options are described on the FDA website. Most local pharmacy's will also take and dispose of prescription medication

20. Are there any rules concerning the moving of a deceased person prior to the arrival of the medical examiner investigator?

Iowa Code 331.8O5Abobe Icon states that when a death falls within the jurisdiction of the medical examiner, the body shall not be disturbed or removed from the position in which it is found without authorization from the county or state medical examiner except for the purpose of preserving the body from loss or destruction or permitting the passage of traffic on a highway, railroad, or airport, or unless the failure to immediately remove the body might endanger life, safety, or health. A person who moves, disturbs, or conceals a body in violation of this subsection of the Iowa Code is guilty of a simple misdemeanor. The purpose of this rule is to ensure that the medical examiner investigator is able to understand the exact circumstances that existed at the time of a person's death.

21. Who is legally required to report a death to the Muscatine County Medical Examiner Department?

Iowa Code 331.802(1) requires any attending physician, law enforcement officer, embalmer, or any other person present at the time of the death report that death to the Medical Examiner Department when the death affects the public interest as specified in Iowa Code 331.802(3).

22. How does HIPAA effect a medical examiner's ability to access protected health information?

There is a specific exemption within HIPAA that allows medical examiners access to patient information during the course of a death investigation. This is for the purpose of determining the cause and manner of death, including identification of the decedent.

23. What do I do next when a loved one dies?

The first thing you need to do is take care of yourself. A lot of information will be shared with you and you will need to make several decisions. The following is a suggested list to help guide you and your loved one through the Medicolegal process:

When notified of a loved one's death, involve your family, friends, and clergy for support and comfort. They will be able to assist you in making sense of this tragic and sometimes sudden news.

You will need to select a funeral home to assist you in making funeral arrangements and to coordinate the final disposition of your loved one's remains. Once you have chosen a funeral home, the funeral director will make arrangements to pick up and transport your loved one's remains back to the funeral home following the autopsy. Keep track of any and all business cards given to you by law enforcement, county medical examiner, ambulance, and funeral home personnel. Start a file or folder to correlate all paperwork and information that will be shared with you as a result of your loved one's passing. Finally, remember to check in on yourself. Stress can come into one's life quickly and unexpectedly. Do not be afraid to use resources available to you in your community.