Services

Investigations of the deaths reported

Each county in Michigan must have a licensed physician appointed by county commissioners to serve as the medical examiner. The Office of the Medical Examiner investigates deaths reported based on Michigan Compiled Laws. In Wayne County, the medical examiner, deputy medical examiner and assistant medical examiners are board-certified forensic pathologists. Unlike the other Michigan counties, The Wayne County Executive appoints the Chief Medical examiner.

In general, the deaths investigated by MEO office include those that are thought to result from injury or drug toxicities, and those deaths that are sudden, unexpected, often violent and occasionally not readily explainable at the time of death. Because deaths occur regardless of time or day, the office responds to deaths 24 hours per day, 365 days per year.

Death Certification

The focus of death investigation is to determine the cause and manner of death, and to clarify the circumstances surrounding the death. The cause of death is related to the underlying disease and injury that resulted in death. The manner of death describes the circumstances surrounding the cause of death. In the state of Michigan, the manner of death is restricted to the following options: natural, accident, suicide, homicide or indeterminate.

Manner of Death

Guidelines for classifying the manner of death:

Natural deaths are solely or nearly completely due to internal disease processes and/or aging.

Accident applies when an injury or poisoning (including drug overdoses) causes death, and there is little or no evidence that the injury or poisoning occurred with intent to harm or cause death. In essence, the fatal outcome was unintentional.

Suicide results from an injury or poisoning because of an intentional self-inflicted act.

Homicide occurs when the death results from a volitional act committed by another person to cause fear, harm or death. Intent to cause death is a common element but is not required for classification as a homicide. It must be emphasized that the classification of homicide for the purpose of death certification is a neutral term and neither indicates nor implies criminal intent, the determination of which remains within the province of legal processes.

Indeterminate is a classification used when the information pointing to one manner of death is no more compelling than one or more other competing manners of death in thoroughly considering all available information.

Generally, when death involves a combination of natural processes and external factors, such as injury or poisoning, preference is given to the non- natural manner of death.

Cremation Permit Authorizations

Michigan Compiled Law 52.210 requires funeral directors and embalmers to obtain a signed permit from a county medical examiner. Our office processes thousands of cremation permits. The request typically involves review of the death certificate provided by the funeral director. Deaths that were not properly reported are investigated before cremation is authorized.

Case Management Approach

The medical examiner, deputy medical examiner or assistant medical examiners, who are each board-certified forensic pathologists, are assigned to each case and generally use one of these approaches in each of the deaths for which the office is responsible:

Declination of Jurisdiction: The body is released directly from the scene to the funeral home. The medical examiner investigator at the scene views the body and collects information on the scene, medical history and social history.This information is provided to the on-call medical examiner, who may decline jurisdiction of the body directly to the funeral home chosen by the family.

The jurisdiction of the medical examiner is generally divided into three categories: sudden unexpected death while in apparent good health, suspicion for unnatural death, and a potential or perceived threat to public health. When receiving a death notification, these categories are taken into consideration in determining if the criteria for accepting jurisdiction is fulfilled, if more information is required of the reporting body, or if a scene investigation is necessary. The medical examiner investigator at the scene views the body and collects information on the scene, medical history, and social history. This information is provided to the on-call medical examiner, who determines acceptance or declination of jurisdiction of the body. When jurisdiction of the body is declined, the body is released directly to the funeral home chosen by the family.

External or Limited Examination: An external examination includes a detailed record of body observations, possible laboratory/toxicology testing and a dictated report. A limited examination generally is within an anatomic boundary (ex: brain-only examination) to recover a foreign body or to answer specific questions. These examinations may also include toxicology testing.

Full Autopsy: An examination that includes external and internal examination, with toxicology (if the appropriate specimens are available).

NAME Accreditation

The National Association of Medical Examiners (NAME) is a national professional organization of physician medical examiners, medicolegal death investigators and death investigation system administrators. The goals of NAME include fostering the professional growth of physician death investigators and disseminating the professional and technical information vital to the continuing improvement of the medical investigation of violent, suspicious and unusual deaths. This ever-expanding establishment incorporates physician medical examiners and coroners, medical death investigators and medicolegal system administrators from throughout the United States and other countries, and its members provide the expertise to medicolegal death investigation that is essential to the effective functioning of the civil and criminal justice systems.

NAME is now the national forum for the interchange of professional and technical information in this important segment of public administration. NAME seeks to promote excellence in the day-to-day investigation of individual cases as well as to improve the interaction of death investigation systems with other agencies and political entities that interface with death investigation in each jurisdiction in this country. NAME serves as a resource to individuals and jurisdictions seeking to improve medicolegal death investigation by continually working to develop and upgrade national standards for death investigation. The published NAME Standards for a Modern Medicolegal Investigative System provide a model for jurisdictions seeking to improve death investigation.

With the purpose of improving the quality of the medicolegal investigation of death in this country, NAME has prepared accreditation standards that applies to not only individual practitioners but offices and systems. These standards emphasize policies and procedures and the professional work product. The standards represent minimum standards for an adequate medicolegal system, not guidelines. NAME accreditation is an endorsement indicating that the office or system provides an adequate environment for a medical examiner in which to practice his or her profession and provides reasonable assurances that the office or system well serves its jurisdiction. It is the objective of NAME that the application of these standards will aid materially in developing and maintaining a high caliber of medicolegal investigation of death for the communities and jurisdictions in which they operate.

The NAME Accreditation Program is a peer review system with the goal of improving performance through objective evaluation and constructive criticism. The inspector is the medical examiner’s peer and serves as a guest consultant to the office or system. The inspector’s evaluation is based on the NAME Inspection and Accreditation Checklist, which provides a realistic assessment of the quality of an office or system operation. This checklist embodies the NAME accreditation standards and covers eight categories (1. General, 2. Investigations, 3. Morgue Operations, 4. Histology, 5. Toxicology, 6. Reports and Record Keeping, 7. Personnel and Staffing, and 8. Support Services and Consultants) and has 355 individual questions.

The questions bear designation into Phase I or Phase II deficiencies, where requirements are either not absolutely essential and will not directly and/or seriously affect the quality of work of significantly endanger the welfare of the public or personnel or are considered essential and may seriously impact the work or adversely affect the health and safety of the public or agency staff, respectively.

The Wayne County Medical Examiner Office (WCMEO) was awarded full NAME accreditation in 2012. Currently, NAME accreditation is conferred for a maximum of four years and the WCMEO has successfully retained accreditation through three cycles of maintenance. Due to attrition in physician numbers and aging infrastructure, the accreditation status was downgraded to provisional accreditation in 2018. Provisional accreditation requires annual online record review, with the office’s most recent being December 2022. Wayne State University and Wayne County are fully engaged in remediating these issues and seek full NAME accreditation through increasing faculty staff and building renovations.

Information regarding inspection and accreditation is available at www.TheNAME.org.

The office received provisional accreditation from the National Association of Medical Examiners after a site visit in December 2021 and records review in 2022. Information regarding inspection and accreditation is available at www.TheNAME.org.

Public Health and Safety Issues

The information obtained from a death investigation is collectively studied to address public health and safety issues. Our office also participates in the child death review process, providing crucial information on how children die, with the goal of preventing future deaths. An example is identifying trends and new variants during the COVID-19 pandemic or identifying novel opioid substances and their prevalence.

Education

Our office has affiliations with many academic institutions. We are part of the Wayne State University School of Medicine, and our medical examiners have a dual appointment with the School of Medicine, associated with teaching and mentoring medical students, graduate residents and other pathologists assistant program students. We also offer students in advanced degree programs the opportunity to fulfill the required experience and exposure to forensic pathology.

Forensic Autopsy

The National Association of Medical Examiners created Forensic Autopsy Performance Standards to provide a constructive framework that defines the fundamental services rendered by a professional forensic pathologist. They are considered the minimum that constitutes a competent autopsy. NAME recognizes that certain standards may not be applicable where they conflict with federal, state and local laws, and that deviation from these performance standards may occur when guided by professional judgment and experience.

NAME has also published position papers on topics like fatal abusive head injuries in infants and young children. Position papers are the gold standard and are not meant to replace pre-existing autopsy standards but instead to enhance them with detailed techniques, procedures and other recommendations for these investigations. Position papers are not meant as a substitute for professional judgment and are not meant to be used to criticize an autopsy that meets the minimum forensic autopsy standards.

Every jurisdiction has laws and statues that define the role of the coroner or medical examiner and the cases that must be reported and investigated. Some of these laws are universal, some are particular to the jurisdiction. When examining a case and something seems unusual, the best place to start is to read the coroner or medical examiner laws and statutes governing that office.

Some death investigations require performing additional tests and professional consultations. Some tests, like toxicology test in suspected drug deaths, are universal and covered in the forensic autopsy standards. Some examinations, like genetic and molecular studies and having the heart examined by a cardiovascular pathologist in sudden cardiac deaths, depend on the case, office resources and access to consulting pathologists.

The end result is that while the minimal standards for performing autopsies are met in each case, there is variance in what else is performed per case.