Medical examiners investigate deaths due to homicide, suicide, or accidental violence, and deaths of persons unattended by a physician, or who succumbed to a contagious disease. They also intervene in cases where death occurs amid suspicious circumstances. Examples of the latter include the sudden death of persons in apparently good health, or who die while in the custody of law enforcement officers. The medical examiner is empowered to overrule family members or legal guardians who refuse permission for an autopsy; however, in cases where the cause of death becomes obvious upon preliminary review, the medical examiner, at his sole discretion, may decline the case and allow family members to claim the body without an autopsy.
Medical examiners are licensed physicians. They are most often pathologists by training, but some medical examiners, especially those for whom the job is a part-time occupation, are family practitioners or have other specialties.
The medical examiner investigating a death will conduct an autopsy. The medical examiner must carefully review and record a history and pertinent past medical history, supplied by witnesses, family members, and medical records obtained from the deceased person's healthcare providers; he/she must then perform a thorough physical examination, which includes inspection of the body, and examination, or weighing, and dissection of organs. The medical examiner may order radiological and laboratory tests as appropriate. Pathology specimens may be prepared as well. The purpose of this work is to reach a conclusion regarding the cause of death. The cause of death may be considered the deceased person's diagnosis.
The medical examiner must prepare a record for a deceased person, not unlike the medical record other physicians prepare
Handbook of Biosurveillance ISBN 0-12-369378-0
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for their living patients, which includes previous medical history and the results of the exams and procedures described above.
The information collected by medical examiners in the course of their work is valuable when considering every category of lethal, or potentially lethal, public health threat. To understand what a vital resource medical examiners represent to disease surveillance, consider that our nation's examiners certify approximately 20% of all deaths in the United States.
Medical examiners must notify governmental public health whenever the deceased suffered from a reportable communicable disease, and whether that disease was the cause of death. They also report deaths resulting from environmental conditions of interest to governmental public health agencies, such as extreme heat during the summer (Young, 2005). Prompt efficient reporting by the medical examiner can assist in the early detection of an outbreak, assuming that the medical examiner did not, by happenstance, decline a relevant case (a given deceased person).
4. MEDICAL EXAMINERS' DATA: ACCESSIBILITY-USE
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