ANSWERS TO FREQUENT QUESTIONS
This FAQ section is divided into seven categories. Click on the blue links to the right for your topics of interest.
Families and Civilians
Here, you’ll find answers to questions you may have as a family member or friend of the deceased.
Physicians and Law Enforcement
Answers to questions you may have as a Physician or Law Enforcement Officer.
Reportable Death Criteria for Davidson County
Find out about Forensic Medical Management Services, PLC.
Answers to your general questions about Forensic Pathology.
Additional Resource Links
INFORMATION FOR FAMILIES
What hours are you open?
Our office is open to the general public 8:00 a.m. to 4:30 p.m. Monday through Friday, except major holidays. An investigator and a medical examiner are available 24 hours a day 7 days a week to accept reports of death.
Why is a body brought to the Medical Examiner’s Office?
Bodies of deceased persons are brought to this office because the law requires that the medical examiner investigate deaths of persons dying from “violence, or suddenly when in apparent health, or in any suspicious, unusual or unnatural manner.” The Medical Examiner is responsible for determining the cause and manner of their death. A body may also be brought to the Medical Examiner’s Office if the identity of the deceased or the next of kin is unknown.
What is an autopsy?
The word autopsy literally means to see for one’s self. An autopsy is a systematic examination of the body of a deceased person by a qualified forensic pathologist. The body is inspected for the presence of disease or injury and specimens of the vital organs and/or body fluids may be taken for microscopic, chemical or other tests. In rare instances, an entire organ might need to be retained for detailed examination and/or consultation with a specialist. These tests are conducted following conclusion of the examination and do not delay release of the body to the next of kin. The autopsy procedure usually takes several hours to complete. The fact that an autopsy has been conducted does NOT in any way interfere with having the body on view at the funeral.
Are all cases accepted by the Medical Examiner’s Office autopsied?
No. Autopsies are conducted for a variety of reasons, including documentation of injuries or determination of the cause of the death. Some cases may receive certain forensic tests combined with external examination of the body in lieu of an autopsy. The decision as to whether or not an autopsy will be performed is at the discretion of the forensic pathologist assigned to the case.
Can I prevent an autopsy from taking place?
The legal next-of-kin should inform our office of any objection they may have to an autopsy being performed. The Medical Examiner’s Office is sensitive to the needs of the family and will seriously consider their objection. However, in many cases an autopsy is required by law and we will be unable to comply with the family’s request.
Is there a charge for a medical examiner autopsy?
No. The costs for autopsies performed under the Medical Examiner system are paid for by our tax dollars.
How do I arrange to have the body released?
To have a body released from the Medical Examiner’s Office, the family must inform our office of the funeral director that has been selected. Our office will then directly contact the funeral director when the body is available for release.
When will the body be released from the Medical Examiner’s Office?
Nearly all cases are available for release within 24 hours after arrival. Occasionally, a body may need to be held longer than 24 hours for additional forensic testing or if special procedures are necessary to confirm the identity of the deceased.
How can a funeral director be selected?
Usually, the next-of-kin discusses the selection of a funeral director with other members of the family, clergy, or friends. Our staff is prohibited from recommending a funeral director.
Where may the deceased’s personal property be located?
In many cases, the property on the person of the deceased is transported to the Medical Examiner’s Office with the body. At our office, the personal property is inventoried, stored and released to the funeral director at the time of release of the body.
Where do I obtain a copy of the death certificate?
Death certificates can be obtained from the Health Department in the county where the death occurred, or from State Vital Records, (615) 741-1763.
Can I obtain a copy of the autopsy report?
Tennessee law states that medical examiner autopsy reports are considered public documents. Certified copies of the autopsy report will be prepared upon receipt of a written request with payment.
How long does it take to receive an autopsy report?
Most autopsy reports are completed and ready for release within 8-12 weeks. In certain cases, additional tests may need to be performed which will delay completion of the report for several additional weeks.
Who do I speak with if I have questions about the autopsy or the autopsy report?
Questions should be referred to the forensic pathologist who performed the autopsy.
Will acceptance of a case by the Medical Examiner’s Office mean that organ or tissue donation cannot take place?
No. The Medical Examiner’s Office supports the community efforts to promote organ and tissue donation whenever possible. Our staff will coordinate with the personnel of the organ bank to maximize the chance of organ and tissue recovery.
If we have no money for burial to whom can we turn for assistance?
In Nashville, the Metropolitan Government Social Service’s department may be able to assist families with financial problems. They can be contacted at (615) 341-4130.
INFORMATION FOR PHYSICIANS AND LAW ENFORCEMENT
What deaths should be reported to the Medical Examiner’s Office?
Reportable deaths are described in Tennessee Code Annotated, and include the death of any person from “sudden violence or by casualty or by suicide, or suddenly when in apparent health, or when found dead, or in prison, or in any suspicious, unusual or unnatural manner.” We recognize that these criteria are somewhat vague, and we encourage persons to report any deaths that they feel may meet these criteria. Our investigators are available 24 hours a day, 7 days a week to discuss the case with you and make a decision regarding Medical Examiner jurisdiction. Reportable Death Criteria Established by the State Medical Examiner Office
Who should report a death to the Medical Examiner’s Office?
Mandated case reporters include law enforcement officers, physicians, undertakers, and health care facilities. State law also provides that “any person” may report a death to the Medical Examiner’s Office.
What is a scene investigation?
When the death of an individual occurs outside of a health care facility, an investigator representing the medical examiner will respond to the scene and conduct a preliminary investigation. The purpose is to provide documentation of the scene of death for the determination of medical examiner jurisdiction and for the physician who will be conducting the autopsy, if ordered. This includes an examination of the scene, the body and their relationship. The findings of the scene investigation are preliminary and no final conclusions should be drawn from them.
Who has jurisdiction at a scene of death?
Generally, the local law enforcement agency has jurisdiction over the death scene and the medical examiner has jurisdiction over the body. At times, state or federal agencies will assume jurisdiction over a scene; however, the local medical examiner usually retains jurisdiction of the body.
How long will I have to wait for a scene investigation?
In Davidson and Williamson counties, an investigator from the Medical Examiner’s Office will generally arrive at the scene within an hour of notification. However, delays may occur if there are multiple scenes to investigate simultaneously. If an investigator anticipates there will be a delay, he or she will inform the appropriate persons.
Has body transport been called and when will they arrive?
The transport service is usually informed after we have been notified of the death. After conclusion of the scene investigation, they are contacted again and informed the body is available for transport to the Medical Examiner’s Office. They usually arrive shortly thereafter.
When are autopsies performed?
Autopsies are performed at the Medical Examiner’s Office every day of the year, including all major holidays. Autopsies generally begin between 8:00 and 9:00 in the morning and continue throughout the day as necessary. Autopsies are very rarely performed at night except in exceptional circumstances.
Who can attend an autopsy?
Law enforcement officials and health care providers are welcome to attend the autopsy of an individual in which they have a professional interest. These persons should contact our office to coordinate their attendance.
REPORTABLE DEATH CRITERIA ESTABLISHED BY THE STATE MEDICAL EXAMINER
The office of the Chief Medical Examiner enjoys a close working relationship with the health care facilities and providers throughout the state. Sometimes there are questions regarding which deaths need to be reported to the Medical Examiner’s Office. Tennessee State Law (38-7-108) states:
“Any physician, undertaker, law enforcement officer, or other person having knowledge of the death of any person from sudden violence or by casualty, or by suicide, or suddenly when in apparent health, or when found dead, or in prison, or in any suspicious, unusual, or other unnatural manner or where the body is to be cremated shall immediately notify the county Medical Examiner.
In the event such death occurs in a suspicious, unusual, or unnatural manner in a hospital, outpatient facility, nursing home, treatment resource, clinic, or other health care facility, the facility shall immediately notify the county Medical Examiner of the occurrence of such death. “
Due to the generalities in the state laws regarding reportable cases, we recommend that the following types of cases be reported to your county Medical Examiner in order that jurisdiction of these cases might be established.
Death when not under the care of a physician for a potentially fatal illness. Generally, we would define “care of a physician” as an ongoing physician – patient relationship where the physician has treated the deceased. This treatment does not necessarily have any defined time restrictions.
Death of a person when the attending physician, or his or her representative, is unavailable to sign the death certificate. (for example, out of state physician or physician on vacation)
Death occurring suddenly when in apparent good heath when the cause of death has not been established by medical treatment.
Death from violence of any type. All gunshot wounds, stab wounds, blunt trauma, fall related deaths, fire deaths, drowning, and motor vehicle collisions, regardless of the time elapsed from onset of incident to the time of death. (for example, if a person is shot with injury to the spinal column resulting in paraplegia then develops a urinary tract infection and sepsis at a later date, the death can be traced back to the injury and this is a reportable Medical Examiner case)
Death related to an overdose of illegal drugs, alcohol or legal medications (including natural or herbal remedies).
All deaths of children without a clear underlying natural cause of death. Any injuries in a child should alert you to contact our office for consultation, even when there is a natural disease present. Sudden infant death syndrome (SIDS) is a diagnosis of exclusion requiring a complete autopsy, and all suspected SIDS deaths must be reported to the Medical Examiner.
Death occurring in a prison or of a prisoner.
Death occurring on the job or related to employment.
Death believed to present a public health hazard.
Death of a patient during or as a result of a diagnostic or therapeutic procedure, a medication error, or adverse, allergic, or toxic reaction to a therapeutic agent.
Death of a nursing home or extended care resident when abuse, neglect, or overmedication is strongly suspected or confirmed as contributing to death.
Death of a fetus of greater than 22 weeks gestation and the death is related to an act of violence, maternal substance abuse, or an accident.
Death of a person from any cause when their identity is unknown or unclear.
Death when cremation of the remains is to be performed.
Tennessee State Law does not contain a “24 hour rule”. In other words, the death of any patient admitted to the hospital in the 24 hours preceding death does not have to be reported to the Medical Examiner unless the death satisfies the criteria outlined above. Also, the above criteria should serve as a guideline. If there are any questions regarding a death in your facility, you should feel free to contact our office for consultation. An investigator and a Medical Examiner are available 24 hours a day, 7 days a week and will be happy to assist you with any questions you might have. Acceptance of a case by the Medical Examiner does not mean that an autopsy will always be performed. These decisions are made by the Medical Examiner at his or her discretion.
ABOUT FORENSIC MEDICAL MANAGEMENT SERVICES, PLC
What is Forensic Medical Management Services, PLC and how does it differ from a traditional Medical Examiner’s office?
We are a professional practice group that provides a broad range of forensic pathology services. These services include all the functions you might expect from a traditional government-based medical examiner or coroner’s office, including death investigation, forensic autopsies, and expert medical testimony.
Who are the employees of Forensic Medical Management Services, PLC?
We are a group of people with a broad base of professional training and experience in forensic pathology and medical examiner systems. Our mission is to provide a high quality forensic service with compassion and understanding.
What is the training and experience of the person who performs the autopsy?
Physicians licensed to practice medicine in Tennessee and who have special training in pathology and forensic pathology are the only persons who perform autopsies at Forensic Medical Management Services, PLC. Each of our physicians is board certified by the American Board of Pathology in Anatomic Pathology, Clinical Pathology, and Forensic Pathology. Between us we have performed thousands of medicolegal autopsies and have years of experience in a variety of practice settings.
Do you testify in court, and if so, whom do you represent?
We testify in court routinely regarding deaths we have personally autopsied, as well as deaths autopsied by others that we have been asked to review. Either side in a trial can call a forensic pathologist as a witness in a trial. As an expert witness, we are able to provide medical and forensic opinions in addition to testifying to fact. As forensic pathologists, we feel that we represent the deceased during our testimony, as the deceased is no longer able to testify for themselves.
Can you provide “second opinions” on autopsy cases?
Yes. Our staff has extensive experience in reviewing autopsies performed and autopsy reports prepared by other physicians and providing a “second opinion” as to the cause of death and mechanisms of injury or disease.
What about “second autopsies”?
Yes. In some cases we are able to perform a “second autopsy,” where we examine the body after an autopsy has already been performed.
Can an exhumed body be autopsied?
Yes. Bodies that have been buried weeks, or even years later can be exhumed and an autopsy performed. The condition of the body may limit the information that can be obtained from an exhumation autopsy.
ABOUT FORENSIC PATHOLOGY
What is forensic pathology?
Forensic pathology is a subspecialty of medicine that studies the causes of human death. The word forensic originates from the Latin forensis, which means “of a forum.” A modern forensic pathology practice contributes to the health and safety of our community.
Who is a forensic pathologist?
A forensic pathologist is a physician who has received special training in pathology and forensic pathology. This training process lasts for up to six years after graduation from medical school. After completion of the training period, physicians can sit for examinations offered by the American Board of Pathology. If a passing grade is achieved on the examination, the physician is considered board certified. All of our staff members have completed this special training and are board certified in forensic pathology, as well as other areas of pathology.
What is the difference between a medical examiner and a coroner?
Medical Examiners and coroners are two different groups that provide a similar service to their communities. Coroners are part of an older system whose origins date back to England many centuries ago, and are usually elected lay individuals. Coroners contract with physicians to provide autopsies and medical expertise to support their investigations. In contrast, the Medical Examiner system is an American creation approximately a century old. Medical Examiners are almost always appointed to their positions, and should be physicians with training in medicolegal death investigation.
Does Tennessee have a Coroner or medical examiner system?
Currently, Tennessee has a medical examiner style system. There is an appointed State Chief Medical Examiner, whose responsibilities include administering the archives of the state’s Postmortem Examination Division, providing education and training for the County Medical Examiners, and medicolegal consultation for state and local officials. Each county in Tennessee has a locally appointed County Medical Examiner who is responsible for medicolegal death investigation in their respective counties. They may perform the autopsies personally or contract with a pathologist to perform the autopsies for them.
How is the Medical Examiner’s Office funded?
The Medical Examiner’s Office is funded by our tax dollars.
What is the difference between a medical examiner autopsy and a hospital autopsy?
medical examiner autopsies are governed by state law and assist the medical examiner in determining cause and manner of death. Permission of the next-of-kin is not required. In contrast, hospital autopsies can only be conducted with the permission of the next-of-kin and assist the medical staff with quality assurance and training. The actual autopsy procedures are similar in nature and scope, but not identical.
I am a big fan of the forensic shows on television. Do these shows accurately reflect the work of a medical examiner?
These forensic shows are very popular and provide a somewhat accurate but skewed perspective on the work of medical examiners. Television medical examiners act more as a detective than a medical examiner usually does. At times, their forensic abilities go beyond what is actually possible in real life. We can all remember Quincy, after completing his investigation, stating something like, “I can’t be exactly sure when he died, but it was somewhere between 6:00 p.m. and 6:12 p.m. last night.” In reality, Quincy should say, “I can’t be exactly sure when he died, but it was sometime between the time he was last seen alive and when he was found dead.” More realistic, but a lot less interesting for a television drama.
How do I become a forensic pathologist?
The training period is long and difficult. First you need to become a physician and graduate from either a medical or osteopathic school. After graduation, you would enter training (residency) in pathology and forensic pathology, which is currently a five year process. You would then be eligible to sit for examinations in order to become board certified in pathology and forensic pathology.
How do I become a Medical Examiner?
In most jurisdictions in the United States, a Medical Examiner needs to be a licensed physician. In some cases specialized training in forensic pathology is required (see previous question). This is typically an appointed position. Courses in death investigation are available from a variety of sources for those without previous training or experience.
Tennessee Laws and Rules
National Association of Medical Examiners
American Board of Medicolegal Death Investigators (ABMDI)
College of American Pathologists (CAP)