Certifying a Death in Vermont
Death Investigation in Vermont
Vermont law created a statewide medical examiner system back in the mid 1950's. From its inception, death investigation has relied upon community based local death investigators coordinated through a central system led by a forensic pathologist, the chief medical examiner.
This system has evolved over the years from local investigators the majority of whom were physicians, to today's statewide cadre of advanced emergency medical service technicians, paramedics, and nurses, as well as physicians.
- Chief Medical Examiner - Steven Shapiro, MD
- Deputy Chief Medical Examiner - Elizabeth A. Bundock, MD, Ph.D.
- Local Medical Examiner Coordinator - Lauri McGivern, F-ABMDI
- Office Manager - Jennifer Sumner
- Records Specialist - Karen Dean
- Local Medical Examiners - Approximately 60 individuals statewide whose backgrounds include service as doctors, nurses and advanced emergency medical technicians.
How the System Works
There are only two places where an individual can die. Either in a health care facility such as a hospital, or somewhere else.
Death outside of a Health Care Setting
When someone is found dead by another person either in a residence or outdoors the usual response is to call 911. This call will activate the police, who will respond to the scene and make an assessment. Unless the death is suspected as in a person sent home with hospice or some other home health care provider, a local medical examiner should be contacted and “(t)he medical examiner and a designated law enforcement officer shall thereupon together immediately make a proper preliminary investigation. 18 V.S.A. § 5205 (b)”.
If preliminary investigation indicates no "suspicious" circumstances, and information gathered from the scene, interviews and the person's primary care physician can determine the cause and manner of death, the OCME will issue the death certificate. If however initial investigation indicates something “suspicious,” the cause or circumstances of death are uncertain or the state's attorney or chief medical examiner, deem it necessary and in the interest of public health, welfare and safety, or in furtherance of the administration of the law, the body will be transported to the OCME facility for further investigation. That investigation may range from a detailed visual inspection, right up to a full medical autopsy, with associated ancillary testing (including, but not limited to toxicology, histology, radiograph, and photography).
Death within a Health Care Setting
The following procedures should be followed when a physician or other health care provider is asked to certify a death under their care:
1. Evaluate if the death is reportable to the medical examiner. In VT these are described under 18 V.S.A. § 5205(exit VDH). Also see reportable deaths.
Familiarity with local law is essential. If it is unclear whether the death is reportable, it is wise to report it, there is no charge for doing so (1-888-552-2952). If the medical examiner accepts the case then they will certify the death.
If the medical examiner declines jurisdiction and asks for the death to be certified, proceed to Step 2. Of course, before reporting a case one must know something of the circumstances of the death which may require contacting another physician or reviewing the medical record. (see #2).
2. Evaluate if there is a more appropriate certifier. Physicians are often asked to certify deaths of patients about whom they have little or no personal knowledge. Examples include emergency room physicians, hospitalists, and cross covering physicians.
In these instances contacting the personal or attending physician should be attempted as they may be able to more accurately and completely certify the death. If there is no one more appropriate, proceed to Step 3.
3. Certify the cause of death as accurately as possible.
Local (Assistant) Medical Examiners
The local (assistant) medical examiners are individuals with extensive experience in the medical profession which may include medicine, nursing, emergency medical work who meet the training and certification requirements for death investigation established by the chief medical examiner and approved by the commissioner. 18 V.S.A. § 508.
Local medical examiners serve under the direction and supervision of the chief medical examiner. They are usually the first-contact people for death notification, and duties include triaging calls, gathering initial information, visiting death scenes, and working with local law enforcement, State’s attorneys, emergency services, hospitals, families, etc. Once primary information is obtained, the local examiner will consult with the OCME. In short, these professionals are the OCME "first responders."
Become a Local Medical Examiner
If you are interested in becoming a local medical examiner, or would like more information, please contact Local Medical Examiner Coordinator Lauri McGivern at Lauri.McGivern@state.vt.us.