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Medical Examiner

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1. On what types of cases are autopsies performed?

The Medical Examiner takes jurisdiction over a wide variety of cases including unexplained, unexpected and violent deaths. The level of investigation and involvement of the medical examiner's office depends on the scene and circumstances of each death. It is up to the discretion of the Medical Examiner on which deaths an autopsy is performed. An autopsy is not usually required when there is adequate medical history to presume that the death is the result of natural causes and there is no evidence of foul play.

2. What is done during a forensic autopsy?

It is a specialized and complete autopsy done by a forensic pathologist on deaths that have legal significance. An autopsy is the postmortem examination that begins with a close external examination and description of the body. Photographs and x-rays are taken, and evidence is collected before a surgical opening the body and removal of organs. A systematic dissection and study of all the organs as well as chemical and toxicological studies of the tissues and body fluids are completed to determine the cause and manner of death. When the examination is complete, the death is certified and a written report is issued.

3. Who gives permission for the autopsy to take place?

The medical examiner's office is given authority to investigate sudden and unexpected deaths that occur in Snohomish County by the state of Washington, (RCW 68.50.010) and Snohomish County (Code 2.74.060). Permission from the family is not required.

4. What is the cost of an autopsy and who pays?

Snohomish County bears the entire cost of the death investigation and autopsy. There is a small fee for a copy of the autopsy report for those entitled to a copy.

5. Who is the next of kin?

Next of kin refers to the blood relatives of the decedent and becomes important in making decisions about funeral arrangements and personal property. The next of kin is the (a) surviving spouse, or such person as he or she may request to have appointed; (b) child or children; (c) father or mother; (d) brothers or sisters; (e) grandchildren; (f) nephews or nieces.
Note: Usually, Guardianship and Power of Attorney cease at time of death.

6. Can the next of kin prevent an autopsy?

No. The medical examiner's office will work with a family that presents a strong objection to an autopsy and may choose not to perform an autopsy in certain situations. However, the Medical Examiner will perform an autopsy when it is necessary to certify a death as per RCW 68.50.

7. Who has the responsibility to make the funeral arrangements for the deceased?

Under RCW 68.50.160, the right to control the disposition of the remains of a deceased person and the liability for the cost for the preparation, care, and disposition of the remains follow the order: (a) the surviving spouse; (b) the surviving adult children of the decedent; (c) the surviving parents of the decedent; (d) the surviving siblings of the decedent, (e) a person acting as a representative of the decedent under the signed authorization of the decedent.

8. Will the Medical Examiner Office recommend a funeral home?

No. The Medical Examiner Office neither recommends nor discourages the selection of any funeral home or crematorium. Links are provided under "Shortcuts - Related Links" to a listing of Washington State licensed funeral directors and establishments, as well as the telephone directory for funeral home services in Snohomish County.

9. What if they can't afford the arrangements?

In a very limited number of deaths where no family is found and no one is able to make funeral arrangements, Snohomish County has very limited funds to cremate the body. If a family is unable to pay for funeral arrangements and abandons the body ignoring their legal obligation under RCW 68.50.160, the Medical Examiner is forced to take action. In these instances the body will be cremated at county expense, but the family will have no right to make funeral arrangements. The remains will then be held for 1 year and a day in an effort to locate next of kin.

10. Is it necessary to come to the M.E. office to identify the body?

No. In most instances positive identification is established at the scene or by fingerprints, dental or medical x-rays. Rarely a family member or friend is asked to make an identification at the medical examiner's office.

11. What happens during the death investigation?

A death investigation has many components and can involve many different agencies depending on the scene and circumstances of the death. Usually law enforcement and the medical examiner's office are involved but the FBI, the prosecutor's office, coast guard, fire department, hospital, health department and many other agencies may be involved. It should be remembered that the medical examiner's office is a separate, independent agency from the law enforcement and the prosecutor's office.
From the medical examiner's office perspective, death investigation centers around the scene and circumstances of the death. Where did this person die and what were the events that led up to the death? Investigators from the medical examiner's office will talk to family and friends, neighbors, physicians, and law enforcement about the circumstances surrounding the death. Medical records will also be examined for information relevant to the death. A scene visit will be made by an investigator from the office to evaluate pertinent findings and gain a better understanding of the physical location of the death. In instances of homicide or suspicious death, one of the pathologists will accompany the investigator to the scene.
Examination of the body is also important to the investigation and is usually performed by one of the pathologists. This examination may or may not include an autopsy. Autopsies are performed at the medical examiner's office and the investigator transports the body from the scene to the medical examiner's office where the autopsy is performed. Following completion of the autopsy, the death is certified, although this can take up to six to eight weeks while waiting for toxicology results. An autopsy report is then written
The purpose of this process is to determine the cause and manner of death to a reasonable medical certainty and to prepare an unbiased record of the medical findings for a potential civil or criminal adjudication.

12. If the cause of death is obvious, why would the M.E. investigate?

The cause of death may seem obvious but it is often not the case. Even in hospitals with sophisticated diagnostic methods and technology, the diagnosis of a disease or the cause of death is wrong in an estimated 10%-15% of cases.
Autopsy means, "to see for oneself". An autopsy provides information that can be reliably obtained in no other way. It is especially important in those deaths that may wind up in civil or criminal proceedings. The autopsy provides for an unbiased, independent record of the anatomic findings made by a physician specifically trained in death investigation.

13. What happens to the personal effects of the deceased?

The medical examiner's office collects only the personal effects that are on the body at a scene. All other effects are left at the scene. The effects that are brought in are cataloged and held at the medical examiner' office until the next of kin can be contacted. If no family is found after 30 days, the effects are turned over to the Snohomish County Treasurer's office for disposal. Weapons that accompany the body are turned over to the investigating law enforcement agency.

14. Can the family view the body at the M.E.Office?

The medical examiner's office does not have the staff nor the facilities to prepare a body for viewing by the family. We understand you may wish to see the decedent as soon as possible. In consideration of this fact, we work with the funeral home of the families choice to expedite the release of the decedent for viewing purposes. You can then work directly with them to arrange the service. Rarely, a family member or acquaintance will be asked to make an identification of the decedent. Most identifications are made by fingerprints, dental or medical x-rays.

15. How do I make arrangements for the release of a body from the M.E.?

The medical examiner's office will release the body to the funeral home the family chooses. We need to hear directly from the family and not the funeral home. The body will not be released until the family's preference is known.

16. Who has access to the autopsy and investigative reports?

According to RCW 68.50.105, autopsy reports are confidential and can be obtained only by the family, attending physician, prosecuting attorney, law enforcement, public health officials or the department of labor and industries in cases in which it has an interest.

17. How can I obtain a copy of the autopsy report?

Autopsy reports will be released only to those that are authorized to have them. This includes family, attending physician, prosecuting attorney, law enforcement, public health officials or the department of labor and industries in cases in which it has an interest. They can be obtained by making a request to the medical examiner's office in writing or by phone. The request must indicate who is making the request and their relationship to the decedent. When the autopsy is ready, it can be picked up at the medical examiner's office in person by showing proper identification.

18. Is there a cost involved in obtaining reports from the M.E. office?

Yes, there is a cost. For autopsy reports, there is a $2.00 charge for the first page and $1.00 for each subsequent page. Autopsy reports are generally 9-10 pages but may be longer

19. Who can I speak to if I have questions about the reports I received?

The medical examiner's office is open to the public from 9:00 am to 5:00 pm Monday through Friday, except for holidays. If you have questions you can call the office and ask to talk with the investigator on the case. If they are not available, someone else will be able to help you.

20. How can I get a copy of the death certificate?

The Office of Vital Statistics, a division of the Snohomish Health District, and not the medical examiner's office issue death certificates. Death certificates can be obtained by calling vital statistics at (425) 339-5280.

21. What is the difference between a Coroner and a Medical Examiner?

A coroner is an elected official who may or may not have any training in death investigation or medicine. A Medical Examiner is a physician, a forensic pathologist, and in Snohomish County, a board certified forensic pathologist specifically trained in death investigation.

22. What is forensic pathology?

Forensic pathology is the study of unexpected, unexplained, or violent death. Many of the deaths examined by a forensic pathologist are natural in origin but are of an unexpected nature. Most of the other deaths examined by a forensic pathologist involve violence of one kind or another. The violence may be self inflicted or be inflicted by someone else. There may be evidence of physical violence in the form of injuries or chemical violence in the form of licit or illicit drugs. Forensic pathology involves the examination, documentation and interpretation of the findings on the body.

23. What are the requirements for board certification in forensic pathology?

To become a forensic pathologist, one needs to first become a physician. This means at minimum an undergraduate B.A. or B.S., good board examination scores, and some practical experience in medicine. Medical school includes 4 years of training; 2 years in didactic training, basic sciences, and 2 years of clinical training including various clinical rotations in medicine, surgery, obstetrics, pediatrics, and psychiatry.
Upon graduating from medical school, one needs to complete 4 or 5 years of residency training in anatomic and/or clinical pathology. During this time, in order to practice medicine, one has to pass the National Boards in Medicine. One of the years in residency is spent in research, internship in clinical medicine or other related clinical practice.
After completing residency in pathology, one needs to complete at least one year of fellowship training in Forensic Pathology. Some programs have a 2nd year of fellowship. Following completion of fellowship, in order to be a board certified forensic pathologist, one needs to pass board examinations in Anatomic Pathology and Forensic Pathology. The minimum time from graduation from college is 9 years.

24. Can I request that an autopsy be performed?

The Medical Examiner's Office does not do autopsies on demand. If a death falls under the medical examiner's jurisdiction the possibility of an autopsy will be considered. However, it is up to the pathologist's discretion to decide if an autopsy is performed or not. If the death does not fall under the jurisdiction of the office, an autopsy will not be done.