Updates the procedures for taking charge of a body, recording the findings and conclusions of the death in the permanent records, relinquishing charge of a body, fetal deaths and remains, amends the procedures for deaths as a result of traffic ...

DEPARTMENT OF LAW ENFORCEMENT
Medical Examiners Commission

RULE NO.: RULE TITLE:
11G-2.001: Determination of Jurisdiction, Preliminary Procedures
11G-2.002: Identification
11G-2.003: Investigation
11G-2.004: Physical Evidence
11G-2.005: Records, Autopsy Report
11G-2.006: Practice Guidelines

PURPOSE AND EFFECT: Updates the procedures for taking charge of a body, recording the findings and conclusions of the death in the permanent records, relinquishing charge of a body, fetal deaths and remains, amends the procedures for deaths as a result of traffic accident, who to notify when a body is released, removes inaccurate rule language and statute references, and makes grammatical corrections. Updates the procedures for identifying unidentified bodies, identifying fetal remains, clarifies existing rule language, and makes grammatical revisions. Updates the procedures for determining the cause and circumstances of a death, release of human remains, and performing autopsies. Clarifies that research during investigation of a death is prohibited; relocates text to another rule section, deletes unnecessary rule language, renames a rule paragraph to better describe the paragraph’s contents, makes grammatical revisions, provide guidelines for the retention and destroying of organs, tissues, sections, or fluids. Makes grammatical corrections, adds additional information for official records that shall be maintained by the district medical examiner, and revises the information required for autopsy reports. Updates the Medical Examiners Commission’s Practice Guidelines incorporated into Rule 11G-2.006, F.A.C., by reference.

SUMMARY: Revises procedures for notification of death, findings and conclusions of death, notification of legally authorized persons of a death, relinquish charge of a dead body, examination of dead body, investigation of death prior to the release of human remains; removal of obsolete rule language; statistical reports; clarification of current rule language; unidentified human remains; examinations required for deaths resulting from violence; revises rules for performing an autopsy; research guidelines; custody and surrender of dead bodies; autopsy report; and how to obtain a copy of the Practice Guidelines.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein:

OTHER RULES INCORPORATING THIS RULE: N/A.

EFFECT ON THOSE OTHER RULES: N/A.

The proposed rule is not expected to exceed any of the criteria set forth in Section 120.541(2)(a), F.S., and thus, a legislative ratification is not required under Section 120.541(3), F.S. This determination is based upon the nature of the subject matter of the proposed amendment.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 406.04 FS.
LAW IMPLEMENTED: 406.11, 406.13, 406.145 FS.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Donna Hunt at [phone], or [e-mail], or write to Florida Department of Law Enforcement, Criminal Justice Professionalism Program, 2331 Phillips Road, Tallahassee, Florida 32308

 

THE FULL TEXT OF THE PROPOSED RULE IS:

11G-2.001 Preliminary Procedures.

(1) When a death is reported to the medical examiner pursuant to Section 406.12, F.S., or the medical examiner learns or is notified of a death in his or her district the medical examiner shall: If a medical examiner becomes aware of a death within the district that may be a death which must be investigated under the terms of Section 406.11, F.S., the medical examiner shall make such inquiry as is necessary to see if jurisdiction exists for an investigation.

(a) Make inquiry to determine whether to examine, investigate, or autopsy pursuant to Section 406.11, F.S., and to determine whether to take charge of the body pursuant to Section 406.13, F.S.

(b) Record the findings and conclusions supporting the medical examiner’s determination of cause of death in the permanent records of the medical examiner, in sufficient detail to allow a review of the circumstances, regardless of whether examination of the body or certification of the death by the medical examiner is required.

(c) Notify the person having custody of the body when the medical examiner has relinquished charge of a body not in the custody of the medical examiner.

(2) If a medical examiner is notified of a death and the medical examiner determines that jurisdiction under Section 406.11, F.S., does not exist, the findings and conclusions supporting that determination shall be recorded in the permanent records of the medical examiner’s office. The person having control of the body shall be notified of the determination.

(2)(3) If a medical examiner makes an investigation solely pursuant to in order that human remains may be disposed of under the terms of Section 406.11(1)(c), F.S., the medical examiner shall relinquish charge of the body when the medical examiner has autopsied the body, or has determined the cause of death by inquiry. may give or deny permission for such disposal under one of the following conditions:

(a) Not until the medical examiner has autopsied the body, or has determined the cause of death by inquiry, shall the medical examiner relinquish jurisdiction for cremation, anatomic dissection, or burial-at-sea. The medical examiner may, absent information to the contrary, rely on the information found on a signed death certificate as being true and accurate.

(b) Excepting medical specimens, fetal remains or other dead human tissue for which a regular death certificate is not required, unidentified human remains shall not be cremated, donated for anatomic dissection, or buried at sea.

(c) Fetal deaths for which cremation, anatomic dissection or burial-at-sea of the remains is intended must be referred to the medical examiner for investigation. For the purposes of this section, “fetal death” is defined by Section 382.002, F.S. The medical examiner shall keep an accurate record of each such investigation in such sufficient detail to allow a review of the circumstances.

(3)(4) If a medical examiner becomes aware of a death, apparently from disease, he or she shall investigate it as a death from a disease constituting a threat to the public health, if:

(a) The investigation is requested by an appropriate official of the Department of Health pursuant to Section 381.0011 or 381.0012, F.S., or

(b) The medical examiner determines that additional information concerning the cause and mechanism of death, beyond that available in the decedent's medical history, is needed to protect the public health.

(4)(5) If the medical examiner takes charge of a body pursuant to determines that jurisdiction for an investigation under Section 406.11(1)(a) or (b), F.S., he or she does exist, he shall:,

(a) Inform the person who has custody having control of the body that, pursuant to Section 406.12, F.S., that Sections 406.12 and 382.008, F.S., the body should not be embalmed or otherwise prepared for burial or disturbed until examined by the medical examiner;,

(b) Arrange for transportation of the body; and for examination of the scene of death or injury,

(c) Notify the appropriate law enforcement official having jurisdiction over persons, criminal scenes or investigations, physical evidence, or records, pursuant to Section 406.14, F.S.;,

(d) Notify the Department of Motor Vehicles if the death is the result of a traffic accident, pursuant to Section 316.065(2), F.S., as necessary,

(d)(e) Ensure that the legally authorized person next of kin is notified that the medical examiner examiner’s office is investigating the death, when this can be done without hindering the legal purpose of the investigation and the identification and location of the legally authorized person next of kin is readily available. The contact with the legally authorized person next of kin, or the attempt to contact, shall be documented in the medical examiner’s case file, whether such contact or attempt to contact is made by the medical examiner examiner’s office or through other persons or agencies such as hospital personnel, law enforcement agencies, funeral homes or friends of the deceased;, and

(e)(f) Promptly notify the legally authorized person next of kin, authorized funeral home, or other representative when the body can be released, provided the identification and location of the legally authorized person next of kin or representative is known.

(5)(6) Section 406.05, F.S., provides for cooperative arrangements among the several districts and Section 406.08(2), F.S., provides for fee payment when an autopsy is performed on a body when the death occurred outside the district. When such a cooperative arrangement is for the purpose of transporting the body of a person who dies in one medical examiner district (hereafter, district of jurisdiction) to another for autopsy or examination (hereafter, district of examination):

(a) The physician performing the examination must have a statutory appointment as an associate medical examiner in the district of jurisdiction pursuant to per the provisions of Rule 11G-1.002, F.A.C.

(b) For each transfer of a body the medical examiner in the district of jurisdiction shall maintain in his or her files documentation of the agreement for the transfer; shall assign a case number from the district of jurisdiction; and shall maintain copies of any reports of examination or opinion by the appointed associate medical examiner, records of identification of the body, and records of the transfer and release of the body to the legally authorized person next of kin.

(c) The medical examiner of the district of examination shall maintain in his or her files documentation of the agreement for the transfer and shall include the case number of the district of jurisdiction on all signed reports.

(d) Statistics that are For Annual Workload reporting purposes for creation of the Annual Report per Section 406.02, F.S., statistics that are required to be sent to the Medical Examiners Commission staff shall be reported by the district of examination.

Rulemaking Specific Authority 406.04, 406.05, 406.08 FS. 406.02, 406.04, 406.05, 406.08, 406.11, 406.13 FS. History–New 10-18-81, Amended 7-10-85, Formerly 11G-2.01, Amended 8-27-87, 11-24-87, 10-14-96, 7-6-99, 6-9-08,________.

 

11G-2.002 Identification.

(1) If necessary to make an identification, or prior to the burial of any unidentified body, the medical examiner shall: The body shall be identified as soon as possible. If necessary to make an identification, the medical examiner shall:

(a) Photograph and record a detailed description of the body; clothing, and personal effects;

(b) Obtain complete skeletal x-rays;

(c) Create thorough dental charts and x-rays;

(d) Retain samples for possible DNA profiling; and

(e) Obtain a complete set of fingerprints, if possible, and these shall be forwarded to the Department by the medical examiner or through the investigating law enforcement agency.

(2) An identification photograph shall be taken of any body in the custody of the medical examiner. In all cases, a photograph of the face shall be taken.

(3) Unidentified remains of any person, in the custody of the medical examiner, that require a certificate of death pursuant to Section 382.008, F.S., shall not be cremated, donated for anatomic dissection, or buried at sea. The medical examiner shall retain unidentified remains and preserve them in accordance with the law.

(4) In the case of criminal homicide, the medical examiner shall take all actions necessary so that he can testify to the identity of the deceased.

Rulemaking Specific Authority 406.04 FS. Law Implemented 406.11, 406.13, 406.145 FS. History–New 10-18-81, Formerly 11G-2.02, Amended 8-22-00, 3-21-07,________.

 

11G-2.003 Investigation.

(1) A medical examiner shall investigate under the authority of Section 406.11, F.S., in order to determine the cause of death and such circumstances surrounding it as are necessary and in the public interest. Such an investigation shall consist of examinations or investigation as the medical examiner shall deem necessary, including but not limited to:

(a) An examination of the scene of death or injury and physical evidence;

(b) Questioning of relatives, witnesses, prior attending physicians, or law enforcement officers;

(c) An examination of the deceased’s medical records;

(d) An examination or autopsy of the body, including the testing of specimens as provided in Rule 11G-2.004, F.A.C., and a complete or partial dissection;

(e) Such photographs as needed to record the findings.

(2) Medical examiner autopsies performed pursuant to Section 406.11, F.S., shall be performed by pathologists or directly supervised residents in pathology. Performance shall require in situ examination of the tissues pertinent to determining the cause of death and the removal of viscera pertinent to the determination of the cause of death. Removal of other organs and tissues during the autopsy shall be under the direct supervision of the pathologist. Direct supervision requires the presence of the supervising pathologist in the autopsy room. A medical examiner shall not sign a death certificate unless he or she has made such investigation as needed to assure the accuracy of the findings.

(3) A medical examiner shall not:

(a) Opine a cause or manner of death, an identification of a dead body, or a disease or injury unless he or she has made such investigations, examinations, autopsies, and laboratory examinations to render an informed opinion; or

(b) Release human remains from custody until he or she has made such autopsies and has retained such specimens and effects to opine a cause or manner of death, an identification of a dead body, or a disease or injury, or support a criminal investigation.

(4) Examination for alcohol and appropriate chemical and drug concentrations shall be done in any autopsy when the death has resulted from violence and has occurred within twelve hours of injury.

(5) Absent good cause, an autopsy shall be performed when:

(a) A reasonable suspicion exists that a death might be by criminal violence or by any violence sustained in prison, a penal institution, or police custody.

(b) A reasonable suspicion exists that the death is by accident, suicide or poison, unless:

1. The death is by poison and the deceased has survived in a hospital for a time sufficient to metabolize the poison, or

2. The death is by accident or suicide and the cause of death can be determined from a review of the circumstances, history, and available medical records.

(c) The death of a child is apparently natural and occurs suddenly while in apparent good health.

(d) The circumstances of death are unusual or suspicious by reason of the body being unidentified after investigation, charred, or completely or partially skeletonized.

(3) A complete autopsy shall be performed when the death:

(a) Is alleged or suspected to be by criminal violence;

(b) Occurred while in police custody;

(c) Occurred in any prison or penal institution;

(d) Appears to have been by gunshot wound;

(e) Is suspected to be as a result of poisoning;

(f) Is suspected to be as a result of Sudden Infant Death Syndrome;

(g) Appears to have been by suicide; or

(h) Whenever requested or directed by the State Attorney under law.

(4) An autopsy is generally needed to complete the investigation of deaths:

(a) Resulting from motor vehicle or aircraft accident;

(b) From a disease constituting a threat to the public health;

(c) By apparent drowning;

(d) In a state institution; or

(e) Otherwise by violence.

(5) This rule serves to require investigations and autopsies in certain circumstances, but does not limit a medical examiner in exercising the authority contained in Chapter 406, F.S.

Rulemaking Specific Authority 406.04 FS. Law Implemented 406.11, 406.13 FS. History–New 10-18-81, Formerly 11G-2.03, Amended 8-27-87, 9-23-93, 12-3-03,________.

 

11G-2.004 Physical Evidence, Body Parts, Specimens.

(1) Definitions. The following definitions apply to this section:

(a) “Body part”. The entire head, an entire extremity, a portion of an extremity that includes a hand or foot, or the torso, of a dead human body. For human skeletal remains a body part is defined as a nearly complete skull, or most of the bones of extremity, or most of the bones of the torso.

(b) “Organ”. An entire internal viscus, such as a brain, heart, larynx, lung, stomach, or uterus of a dead human body.

(c) “Tissue”. A representative sample of a body part or organ, constituting a minority of the volume or mass of the part or organ.

(d) “Embedded tissue”. Tissue which has been embedded in paraffin blocks, or the like, for the purpose of histological study.

(e) “Sections”. Tissue mounted on glass slides for the purpose of histological staining.

(f) “Stained sections”. Sections which have been stained for the purpose of microscopic examination.

(g) “Fluid”. Liquid from a blood vessel, body cavity, hollow viscus, hematoma, or abscess of a dead human body. Fluids include blood, vitreous humor, bile, gastric content, urine, cerebrospinal fluid, and effusions.

(h) “Specimen”. A body part, organ, tissue, fluid, embedded tissue, section, or stained section; or a swab from a body part, organ, tissue, or body surface.

(i) “Physical evidence”. An item or items taken during an investigation which is believed to be pertinent to the determination of the cause of death, manner of death, identification of the deceased, determination of disease, injury or intoxication, or which is taken to answer anticipated questions in any investigation. Includes specimens.

(j) “Retained”. With respect to specimens, kept by the medical examiner after the release of the remains to the legally authorized person next of kin.

(k) “Research”. Any one of the following:

1. Procedures designed for therapy or resuscitation, performed on a dead human body for experiment or practice, unrelated to the determination of cause of death, mechanism of death, manner of death, presence of disease, injury, or intoxication, or identification of the deceased.

2. Testing of body parts or organs for purposes unrelated to the determination of cause of death, manner of death, presence of disease, injury, intoxication, or identification.

3. Testing of tissues or fluids by an experimental scientist that results in no report to the medical examiner.

4. Research does not include test development, test validation, quality assurance testing, or investigative work, utilizing tissues or fluids, when the tissues or fluids are received by a laboratory in support of a death investigation by a medical examiner.

(l) “Next of Kin”. “Legally authorized person” as defined by Section 497.005(37), F.S.

(2) The medical examiner shall seize such physical evidence as shall be necessary to determine the cause and manner of death, presence of disease, injury, intoxication, and identification of the decedent, or to answer questions arising in criminal investigations, and shall label, prepare, analyze, examine, and catalog such evidence as needed.

(3) Examination for alcohol and appropriate chemical and drug concentrations shall be done in all deaths resulting from violence to persons over ten years of age, when death occurs within twelve hours of injury.

(3)(4) Physical evidence Evidence shall be retained by the medical examiner as follows:

(a) Stained sections shall be preserved indefinitely and embedded tissue preserved for at least ten (10) years.

(b) Fixed organs shall be retained until the medical examiner has completed his or her studies of them.

(c) All other specimens shall be retained for one year.

(d) All other physical evidence not released to another investigative agency or to the owner shall be retained for one year.

(e) Physical evidence Evidence that is retained for any period longer than is specified above must be held in accordance with Rule 11G-2.006, F.A.C.

(4)(5) Requests for independent examination and analysis of physical evidence in the custody of the medical examiner shall be allowed by the medical examiner under his or her supervision and control in a manner designed to provide maximal preservation of the physical evidence. Unless compelling reasons dictate, irreplaceable, non-duplicable and non-divisible physical evidence such as embedded tissue shall not be released for independent analysis and examination.

(5)(6) Physical evidence specimens no longer required to be retained by the medical examiner shall be disposed of.

(6)(7) Procedures Concerning Body Parts.

(a) Human remains released by a medical examiner to the legally authorized person next of kin shall include all body parts unless the legally authorized person next of kin explicitly agrees agree to claim an incomplete body.

(b) If human remains recovered by the medical examiner are incomplete owing to dismemberment or decomposition, and there is a possibility that further body parts will be discovered subsequently, the legally authorized person next of kin shall be given the choice of claiming incomplete remains, or waiting to claim the remains until further parts are recovered.

(c) If a body part such as a skull requires special examination, release of the remains should be delayed until the special examination is completed unless the legally authorized person next of kin explicitly chooses choose to claim incomplete remains.

(d) Body parts retained by the medical examiner shall be subsequently released to the legally authorized person next of kin or disposed of pursuant to paragraph (6)(e) of this rule section the wishes of the next-of-kin.

(e) Body parts not claimed by the legally authorized person next of kin are considered biomedical waste [Section 381.0098(2)(a), F.S.] and shall be destroyed by legally prescribed means, at the expense of the medical examiner.

(f) Evidentiary aspects of retained body parts shall be preserved by documentation by writing, photography, radiography or other indirect means, or by retention of tissue samples. Body parts themselves shall not be retained as evidence for legal proceedings.

(g) Permission of the next-of-kin is not required to retain organs, tissues, sections, or fluids for the determination of cause of death, manner of death, disease, injury, intoxication, or identification of the deceased.

(h) Permission of the next-of-kin is not required to destroy retained organs, tissues, sections, or fluids.

(7)(8) Retention, Utilization, and Destruction of Specimens Research.

(a) Permission of the legally authorized person next of kin is required for:

1. Retention of specimens solely for the purpose of research.

2. Research procedures, designed for therapy or resuscitation, performed on a dead human body for experiment or practice, unrelated to the determination of cause of death, mechanism of death, manner of death, presence of disease, injury, or intoxication, or identification of the deceased.

(b) Permission of the legally authorized person next of kin is not required for:

1. To retain organs, tissues, sections, or fluids.

2. To destroy retained organs, tissues, sections, or fluids.

3.1. For the The utilization of specimens for teaching and educational purposes, or publication in scientific or medical publications, or other purposes that are not research, when the specimens were retained for the determination of cause of death, manner of death, disease, injury, intoxication, identification of the deceased, or preservation of evidence.

4.2. For the The utilization of medical examiner records for teaching and educational purposes, or publication in scientific or medical publications, when the records were created in the course of medical examiner death investigations

Rulemaking Specific Authority 406.04 FS. Law Implemented 406.11, 406.13 FS. History–New 10-18-81, Formerly 11G-2.04, Amended 8-27-87, 10-14-96, 7-29-01, 11-30-04,_________.

 

11G-2.005 Records, Autopsy Report.

(1) The district medical examiner District Medical Examiner shall keep among the official records:

(a) The appointment as district medical examiner DME by the Governor;,

(b) A copy of each letter of appointment, resignation, and removal of an associate medical examiner; AME,

(c) A log or registry of all cases referred to the medical examiner; examiner’s office,

(d) Records of all investigations performed, including findings, laboratory reports, photographs, and autopsy reports;,

(e) Photocopies Copies (typed) of all death certificates Death Certificates signed by a DME or AME in his capacity as a medical examiner;, and

(f) All other notes or documentation forming a record of an investigation; and.

(g) Documentation of the custody and surrender of dead bodies.

(2) Autopsy Report:

(a)(2) The detailed findings of each autopsy shall be included in an autopsy report. The autopsy report shall be typed and shall only include the objective results of the examination of the body and the toxicologic samples. The circumstantial history and toxicologic correlations shall constitute a separate portion of the investigative report.

(b) The autopsy report shall be typed and shall include among the case identification data the following information:

1. The medical examiner district or county;

2. The place, date, and time of the autopsy;

3. The name of the decedent, if known;

4. The medical examiner case number;

5. The name of the medical examiner responsible for the opinions; and

6. The name of any other pathologist who performed or assisted with the autopsy.

(c) The autopsy report shall be signed by the medical examiner completing the autopsy and the signature line shall be dated.

(d) The autopsy report shall clearly distinguish objective observations from opinions. Among the objective observations to be included or appended shall be the gross observations, any microscopic observations, and any results of toxicology tests. Among the opinions to be included shall be the cause of death.

(3) Any death certificate signed by a DME or AME in the capacity of medical examiner shall show the address of the District Medical Examiner’s office.

Rulemaking Authority 406.04 FS. Law Implemented 406.11, 406.13 FS. History–New 10-18-81, Formerly 11G-2.05, Amended 6-3-10,________.

 

11G-2.006 Practice Guidelines.

The duties and standards of care of a medical examiner are to be consistent with those contained in the “Practice Guidelines for Florida Medical Examiners, sponsored Sponsored by the Florida Association of Medical Examiners,” revised July 28, 2010, which publication is dated 11-19-2009 and is hereby incorporated by reference. The Practice Guidelines can be obtained at the Florida Department of Law Enforcement, Post Office Box 1489, Tallahassee, Florida, Attention Medical Examiner’s staff.

Rulemaking Authority 406.04 FS. Law Implemented 406.075, 406.11, 406.13 FS. History–New 7-29-01, Amended 11-30-04, 3-21-07, 6-3-10,________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Donna Hunt

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Governor and Cabinet

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: November 15, 2011

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: October 14, 2011