Partnerships for Success Corner Medical Examiner: Preserving Evidence and Saving Lives
description
Transcript of Partnerships for Success Corner Medical Examiner: Preserving Evidence and Saving Lives
Partnerships for Success Corner Medical Examiner: Preserving
Evidence and Saving LivesBreakout Session A
Presenters:Allison O’Neal, Orange County Sheriff-Coroner
Anthony Maldonado, ME / Coroner Specialist, OneLegacyModerator:
Barbara Anderson, RN, Ronald Reagan UCLA Medical Center
• Demonstrate a basic understanding of the coroner role and responsibilities in regards to the donation process• Discuss CA Coroner Law, Coroner Relationships
and Coroner Case Statistics• To be able to identify a reportable death
Objectives:
When is it necessary to report a death to the coroner?
How has the collaboration between OneLegacy and the coroner increased
donation in our community?
Questions to Run On:
Coroner/Medical Examiner: Preserving Evidence and
Saving LivesAllison O’Neal,
Supervising Deputy Coroner
Orange County Sheriff’s Department-Coroner Division
948 square miles 3 million people Sheriff-Coroner system Total Deaths per year: 18,915 Orange County Coroner investigated: 5,093 Autopsies Performed: 1,654 Of autopsy cases:
◦ Natural 84%◦ Accident 10%◦ Suicide 4%◦ Homicide 1%◦ Undetermined 1%
County of OrangeCoroner Statistics
The California Government Code 27491 states that the coroner is required to:• Investigate all unnatural deaths-COD, Manner (homicide, suicide, accident,
natural, undetermined)• Deaths where the MD is unable to state COD• When deceased saw MD >20 days prior to death
Responsibilities are all or some of these depending on case. We may not physically complete the task but need to ensure it gets done:• Positively identify the deceased• Examine the deceased to document condition of body• Determine place, date and time of death• Locate and notify the next of kin• Secure personal belongings and residence• Collect evidence related to the death• Ensure the body is moved to the appropriate facility• Communicate with the related law enforcement agency or District Attorney
Role & Responsibilities of the Coroner
The Coroner is governed by California Government Code Section 27491 and Health and Safety Code Section 102850. The law states: “…a physician and surgeon, physician assistant, funeral director, or other person shall immediately notify the Coroner when he or she has the knowledge of a death that occurred or has charge of a body in which death occurred under ANY of the following:
What is Reportable to the Coroner?
Without medical attendance Not attended by an MD in 20 days prior Attending MD unable to give opinion for COD When homicide is known or suspected When suicide is known or suspected When a criminal action is involved or suspected to
be involved in a death Self-induced or criminal abortion Related to rape or crime against nature Known or suspected injury, accident-old or recent Aspiration, starvation, exposure, drug addiction or acute
alcoholism
Reportable Information (ctd.)
Poisoning Occupation diseases Contagious diseases While in-custody of a law enforcement
agency All state hospital deaths- Fairview in OC All Sudden Infant Death Syndrome
cases During or related to surgery, following
surgery or did not wake from anesthesia
Reportable Information (ctd.)
Decline (no case # given); not reportable but brief report taken.
Reportable, Non-Autopsy case Sign Out No Autopsy (SONA) Autopsy case
For Autopsy and SONA cases there is no difference in the interaction between the deputy coroner and the OL representative.
Types of OC Coroner Cases
The death is reportable but an autopsy is not necessary. In this situation the OneLegacy coordinator or hospital staff reports the death and receives a coroner case number. OL notifies OCCO on every potential organ and tissue donor.
Examples: Natural death with marijuana or ethanol in system unrelated to the COD.Positive for a contagious disease such as Hepatitis C but died from a ruptured AAA.
Non-Autopsy cases as they relate to OneLegacy
Reportable Non-natural deaths that are acute or delayed but the COD is known, well documented and a physician can state his/her opinion on the death certificate
Examples: Inpatient MVA with multiple traumatic
injuries Tylenol overdose with suicide notes found Elderly inpatient with recent fall with SDH
Sign Out No Autopsy (SONA)
After procurement, the body is picked up by the coroner and scheduled for coroner autopsy. The coroner handles the death certificate completely-cause and manner.
The OCCO does not perform autopsies over the weekend however we pride ourselves in completing our forensic investigation quickly and releasing the deceased in an average of 48 hours.
Examples: MVA’s, homicides, non-accidental trauma, competing causes such as accident vs. suicide overdoses and undetermined cases.
Autopsy Cases
The OneLegacy coordinator notifies the OCCO after brain death notes. On DCD it is after the NOK signs consent.
OL coordinator sends available charting.
OL coordinator and OCCO in constant communication.
Brain Death and DCD Cases
Case Study:Non-Accidental Trauma
OL reported brain death of a 17 month female admitted from home with suspected non-accidental trauma. Initial story to 911 was that she fell approx.
18 inches off a chair. Child was under the care of one parent’s
significant other. Admitted in full arrest. Head CT showed
complex skull fx and additional head trauma.
Case Study
Case Study
Case Study
OneLegacy obtained consent from NOK for all organs and tissue.
OCCO requested additional studies including CT chest, abdomen, pelvis, CBC, WBC, chem panel, long bone study, ocular examination
While awaiting these results we used the time to obtain information from the handling police agency, confer with child services and conduct interviews.
Case Study
An additional challenge in this case was that the incident occurred in an out of county law enforcement jurisdiction.
Coroner approved recovery of organs. Stipulation given that transplant recovery surgeons document any trauma observed during recovery.
Case Study
Based on autopsy, microscopic tests and neuropathology and toxicology the following was documented.
Confluent areas of purple-red ecchymosis of posterior base of head and posterior right ear.
Focal purple contusions of the bilateral posterior forearms. Small faint purple contusion of the right cheek. Internal trauma: a. Occipital scalp hematoma. b. Diffuse posterior subgaleal hemorrhage. c. Complex skull fractures. d. Bilateral occipital epidural hematomas. e. Bilateral optic nerve sheath hemorrhages.
Case Study
We at the OCCO are proud to be able to save lives while still conducting thorough medico-legal death investigations.
3 Lives saved from this case alone: Local 40 y/o received en bloc kidneys Local 9 month old received liver Local 2 month old received heart
Case Study
Coroner/Medical Examiner: Preserving Evidence and Saving Lives
Anthony MaldonadoM.E./Coroner Specialist
The Donation & Transplantation SymposiumOctober 15, 2013
CA Health & Safety CodeSection 7151.15
• 7151.15. (a) A county coroner shall cooperate with procurement organizations to maximize the opportunity to recover anatomical gifts for the purpose of transplantation, therapy, research, or education.
CA Health & Safety CodeSection 7151.20 (d)
• (d) If a county coroner is considering withholding one or more organs of a potential donor for any reason, the county coroner, or his or her designee, upon request from a qualified organ procurement organization, shall be present during the procedure to remove the organs. The county coroner, or his or her designee, may request a biopsy of those organs or deny removal of the organs if necessary.
Coroner protocols established and routinely revised
Coroner may request photos,
medical diagnostic testing,
consultations, etc.
Case reviews and education for
coroner staff and OneLegacy staff
Coroner/ME Relationships
2010 Organ Coroner CasesBy Circumstance of Death
CountyAlleged
Child Abuse
Alleged Homicide
Alleged Suicide
Death by Natural Cause
Drowning/Near
Drowning
Hospital Death:
Inpatient
Motor Vehicle
AccidentNone of
the Above
Non-Motor Vehicle
Accident
Unknown/Other: See Comments
Grand Total
Kern 0 5 3 1 0 0 2 1 0 0 12
Los Angeles 0 25 14 29 1 28 12 14 1 124
Orange 0 3 1 4 0 0 3 5 3 0 19Riverside 1 1 5 5 1 5 1 3 0 22San Bernardino 5 4 5 9 0 1 2 1 6 1 34Santa Barbara 0 0 1 0 0 0 0 0 1 0 2
Ventura 0 0 2 1 0 0 0 0 3 0 6
Grand Total 6 38 31 49 2 1 40 20 30 2 219
CountyAlleged
Child Abuse
Alleged Homicide
Alleged Suicide
Deathby Natural
Cause
Drowning or Near
Drowning
HospitalDeath: ER or
Outpatient
Hospital Death:
Inpatient
Motor Vehicle
Accident
Noneof the Above
Non-Motor Vehicle
Accident
Unknown/Other:
See Comments
Grand Total
Kern 0 1 1 0 0 0 0 3 0 0 0 5
Los Angeles 8 20 13 43 0 0 0 37 16 23 0 160
Orange 0 6 9 7 1 0 0 10 1 5 0 39
Riverside 0 1 5 5 1 0 0 10 0 4 0 26San Bernardino 2 5 2 5 0 0 0 8 2 6 1 31
Santa Barbara 0 0 2 0 0 0 0 0 0 0 0 2
Ventura 0 0 3 0 0 0 0 1 1 0 0 5
(blank) 0 0 0 0 0 0 0 1 0 0 0 1
Grand Total 10 33 35 60 2 0 0 70 20 38 1 269
2011 Organ Coroner CasesBy Circumstances of Death
CountyAlleged
Child Abuse
Alleged Homicide
Alleged Suicide
Deathby Natural
Cause
HospitalDeath: ER or
Outpatient
Hospital Death:
Inpatient
Motor Vehicle
Accident
Noneof the Above
Non-Motor Vehicle
Accident
Unknown/Other:
See CommentsGrand Total
Kern 0 0 1 3 0 0 2 1 1 0 8
Los Angeles 0 33 13 32 0 0 26 10 15 0 129
Orange 2 2 3 8 0 0 9 3 12 0 39Riverside 0 3 5 12 0 0 11 1 1 0 33San Bernardino 0 4 6 15 0 0 8 3 4 0 40
Santa Barbara 0 0 0 0 0 0 1 0 0 0 1
Ventura 0 0 1 0 0 0 0 2 0 0 3
Grand Total 2 42 29 70 0 0 57 20 33 0 253
2012 Organ Coroner CasesBy Circumstances of Death
CountyAlleged
Child Abuse
Alleged Homicide
Alleged Suicide
Deathby
Natural Cause
Drowning/Near
Drowning
HospitalDeath: ER or
Outpatient
Hospital Death:
Inpatient
Motor Vehicle
Accident
Noneof the Above
Non-Motor Vehicle
Accident
Unknown/Other:
See CommentsGrand Total
Kern 0 4 1 3 0 0 0 1 0 0 0 9
Los Angeles 4 13 10 42 0 0 0 33 6 16 0 124
Orange 0 3 7 3 0 0 0 7 3 6 0 30Riverside 0 2 1 8 1 0 1 6 2 6 0 27San Bernardino 3 3 2 14 0 0 0 11 2 5 0 40
Santa Barbara 0 0 1 0 0 0 0 2 0 0 0 3
Ventura 0 1 3 1 0 0 0 1 0 1 0 7
Grand Total 7 26 25 71 1 0 1 61 13 35 0 240
2013 YTD Organ Coroner CasesBy Circumstances of Death - as of September 2013
OneLegacy Organ CasesUnder Coroner Jurisdiction
2010 2011 2012 2013 YTD0
50
100
150
200
250
300
350
400
450
0%10%20%30%40%50%60%70%80%90%100%
349
417 391
322
219269 253 240
63% 65% 65%75%
Total Organ Cases Coroner's Jurisdiction % of Total
Org
an C
ases
% o
f Tot
al
OneLegacy Tissue CasesUnder Coroner Jurisdiction
2011 2012 2013 YTD0
200400600800
100012001400160018002000
0%10%20%30%40%50%60%70%80%90%100%
1600 1644 1577
990 1050 992
62% 64% 63%
Total Tissue Cases Coroner's Jurisdiction % of Total
Tiss
ue C
ases
% o
f Tot
al
When is it necessary to report a death to the coroner?
How has the collaboration between OneLegacy and the coroner increased
donation in our community?
Questions to Run On: