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Explore a range of natural deaths examined by the Nova Scotia Medical Examiner Service through case examples and investigation outcomes. Gain insights into unexpected deaths and reporting criteria. Learn about jurisdiction and notification protocols for different scenarios.
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Manner: Natural – Natural disease presenting as unexpected death Marnie Wood MD FRCPC (Anatomic and Forensic Pathology) ABP March 20, 2012
Objectives • Gain better understanding of natural deaths over which the Nova Scotia Medical Examiner Service (NSMES) assumes jurisdiction • Have an appreciation of the spectrum of natural disease seen by MES as unexpected deaths • View case examples of ME investigation of natural deaths
Introduction • May think violent/suspicious deaths are the majority of Medical Examiner cases
Introduction • Anecdotally Natural deaths compose 56% of autopsied NSMES cases (Accident 29%, Suicide 12%, Homicide 3%, Undetermined <1%) • The cause of death in majority is some variety of ASCVD or chronic ethanol abuse
Introduction • Natural deaths are reportable to Medical Examiner under several subsections of Fatality Investigations Act • May or may not assume jurisdiction over the reported death
Duty to notify Medical Examiner Service: • Death result of violence, accident or suicide • Unexpectedly when in good health • Where person not under care of a physician • Where cause of death is undetermined • Result of improper or suspected negligent treatment by a person
Definition of unexpected varies markedly depending on perspective • Tragic does not equal unexpected • Cause of death need not be determined with 100% certainty • Opinion based on reasonable interpretation of data
Notify ME where person dies in health-care facility and there is reason to believe: • Death result of violence, suspected suicide or accident • Death result of suspected misadventure, negligence or accident on part of attending physician or staff • Cause of death is undetermined • Stillbirth or neonatal death where maternal injury before admission or during delivery • Within 10 days of surgery, or during anaesthesia
Death in Health Care Facility • Threshold for taking jurisdiction over deaths during medical intervention tends to be high • Accidental or intentional overdose of medication • Injury from malfunction of equipment (eg electrocution) • Procedure outside of scope of licensed practice • Complication beyond reasonable/foreseeable • Consider any allegations being made
Death in Health Care Facility • Tragic does not equal unexpected, accidental or negligent • Cause of death need not be determined with 100% certainty • May be able to determine cause without knowing exact mechanism
Notify of deaths in custody • Death while detained, or in custody in a correctional institution • While an inmate is in Hospital • While in custody under Children and Family Services Act • While detained by, or in custody of peace officer
Notify of death related to employment or occupation • Where person dies as result of: • Disease or ill health • An injury sustained by the person • A toxic substance introduced into the person Probably caused by or connected with the person’s employment
Typically do not take jurisdiction: • Natural Manner when sufficient clinical information with which to form reasonable opinion of cause of death • Natural Manner where mechanism of death was a reasonable/foreseeable complication of appropriate medical therapy • Deaths during surgery/treatment for natural disease • Natural Manner where occupational disease did not contribute in any way
Of reportable, typically take jurisdiction over: • All accidents, homicides, suicides • All possible accidents, homicides, suicides • Where negligence is alleged • All in custody, regardless apparent manner • All possibly related to occupation • Where insufficient clinical information to determine cause of death
Introduction • Deaths occurring under these circumstances are investigated by the Medical Examiner, through review of scene and history information, +/- autopsy to determine • Identity of deceased • Time and place of death • Cause and manner of death
Case 1 • 64 year old woman • Found deceased in bed, no recent complaints • Recent long flight • No known medical history
At autopsy: • Abundant pulmonary edema • Subarachnoid hemorrhage concentrated at base of brain
Case 2 • 55 year old woman • Found collapsed in bedroom, unresponsive with labored breathing, arrest prior to EHS • Death declared at scene • Six month history increasing shortness of breath, palpitations following flu-like illness
At autopsy: • Serous pleural and pericardial effusions • Abnormal texture of organs