The Fulton County Medical Examiner
Atlanta, Georgia

How You Can Help Us (and Information to Help You)

NOTE: This section contains information designed to assist various people and agencies who interact with the Fulton County Medical Examiner, such as hospital staff, private physicians, funeral homes, law enforcement officers, and the general public. If you were to print out this section, it would take about 30 pages. You may wish to read through the information and "cut, copy, and paste" those sections which are applicable to you. We hope the information provided will help you learn more about how we operate; answer common questions that you may have about our operations; and help you in your interactions with us.

FULTON COUNTY MEDICAL EXAMINER'S OFFICE

(404) 730-4400

Deputy Chief Medical Examiner

Rev. August 1999

INDIGENT DISPOSITION

The Office of the Fulton County Medical Examiner's Office was created on March 24, 1965, and operates under the Fulton County Commission in accordance with state and local statutes in the State of Georgia.

The office, is located at the Fulton County Medical Examiner’s Center (FCMEC), 430 Pryor Street SW, Atlanta, Georgia 30312. The FCMEC has facilities for forensic pathology, investigative, and support services to aid in the investigation of deaths defined by law as being subject to public inquiry.

This manual was written to familiarize those persons and organizations who work most closely with the FCME with our policies, procedures, and statutory duties. The goal of the manual is to outline our needs and duties so that agencies and organizations with whom we interact can understand our role and assist us in the orderly discharge of our responsibilities. It is hoped and expected that this information will result in a better understanding of needs that arise during death investigations, and how you, your agency, or your organization can assist the FCME in conducting quality death investigations.

The Medical Examiner is a physician and forensic pathologist who is authorized by Fulton County, Georgia, to investigate sudden, unexpected, violent, suspicious or unnatural deaths that occur within the county. The main function of the Medical Examiner is the determination of the cause, manner, and circumstances of death which are of concern to the public health, safety and welfare.

There are several reasons why an accurate determination of the cause, manner, and circumstances of death is essential to our society:

• The innocent should be exonerated.

• Homicide, foul play, and unnatural death should be recognized

• Criminal and civil court proceedings should be provided with documented,  sound, and impartial medical evidence and opinion.

• Unrecognized hazards to public health and safety should be revealed.

• Occupational hazards should be detected and evaluated.

Jurisdiction is vested in the Fulton County Medical Examiner over certain deaths if the events leading to death occur in Fulton County, or, if the place of onset of the fatal event(s) is not known and the body is found in Fulton County. Jurisdictional criteria is specified in the Georgia Death Investigation Act (Official Code of Georgia Title 45-16-20). The following explains the types of deaths described in that statute. All of them must be reported to the Medical Examiner's Office.

Anyone who becomes aware that a person has died under any of the following circumstances must report the death immediately to the Fulton County Medical Examiner. The Georgia Death Investigation Act provides failure to appropriately report a death is a misdemeanor. The investigation of death is a timely matter. Any delay in reporting can create increased investigative difficulties and hamper the investigation.

The criteria of reportable deaths are taken from the Georgia Death Investigation Act. We have attempted to clarify the legal terminology in a more understandable manner. Although we have tried to be as complete and specific as possible in compiling this list, we realize there will always be cases that may not fit the criteria exactly or which are subject to interpretation. Please call the Medical Examiner's Office if you are uncertain whether a case falls within our jurisdiction and whether or not you should report the death. Our phone number is (404) 730-4400.

The following types of deaths should be reported to our office:

1) Persons who die suddenly when in apparent good health or without medical attendance preceding death. This category should be reserved for the following situations:

• Sudden death occurring in a person without a known natural cause;

• Death occurs within 24 hours of admission to a hospital during an acute or unexplained rapidly fatal illness, for which a reasonable natural cause has not been established; or, a person is admitted to the hospital in coma and dies within 24 hours without having regained consciousness;

• Deaths occurring in anyone who does not have a licensed physician;

• Deaths of persons in nursing homes or other institutions where medical treatment is not provided by licensed medical personnel;

• Deaths where no physician can certify that death is due solely to natural causes

2)   Circumstances indicate death caused entirely OR IN PART, by unnatural or unlawful means. This category includes all types of injury and/or poisoning and typically includes:

• Drowning, suffocation, smothering, burns, electrocution, lightning, radiation, chemical or thermal injury, starvation, environmental exposure, neglect;

• Unexpected death during, associated with, or as a result of, diagnostic or therapeutic medical or surgical procedures;

• Deaths from narcotics or other addictions, other drugs, including alcohol or toxic agents, or toxic exposure;

• Death thought to be associated with, or resulting from, occupational injury.

• Death thought to be caused by unlawful termination of pregnancy (abortion);

• Deaths occurring from apparent natural causes during the course of a criminal act; i.e., victim collapses during a robbery;

• Death following all injury producing accidents, if recovery was considered incomplete or if the accident is thought to have contributed to the cause of death (regardless of the interval between accident and death).

3)  Suspicious circumstances. This category includes, but is not limited to, deaths under the following circumstances:

• Deaths resulting from apparent homicide or suicide;

• Hanging, gunshot wounds, stabs, cuts, strangulation, etc.;

• Deaths occurring during the course of, or precipitated by, a criminal act;

• Deaths that occur while in a jail, prison, in custody of law enforcement, or other state or county institutions such as mental institutions.

4) Unknown or obscure causes. This category includes:

• Bodies that are found dead without and apparent natural cause. (See Criteria #1)

• Deaths during or following an unexplained coma.

5) Deaths caused by any violence whatsoever, whether the primary cause or any contributory factor in death. This category includes but is not limited to:

• Injury of any type including falls

• Any deaths due to, or contributed to, by any type of physical trauma, chemical injury, or intoxication or poisoning.

6) Contagious disease. This category includes only those deaths wherein diagnosis is undetermined and a contagious disease which may be a public health hazard is possibly the cause of death.

7)   Bodies that are not claimed. This category may involve cases where no next-of-kin or other legally responsible representatives can be identified for disposition of the body.

8)  Premature or stillborn infants. The Medical Examiner has an interest if intrauterine fetal demise or birth with subsequent death may have been precipitated by maternal injury, criminal negligence, or abortion under unlawful circumstances.

9) Unidentified deceased. A death cannot be accurately certified if the identity of the deceased is not known. Our office will accept jurisdiction in such cases.

Overall, this list of cases reportable to the Fulton County Medical Examiner can be summarized as follows: A death should be reported if it was sudden, unexpecetd, and unexplained with reasonable medical certainty, or, death was thought to have been brought about or hastened by an injury or poisoning (regardless of the interval between the injury and death), or, death occurred while in custody of a law enforcement agency, or in a state or county institution.

After receiving a report of a death, a determination will be made by a Medical Investigator as to whether or not to assume jurisdiction (further investigate the case in order to certify the cause and manner of death). The Medical Examiner's Office will assume jurisdiction of all cases involving any type of trauma (injury or poisoning), accident, or violence, or, if based on the decedent’s age, medical history, and circumstances of death, the death is sudden, unexpected, and not reasonably explained. Cases that are reported to the Medical Examiner that do not result in further investigation follow a Decline Jurisdiction (DJ) procedure. These cases most frequently are those in which the deceased was not recently seen by a physician but a significant medical history exists and death is almost certainly due to natural causes. Cases are also declined when circumstances indicate that the death should have been reported to the medical examiner or coroner of another county because the incidents leading to death occurred in another county.

The Medical Examiner's Office applies a rather narrow interpretation of the legislative language about people who come to their death suddenly when in apparent good health, and without medical attendance preceding death (A Georgia Death Investigation Act). If both conditions (lack of medical care and apparent good health) apply, the Medical Examiner's Office will usually take jurisdiction. If one or both conditions do not apply, the case may be placed in the DJ category. For all DJ cases (except those that should have been reported to another county), a prerequisite is that the FCME must be able to locate a physician who has knowledge of the patient's medical history and is able to reasonably certify death as being due solely to natural causes (disease and/or aging process). Thus, we try to locate the deceased’s attending physician. Medical attendance is defined as having a physician (physician of record) responsible for a person's care. It does not mean that the physician has to be present at the time of death, nor does the physician have to have seen the patient recently.

A record of all deaths reported to FCME is kept on file in the Medical Examiner's Office. Each DJ case is given a number and basic details are documented in a case report.

THE PRACTICING PHYSICIAN AND THE MEDICAL EXAMINER

Some physicians may be confused as to their responsibility to the Medical Examiner. The purpose of this section is to clarify that responsibility.

The relationship between the Medical Examiner and the practicing physician can be mutually beneficial. The cooperation of physicians whose patients have become Medical Examiner cases is frequently instrumental in making an accurate certification of the cause of death. This is particularly true in supplying medical and psychological history and medical records. The Medical Examiner is often able to provide physicians with an accurate determination of the cause of death when an autopsy is performed.

The Medical Examiner's responsibilities do not revolve solely around certifying criminal deaths or serving in the prosecution of criminals. In practice, and as provided for in several Georgia Codes, the Medical Examiner inquires into deaths impartially to prepare a record of facts which are available to anyone whose lawful purpose requires them, whether these be for criminal or civil legal purposes, or other purposes that serve the public or an individual. Also, the Medical Examiner is charged with certifying the cause, manner (homicide, suicide, accident, natural, or undetermined), and circumstances of death which are reasonably accurate and acceptable for purposes of vital statistics.

When there has been no physician in attendance, there is obviously no one other than the Medical Examiner who can sign the death certificate. The Medical Examiner thus has clear authority to proceed with investigation in these cases. Where there has been previous medical attention, the attending physician may be required to provide the Medical Examiner with copies of the medical records and any other pertinent information that would assist the Medical Examiner in case management and disposition. The Medical Examiner has authority to subpoena such records. Evaluation of medical records and history form the basis and legal grounds for the Medical Examiner to decline jurisdiction or authorize further investigation an possible postmortem examination. The Medical Examiner will make the decision to accept or decline jurisdiction of a case based on the sum of the facts learned from the physician and evaluation of the circumstances surrounding death.

It is important to bear in mind that inquiry by the Medical Examiner or one of his/her investigators into the manner or mode of medical treatment is done to ascertain whether there are sufficient grounds for the Medical Examiner to proceed, or, to clarify the circumstances surrounding death, or, to assist in the evaluation of findings at postmortem examination. With rare exceptions, the primary purpose of such inquiry does not involve judgment or evaluation of the adequacy or propriety of any particular treatment.

Cases which the Medical Examiner finds are not within the jurisdiction of the office will be referred to the physician whose responsibility it is to sign the death certificate. The FCME will be happy to assist physicians with instruction for proper certification of death or provide references to educational materials. A tutorial on death certification is located on the internet at www.TheNAME.org (go to main menu and select "Help with Cause-of-Death Statements."

In most instances, the FCME is quite willing to discuss autopsy findings with any physician who was caring for the patient and may also provide a copy of the autopsy report if one is requested by the physician and there is no legal basis for denying such a request.

If a physician is called to, or is present at the scene of death and is quite satisfied that the death is outside the jurisdiction of the Medical Examiner, the Medical Examiner need not be called and the body can be released to the funeral home. If, in the opinion of the attending physician, criteria have been met which require the reporting of the death to the Medical Examiner, the physician should ensure that the death is promptly reported by telephone to the Medical Examiner's Office (404-730-4400), any time of day or night. The office number is monitored 24 hours a day. Whenever a question exists about whether to report a death, it should be reported. Qualified Medical Examiner investigative personnel will make an assessment quickly and expeditiously and provide appropriate guidance. A physician should approach the next-of-kin about performance of an autopsy at the hospital only after it has been determined that the death is not a medical examiner’s case, or, if the medical examiner has accepted jurisdiction on the case but will not need the body for postmortem examination.

The attending physician, upon learning that the Medical Examiner's Office has accepted the jurisdiction of the death, may report this to the family so they are aware of the fact that the body will be removed by the Office of the Medical Examiner and that there is a probability this office will conduct a postmortem examination. In those instances in which this office accepts jurisdiction, the body will be transported to the Office of the Medical Examiner under the direction of the Medical Examiner’s Investigator.

In Medical Examiner cases, and especially in possible homicide cases, no postmortem examination, removal of clothing or effects, or handling the body in any manner by persons not associated with the Medical Examiner should be performed except by specific authorization of the Medical Examiner's Office and only to the extent needed to properly prepare the body for transport. All medical devices such as airways and intravascular lines should be left in place.

When patients die in the emergency room and especially if death is apparently due to injury of any type, all efforts should be made to keep track of the clothing, personal effects, and other items with the body so they can be made available to the medical examiner. If clothing must be removed by cutting in the emergency room, it is important to avoid cutting through any pre-existing defects in the clothing.

If a patient has been injured and is in critical condition, it is very important to accurately document and describe all injuries in the medical record. If possible, photographs should be taken as well. Such procedures become very important if the patient survives for a long period of time and then dies, in which case the original injuries may be obscure, difficult to evaluate, or healed. In homicide cases and other cases in which some legal proceeding may eventually occur, such information and documentation can be invaluable in management of the case.

For additional information, see "Guidelines for Hospital Staff" below.

If any attending physician wishes to attend the autopsy, this request should be made to the Medical Examiner. Every effort will be made to accommodate the request.

When it has been determined that the death of a patient does not meet the criteria for the Medical Examiner to take jurisdiction and therefore certify death, completion of the death certificate becomes the responsibility of the attending physician. The requirement for certification is a statement of the disease processes or sequence of condition(s) which started the sequence of fatal events and ultimately resulted in death.

Some physicians express uncertainty about why a patient died even though they have been treating the patient for a condition that is associated with sudden death; e.g., a hypertensive patient, apparently well controlled, who collapses suddenly and dies in view of many witnesses. The physician may feel that such a death is unexplained and needs an autopsy for specific anatomic diagnosis. Depending on the age of the patient and other factors, this death would possibly be viewed as being outside the Medical Examiner's jurisdiction since the medical history provides a background for a reasonable, natural cause of death; i.e., hypertensive heart disease.

A second example may be useful. A patient with diagnosed, long-standing alcoholic cirrhosis may die suddenly with no suspicion surrounding death. The anatomical reason may be ruptured esophageal varices or pneumonia or pulmonary embolus. However, the certification requirement is simply alcoholic cirrhosis; the terminal condition (e.g., varices) does not necessarily have to be established to certify death, although it is desirable to do so in order to certify the death as accurately and completely as possible.

A well-written cause-of-death statement makes clear the entire sequence of conditions which led to death, such as:

Bilateral aspiration pneumonia

due to or as a consequence of:

Subarachoid hemorrhage

due to or as a consequence of:

Rupture of berry aneurysm, anterior communicating cerebral artery

Other significant conditions: Systemic arterial hypertension

Absolute certainty is not needed to certify a death. The stated cause of death merely reflects the best opinion of the certifier based on information that is available. Only reasonable medical probability is required ("more likely than not"). If a significant error is discovered at a later date, death certificates can be changed (amended). It is acceptable to use probable to identify a suspected final event; i.e., "probable rupture of esophageal varices due to or as a consequence of alcoholic cirrhosis of the liver," or "probable atherosclerotic coronary artery disease."

The most important item to list in the cause of death is the underlying cause of death (such as atherosclerotic coronary artery disease), which is the disease that started all of the medical complications that lead to death. It is also desirable to include the immediate cause of death (such as acute myocardial infarction) that ultimately caused death and any intermediary causes (such as coronary artery thrombosis). Sometimes, however, the immediate and intermediary causes may not be known although the underlying cause is virtually certain. In such cases, it is acceptable to list only the underlying cause of death.

If a more specific determination of the cause of death is desired by the physician, he/she is free to seek autopsy permission from the family after clearing the death with the Medical Examiner.

Mechanistic terminal events include cardiac arrest, cardio-respiratory arrest, etc., and are so general as to be meaningless for purposes of death certification. They should not be written on the death certificate. If a physician has difficulty in completing the death certificate, she/he may consult with the Medical Examiner's Office. Other guidance is also available on the internet at www.TheNAME.org.  To go there, click here>>>>  Writing Causes of Death

If an accident or any type of injury (such as hip fracture due to a fall) causes or contributes to the death, the death is within the jurisdiction of the Medical Examiner and should be reported. Common types of cases that may be overlooked as medical examiner cases include delayed complications of burns, post-traumatic seizure disorders, pulmonary embolism due to immobility related to an injury, and complications of falls in the elderly.

If you are certifying a death and are tempted to certify the manner of death as an accident, suicide, homicide, or undetermined, you should report the death to the medical examiner. Physicians who are not medical examiners should only certify deaths which are due solely to natural causes (disease and/or the aging process).

WHEN AUTOPSIES ARE PERFORMED

Whether to perform an autopsy is the discretion of the Medical Examiner if jurisdiction has been accepted. In general, if a reasonable and probable cause of death can be deduced from the decedent's medical history, the circumstances surrounding death, and an external examination of the body, an autopsy may not be necessary. On the other hand, public interest results in an autopsy being performed when death involves homicide, an inmate who dies in penal incarceration (unless it is a hospice situation with an expected death within the infirmary or a hospital), an individual whose death is suspicious, or deaths suspected to be due to injury of any type. Such deaths often result in legal proceedings which are facilitated by having well-document postmortem information available. False claims or allegations can also be more adequately addressed.

The forensic autopsy is a special kind of autopsy, performed for special reasons. It must be emphasized that there are differences between a hospital autopsy and a forensic autopsy. Reasons for doing an autopsy which most physicians learn during medical school, internship and residency are mostly medical, scientific and for academic reasons. The hospital autopsy is directed principally towards substantiating the accuracy of a clinical diagnosis, the effectiveness of therapy, to evaluate the extent of disease, to determine more completely the cause of death, or for quality assurance reasons.

The reasons for performing a medico-legal (forensic) autopsy include the following:

1. To determine the cause of death where it cannot be determined otherwise.

2. To collect evidence from the body.

3. To document findings useful in clarifying time and circumstances of death.

4. To obtain evidence aiding in the identification of the body.

The concept of "public interest" is of importance in determining which Medical Examiner cases require an autopsy. Public interest is often high in the following types of cases:

• Homicides and deaths suspected of being homicides.

• Deaths occurring in jail, prison, under police custody, or in other state or local institutions.

• Suspicious deaths (suspected of being traumatic or due to foul play but not obviously so).

• Unexpected and unexplained deaths suspected to be due to infectious agents or other causes of public health interest.

Other cases in which an autopsy is usually in the public interest include:

• Sudden, unexpected and unexplained deaths in the young (including the Sudden Infant Death Syndrome) without any history of potentially fatal disease.
• Occupational accidents and on-the-job deaths.
• Suspected drug overdose or poisoning.
• Airplane pilots.
• Driver of a motor vehicle accident wherein other persons were involved.
• So-called accidental gunshot wounds.
• Unrecognizable bodies wherein identification is a question.
• Any death in which the manner (natural, homicide, suicide, accident or undetermined) is in question
• Unexpected deaths during surgery and therapeutic procedures.
• Sudden collapse and death in a public place.
• Apparent suicides, especially in public places.
• Deaths of famous people or public figures

Cases that may not require an autopsy often include the following:

• Apparent natural deaths in the elderly.
• Apparent natural deaths in persons of any age with a history of potentially fatal disease if the circumstances of death are known; are consistent with death being due to that disease; and there is no evidence to the contrary.
• Delayed injury deaths if the nature and circumstances of injury are determined and well documented.

In general, if a reasonable and probable immediate and underlying natural cause of death can be deduced on the basis of the decedent's medical history, the circumstances surrounding death and a careful examination of the body, an autopsy is may not necessary. It is our general practice, however, to perform an autopsy whenever death results from the immediate effects of an injury (or poisoning) or death or is suspected as having resulted from an injury (or poisoning) because of the high likelihood that such deaths will raise legal issues. We also perform an autopsy when death is sudden, unexpected, and not reasonably unexplained, even if death appears to be due to natural causes.

The cooperation of hospital staff is essential for the smooth operation of the Medical Examiner's Office.

It is recommended that each hospital appoint a responsible agent(s), office or individual(s) with whom the Medical Examiner can communicate regarding Medical Examiner cases in the hospitals. The agent who is appointed must be well versed with procedures in reporting cases to the Medical Examiner's Office. The FCME office will provide in-service orientation to the responsible agent(s), if needed. Please contact our office to arrange this training, (404-730-4400). Upon determining that a death falls under the jurisdiction of the Medical Examiner, the designated agent should make the report by telephone to the Medical Examiner's Office (404-730-4400). At this time, information regarding the deceased's medical history must be available in order to provide sufficient information to the medical examiner.

In order to assist the Medical Examiner, hospital personnel should use the following procedures with a Medical Examiner case. All are designed to most accurately determine the cause and manner of death.

• Do not clean a body or clothing after death

• Special care should be used in cutting and handling of clothing so that valuable evidence such as bullet holes remain intact.

• All the clothing of the deceased should accompany the body

• Any I.V. lines, tubes, and catheters should be left in place, as well as endotracheal tubes, dressing, splints, clamps and orthopedic devices. Reusable therapeutic paraphernalia of value will be returned to the hospital upon request

• Avoid using injury sites for chest tubes, drains, etc. This greatly assists the pathologist in the interpretation of injuries.

• Do not bind the arms, legs or jaw after death.

• Any blood, urine, gastric material, or other body fluid collected at the time of

  admission (or as close to that time as possible) should be saved and retrieved

  from the lab, if necessary, and accompany the body to the morgue.

• If possible, admitting blood and urine should be saved on all patients classified

  in critical condition if their death would result in jurisdiction of the Medical

Examiner. This may be helpful in determining cause, manner, and

          circumstances of death.

• If the family wishes to view the body before removal, this is permissible

        provided the body is not cleaned or otherwise disturbed. In cases where there

        is a potential criminal investigation, viewing should be strongly discouraged.

        The Family should be encouraged to wait until the body is at the funeral home

        to view it.

• If surgery has been performed, the location of all debrided tissues and removed

        foreign bodies (such as bullets) should be determined so they may be made

        available to the medical examiner.

• When the medical examiner assumes jurisdiction and perinatal or neonatal deaths,

        the placenta is also usually needed for examination. Arrangements should be made

        to make it available to the medical examiner.

• The medical records department should prepare to copy portions of the record

        requested by the medical examiner. At a minimum, this usually includes the

        admission history and physical, the death/discharge summary, and laboratory

        reports. Progress notes are also often needed.

The hospital pathologist when requested to do an autopsy should be sure, from the review of the history, that the death is not in the Medical Examiner's jurisdiction. If there is doubt, and the Medical Examiner has not been notified of the death, it is prudent to notify the Medical Examiner and to abide by his/her instructions. If any autopsy commences and during the course of an autopsy it becomes clear that the case should have been in the Medical Examiner's jurisdiction, the autopsy should be stopped at that point and the Medical Examiner's Office consulted to ascertain the Medical Examiner's requirements in the case. The hospital staff should not request autopsy permission from the family when the death is clearly a Medical Examiner case. Physicians should wait to approach the family for permission or autopsy until it has been determined that the death does not fall under the medical examiner’s jurisdiction or that the medical examiner will not need the body for an autopsy. If the family has refused autopsy permission, and then the Medical Examiner is notified, needless difficulties can occur, including claims that the Medical Examiner was called just to get an autopsy.

The Medical Examiner is authorized to perform autopsies by the Georgia Death Investigation Act. No permission is needed by the Medical Examiner in order to perform autopsies, unlike the hospital autopsy where permission of the family or legal agent is required.

If an autopsy is clearly required for medicolegal purposes, it will usually be performed by the Medical Examiner. In rare instances, the medical examiner may take jurisdiction in the case but allow the hospital to perform an autopsy if they have obtained permission.

Interested physician(s) may attend a Medical Examiner's autopsy and/or receive a copy of the autopsy report unless providing such a report may interfere with a criminal investigation or is in conflict with other laws or legal procedures.

Instances may arise where the Medical Examiner has jurisdiction in a death, e.g., hospitalized patient with a fractured femur sustained in a fall at home, but clinicians desire an autopsy authorized by the next-of-kin to be performed by the hospital pathologist. This can usually be accomplished if the following procedure is followed:

• Notify the Medical Examiner's Office of the death immediately with a clear

  statement of events which caused the injury. A Medical Examiner investigative

  record will be prepared and a case number assigned to the death.

• Inform the investigator taking the call that an autopsy is desired at the hospital for

  clinical interest. Do not request autopsy permission from the family until

  assessment has been made by the Medical Examiner that a hospital autopsy can

  be performed and that the medical examiner will not need to perform an

  autopsy.

• If the death has been assessed by the Medical Examiner and approval given to seek

  autopsy permission from the surviving next-of-kin, the physician can then

  request permission from the next of kin. If permission is not granted, an

  autopsy obviously will not be performed.

• Once the autopsy is completed, a copy of the report should be forwarded to the

  Medical Examiner's Office to complete the record. The FCME will complete

  the death certificate in such cases.

                                                      ORGAN AND TISSUE DONATION

When death falls under the jurisdiction of the Medical Examiner's Office, requests from organ/tissue procurement agencies to proceed with organ or tissue procurement (donation) MUST be cleared by the Medical Examiner. Permission of the legal-next-of-kin is also required, This office’s policy is to facilitate organ/tissue when possible, and we authorize requests in most cases. The removal of organs or tissues on violent deaths must be coordinated with the duty Medical Examiner. The duty Medical Examiner or his designee must be notified for clearance for the procedure, to document removal and, if necessary, examine organs removed. The Medical Examiner's Office must be immediately contacted about any potential transplant donor. On cases where organ or tissue removal is made, copies of authorization forms, signed by the family, must accompany the body to the office. The information must clearly state which organs and tissues were (or are to be) donated.

Some procurement agencies procure organs/tissues prior to autopsy and others do it after the autopsy. Such procedures depend on the nature of the donated tissue and on the policies and procedures of the procurement agency. Our office cooperates in both settings.

Although Georgia’s presumed consent law allows medical examiners to release cornea tissue without expressed family permission (as long as no objection is known), our office requires that the family authorize such donation. Cornea procurement is organized through the Georgia Eye Bank and other tissue procurement agencies, as needed.

There will be circumstances not covered by the above. Please ask questions as required any time of the day or night. Remember, when in doubt, contact the Medical Examiner's Office for information.

Death investigations conducted by the Medical Examiner's Office are designed to complement the police agency investigation and are not intended to replace or interfere with that investigation. All violent deaths and all deaths that occur without medical attendance fall under the jurisdiction of the Medical Examiner's Office (Georgia Death Investigation Act). Law enforcement officers should be aware of the Medical Examiner's jurisdiction, duties and responsibilities. The Medical Examiner's Office must be notified promptly of the existence and location of a body coming under its jurisdiction. The telephone number of the Medical Examiner's Office is 404-730-4400 and is monitored 24 hours a day , seven days a week.

NON-HOMICIDE SCENE INVESTIGATION:

Following the report of a death, a Medical Examiner Investigator will respond to the scene when the nature of death requires a response. The person who notified the FCMEO will be instructed that the body and its immediate surroundings should remain undisturbed until the Medical Examiner Investigator's arrival at the scene. Any disruption of the scene or movement of the body must be reported to the Medical Examiner Investigator upon his or her arrival. If tentative identification of the deceased is absolutely necessary by law enforcement officers prior to notifying the Medical Examiner, they may take possession of the wallet or purse. Law enforcement officers then will be responsible for the property and document contents on a property form and place the property into evidence until the next-of-kin takes possession.

The Medical Examiner Investigator's responsibilities at the scene of death are primarily: (1) determining the circumstances surrounding death; (2) collection, documentation and safe-keeping of property and potential evidence which is on the body or in its immediate surroundings; (3) notification of the death to the next-of-kin if such notification is not performed by the law enforcement agency; and (4) controlling the proper removal of the body from the death scene.

In cases of apparent suicide, the Medical Examiner Investigator will take possession of any suicide note, as well as the instrument of death. Wherein a question exists as to whether a death resulted from a suicide or homicide, it will be investigated as a homicide and the law enforcement agency will usually take custody of relevant physical evidence. The Medical Examiner Investigator, in general, does not search the body or the premises without a witness being present. Law enforcement officers may be asked to witness the search and sign relevant documents as a witness to the items taken into custody by the Medical Examiner Investigator.

In some deaths, a medical examiner may also be present at the scene in addition to the medical examiner investigator.

HOMICIDE SCENE INVESTIGATION:

For a death in which there is clear evidence of homicide, a Medical Examiner Investigator will respond to the scene in most cases. It is extremely important in homicide cases that the body of the deceased, including the immediate surrounding, not be moved or disturbed in any way inconsistent with police crime scene investigative techniques. Any such movement or disruption will be reported to the Medical Examiner. After photographs are taken and the scene investigation is completed, the Medical Examiner will take possession of the deceased along with the clothing and other apparel worn on or attached to the body, and other potential evidence integral to the body. The homicide detectives will take possession of all other evidence relating to the death including the weapon (if not in the body), and will secure the scene.

In all homicide scenes, an attempt should be made to keep the number of people going to the scene to a minimum unless needed for organized searching or scene processing. This prevents confusion, hastens the investigation, and prevents unnecessary disturbance and loss of important evidence. The collection of evidence such as fingernail scrapings, collection of bodily hair and fingerprints from the deceased are usually postponed until the body is at the morgue for autopsy.

Where it is unclear whether or not the death was the result of a homicide, law enforcement agencies are urged to utilize the resources and expertise of the Medical Examiner's Office in determining the cause of death. Until the cause of death is clear, the death scene should be treated with the same care utilized in a homicide case. When a death being investigated by the Medical Examiner's Office comes into question as a possible homicide, the Medical Examiner Investigator will immediately notify the law enforcement agency having jurisdiction (if they are not already present) and preserve the scene until their arrival. The death will then be investigated as a potential homicide case by all parties concerned.

As soon as it is confirmed that a traffic death has occurred, that death must be reported to the Medical Examiner's Office. The body is not to be moved from the scene of the accident without the authorization of the Medical Examiner. If the body is in public view, it should be covered and care should be taken to keep the public view of the body at a distance and at a minimum. If a body is in danger of being mutilated or damaged at the scene, it should be moved only so far as to get it out of the troubled area, i.e., freeway center lane to shoulder, such movement must be reported and details of the body position prior to movement recorded.

If the body is removed from the vehicle, it is imperative that information regarding position of the body in the vehicle and the usage of restraint system be documented and reported to the Medical Examiner Investigator.

Vehicles should not be moved from their original position except where; (1) the Medical Examiner's Office will not be responding (victim died at a hospital); and (2) where, in the judgment of the law enforcement officers at the scene, traffic flow problems would likely result, or where public safety would be in jeopardy. Movement of the vehicle must be documented and reported to the Medical Examiner Investigator upon his or her arrival.

It is the responsibility of the Medical Examiner's Office to analyze, as appropriate, blood samples from all drivers and pedestrians who are killed in a traffic accident. In some cases, these samples must be obtained from the hospital.

In order to prevent considerable inconvenience to all involved, it is requested that law enforcement agencies, when needed, ascertain the name of the family physician and any medications being taken by the decedent, but not contact the family physician. Usually, police arrive at the scene prior to the medical examiner, and having such information available can be of help to the medical examiner investigator. Any questions that may arise should be given to the Medical Examiner Investigator who will answer them or direct them to the family physician and document them in his or her report. Appropriate medications, either prescribed or of unknown origin may be taken by the Medical Examiner Investigator for analysis, identification and determination of drug levels.

It is requested that as soon as possible an official copy of the incident report and subsequent investigative report compiled by law enforcement be provided to the Medical Examiner's Office when death falls under the jurisdiction of the medical examiner. Such documents included in the medical examiner case folder will not be released to the public. All requests for access to or copies of police investigative reports or other reports from outside agencies will be referred to the relevant agency.

It is anticipated that the Medical Examiner responsible for any portion of the investigation or examination of criminal cases will be routinely subpoenaed to appear in court. The Medical Examiner and other personnel are available to the prosecuting (plaintiff) or defense attorneys to discuss any testimony prior to trial. It should be recognized and understood by both prosecutor and law enforcement officers that the Office of the Medical Examiner, or any member of the staff, are not an arm of prosecution. The Medical Examiner staff are to be considered independent, objective, professional, unbiased witnesses without vested interest in the outcome of the trail. The medical findings of the Medical Examiner may be made available to representatives of the defense as well as the prosecution. Pretrial conferences are strongly encouraged.

OTHER:

It is a goal of our office to investigate the scene of death in all cases which come under our jurisdiction and in which the body is dead at the scene outside of a medical care setting. Other death scenes are investigated as needed. It is also a goal of our office to have an investigator and/or medical examiner view or examine the body in every case in which death will be certified by the office.

It is the responsibility of medical aide personnel responding to the scene to ascertain whether medical measures are needed.

When it can clearly be determined by simple inspection that medical attention would be of no avail, the body and surroundings should not be disturbed. The Medical Examiner's Office must be notified immediately upon determination of an apparent natural death outside of a medical care setting. In the event of a violent death, the Medical Examiner's Office and the affected law enforcement agency must be notified immediately. It is important that the body and its surroundings be preserved in its original position. Your responsibility will be to preserve the scene until relieved by either the Medical Examiner Investigator or concerned law enforcement agency.

If the body is in public view, it should be covered and care taken to keep the public back and away. In the rare instance, if the body is in danger of being damaged or mutilated at the scene, it should be moved, but only so far as to get it out of a dangerous area; i.e., from a highway lane to the shoulder. The body should be outlined with chalk prior to movement. It cannot be overemphasized that care be taken at the scene of a violent death, and that movement of articles; i.e., firearms, knives, etc., be made only when absolutely necessary during life threatening situations. Any movement must be made with extreme caution so as not to destroy possible evidence; i.e., fingerprints. Any movement must be documented and presented to the Medical Examiner Investigator or law enforcement officers on their arrival.

Under no circumstances should medical aide personnel probe or place any objects into wounds, such as a bullet or knife wound. Such probing could destroy valuable evidence which is important in the proper interpretation of injuries. In cases of ligature strangulation, if there is reason to believe that the victim may respond to first aid measures, the ligature should be removed by cutting in some location well away from the knot. The type of knot, the position of the knot and the general appearance of the ligature all contribute to the Medical Examiner's conclusions as to the cause and manner of death. Under no circumstances should the knot be untied.

Medical aide personnel should leave any I.V. lines, tubes and dressings in place. Any needle or other puncture wounds made by medical aide personnel where lines are not still in place may be circled with a ball-point pen. If at all possible, the emergency treatment run sheet indicating aide personnel, names, time, day, observations and actions taken relevant to the treatment of the deceased, should be promptly provided to the Medical Examiner Investigator.

Medical aide personnel are reminded to remove from the scene all articles that they may have introduced, such as used bandages, gloves, wrappers and I.V. lines not attached to the body. Such articles contaminate a crime scene and must be accounted for during the investigation and following legal proceedings.

Frequently, medical aide personnel have valuable information about the terminal event. Examples include whether foreign material or objects were present in or removed from the airway, or whether intubation attempts were met with difficulty. Any information concerning the event should be reported to the Medical Examiner Investigator or investigating law enforcement agency. Please feel free to contact the Medical Examiner's Office regarding any questions or information you may have.

Since it is often the responsibility of the Medical Examiner's Office to notify the next-of-kin, medical aide personnel are asked not to search the body, clothing or premises for identification. This information will be given to those interested parties upon request by the Medical Examiner's Office. An exception to this rule is when a patient is comatose and unable to communicate, you must search the decedent to find any medical tags, bracelets or necklaces. If this search is with negative results, you may look to the wallet or purse for any information which would help in diagnosing and treating the patient. This property then becomes your responsibility and must be turned over to law enforcement or to or the Medical Examiner Investigator. PLEASE DO NOT TURN THIS PROPERTY OVER TO ANYONE ELSE. Please document your actions on the emergency medical run sheet. This action will greatly reduce any problems which might occur when many people handle personal property. Medical aide personnel, excluding the emergency physician, are asked not to contact the family physician as this will cause unnecessary duplication of inquiries. If contact is made during the life maintaining efforts, this contact should be reported to the Medical Examiner Investigator upon his or her arrival or documented on the emergency run sheet.

Medical Aide personnel may have occupational exposures to blood-borne or airborne pathogens. Those with such concerns should follow their agencies exposure protocol and have their safety officer or medical director contact the FCMEO at 404-730-4400.

Nursing home personnel should be familiar with all types of deaths to be reported to the Medical Examiner (see above).

Deaths which occur in nursing homes are not required to be reported to the medical examiner just because death occurred in a nursing home. The same applies to a licensed hospice. If the patient died from a natural disease process or from the natural sequelae of a natural disease process while under the care of a physician who is willing to sign the death certificate, such deaths need not be reported. Cases of suspected abuse, neglect, or euthanasia should be reported, as should any death which meets any of the other criteria which require reporting, such as evidence of injury or poisoning.

The most frequent type of nursing home death that is reported to this office involves fracture cases and other accidental deaths. Death following all injury producing events, if recovery is considered incomplete (without return to original or normal level of activities), or if the injury is thought to have contributed to the cause of death (regardless of the interval between injury and death), are to be reported. This includes all post-traumatic seizure disorders and pulmonary emboli following hip fracture or other injury. All deaths as the result of gunshot wounds (such as delayed death from pneumonia related to quadriplegia from a gunshot wound in the past) must be reported.

If there is any doubt as to whether to report a death or not, please report the death and let our investigators make the determination as to jurisdiction.

When notifying the Medical Examiner of a reportable death, be prepared to relate the following data:

a. Patient's name

b. Residence address

c. Date of birth and birthplace

d. Social Security Number

e. Name, address and telephone of next-of-kin

f. Date and time of death

g. Reason for reporting death

h. Attending physician and whether he/she will sign the death certificate

I. Medical History

j. Probable cause of death

k. Funeral home selected to make the removal

If there are any further questions that our office may answer, please phone 404-730-4400.

A close working relationship with funeral directors is essential for the smooth operation of the Medical Examiner's Office.

We realize the funeral director is under pressure from the family and must get the body in time to make scheduled funeral arrangements. It is the policy of the Medical Examiner's Office to provide prompt examination of body, determine cause and manner of death and to prepare the necessary certificates in the most timely and expeditious manner. It must be kept in mind that there are instances when release of a body to a funeral home will be delayed (i.e., positive identification has not been confirmed, homicides, etc.). Most bodies are released within 24 hours of the report of death to our office.

The funeral director and all of his/her employees need to be aware of all types of death reportable to the Medical Examiner as described under "Types of Deaths to be Reported to the Medical Examiner" (above). Whenever it becomes apparent that a case is reportable, it is incumbent upon the funeral director to report the case to the Medical Examiner. This should be done before embalming. These cases should be reported even though the attending physician may have agreed to sign the death certificate. This will prevent needless disturbance or inconvenience to the family and the mortician in preparation for the funeral.

When the death comes under the jurisdiction of the Medical Examiner, the funeral director may not remove the body from the place of death without permission of the Medical Examiner. It is not acceptable practice to remove the body on the verbal opinion of the family that the physician will sign the death certificate. The physician should be contacted directly in order to learn whether or not the death certificate will be signed. In addition to his/her own observations, the funeral director should inquire of both the family and the physician whether there was any accident or injury associated with the death.

Autopsies in Medical Examiner cases may be performed only by the Medical Examiner or consultant pathologists appointed by the Medical Examiner for that purpose. In the absence of the Medical Examiner, it is the responsibility of the Medical Examiner Investigator to notify the consultant pathologist of the Medical Examiner's Office's request for an autopsy and to inform him/her of a summary of the circumstances of death. Upon completion of the autopsy, the consultant pathologist should communicate his/her findings to the Medical Examiner so that the latter can complete the certification (cause and manner) of death properly and as promptly as possible. This provision is employed when there are potential conflicts of interest or a situation arises in which a medical examiner does not wish to perform an autopsy on the body of someone who was a personal friend, family member, or employee.

The Medical Examiner is authorized by statute to perform an autopsy on any body within his/her jurisdiction. Autopsies are performed when, in the judgment of the Medical Examiner, a medico-legal requirement exists which can only be satisfied by autopsy. Generally, autopsies are performed if there is evidence of violence (recent or remote) or evidence of suspected unnatural death or a death that needs explanation. The Medical Examiner will not perform an autopsy simply because the attending physician refuses to sign the death certificate and wants to know the extent of the natural disease process. The Medical Examiner has the authority to perform autopsies when clear jurisdiction to investigate the death exists. The authority to perform autopsies is defined by statute and does not require concurrence or consent of surviving family. Whenever possible, the wishes of the family which raises an objection to autopsy will be considered, but in some cases, an autopsy will need to be performed over family objections.

TISSUE RETENTION AND DONATION

Many physicians who are doing medical research are interested in obtaining tissue or organs from Medical Examiner cases. We recognize the value of such research and wish to cooperate as fully as possible. We are, however, limited by law as to the amount and kinds of tissues that we can retain.

According to the Georgia Death Investigation Act, we are authorized to obtain and retain tissues and organs only for diagnostic or evidence purposes. We cannot specifically take samples only for research purposes unless we obtain permission from the family or next-of-kin. There is an exception to this general rule. We may provide corneal tissue to the Georgia Eye Bank when it is needed for transplantation and no objections of the next-of-kin are known, but, as previously described, we prefer to have specific permission from the family.

Requests for specific tissues or organs from Medical Examiner cases for research or teaching purposes do occur, but require that the requesting party obtain specific permission from the next-of-kin before we can obtain and provide the organs or tissue.

The Medical Examiner's jurisdiction begins at death. The office has no jurisdiction over living persons. Jurisdiction is determined by where the lethal wound or onset of fatal events occurred, not necessarily the location where death occurred. The Medical Examiner's geographic jurisdiction extends to the borders of Fulton County, Georgia and includes all cities and municipalities within the county.

Deaths which occur on Federal property such as military bases, federal prisons, post offices, and other federal lands are not within the jurisdiction of the Medical Examiner. Federal authorities usually investigate such deaths. The Medical Examiner may investigate any death occurring on Federal property if invited to do so by the respective Federal authorities. In practice, nearly all deaths on Federal property in Fulton County are investigated by the appropriate Federal agency and their designated contract pathologists. This applies to deaths of both military and civilian personnel. Often, Federal authorities give FCMEO jurisdiction when civilians die on military property, or when a decedent normally under federal jurisdiction dies on non-Federal property.

All human remains, regardless of their state of preservation will be handled with dignity. When an autopsy examination is required by the investigating Medical Examiner to accurately certify the cause and manner of death, this autopsy will be performed expeditiously and without unnecessary delay. Every effort is taken to avoid disfigurement of the body unless special procedures are necessary to establish identification (as might occur when it is necessary to remove the jaws and teeth for identification in a severely burned body), or to accurately determine the cause and manner of death or collect needed evidence. Every attempt will be made to prepare and cleanse the body for prompt release to the funeral director for further body preparation, embalming, and burial or other disposition.

After the autopsy examination has been completed, it is the policy of this office to release all remains that have not been retained for diagnostic or evidentiary purposes. Once the examination is complete, the funeral home which has been designated by the surviving family as a responsible agent for disposition of the human remains will be notified as soon as possible.

In most instances, bodies are released within 24 hours of when they arrive at the medical examiners center. In some instances, we are entitled by law to keep the remains for longer periods if they are needed for further evaluation for identification or evidence purposes. As required by law, we release the remains to the legally entitled person after we have completed our inquiry, unless otherwise directed by a court having proper authority.

There are rare instances where criminal action is responsible for the death and a defendant's attorney appeals to the Medical Examiner to retain the body. Upon such a request, consultation will occur with the District Attorney's Office and we will follow instruction provided by the court.

Personal property that accompanies the decedent to the Medical Examiner's Office will usually be released to the next-of-kin or other person authorized by the next-of-kin unless such property is to be used as evidence or is deemed to pose some hazard. Generally, personal property can be picked up during normal working hours at the Medical Examiner's Office the day following death. In most instances, personal property is released with the body to the authorized funeral home. In those cases in which personal property is used in legal proceedings, the property must be obtained from the police department or District Attorney which has jurisdiction over the case, when all proceedings have been concluded. This could take many months, or even years.

If the next-of-kin cannot be located the property is kept in the Medical Examiner's Office thirty (30) days before it is turned over to the Fulton County Treasurer. The treasurer in turn, holds the property for sixty (60) additional days. If unclaimed, it is held for auction.

Weapons used as instruments to commit suicide, unless needed as evidence and analysis, are routinely held for a period of 90 days. They are then returned to the legal next-of-kin or their agent, upon request. If unclaimed, they are eventually destroyed.

The Fulton County Medical Examiner's Office is required by law to make available for public inspection all public records maintained by this office. Specifically exempt from disclosure are all confidential records as exempted by the public disclosure act, preliminary records and notes of investigators and pathologists, records obtained from other sources, and information held on cases undergoing active criminal investigation.

The Medical Examiner does not have the authority or right to disclose any documents, including medical records, which have not originated from this office. These documents must be obtained from their original source. These include the police and traffic reports which may or may not have been released by law enforcement agencies; and death certificates which have been released by the Vital Statistics Registrar of the Fulton Health District. Medical or hospital records are not public records and therefore not disclosed to the public. Suicide notes are not public records and their contents are not disclosed.

When disclosure of information could jeopardize an ongoing criminal investigation, the Medical Examiner has authority under Georgia Law to seal the record and withhold the information from public disclosure.

A certificate of death should be filed by the funeral director with the Vital Statistics  Registrar of the Fulton County Health Department, as soon as possible after death. A certificate of death contains personal information about the deceased (name, age, marital status, parents and spouse's names, etc.), time, location, cause and manner of death. The Medical Examiner certifies all deaths over which we assume jurisdiction. Occasionally, completion of the death certificate by the Medical Examiner's Office will be delayed because of various circumstances surrounding the death. If there is uncertainty as to the cause or manner of death following autopsy, investigation by the Medical Examiner's Office continues. The investigators may continue to search for more information regarding the circumstances of death. Laboratory tests may be done on samples taken from the body at time of autopsy. Toxicological tests or drug screens may be done on the body fluids or stomach contents. Tissue samples are examined microscopically. All of this work is done in order to more accurately determine the cause and manner of death and may result in considerable delays in completion of the death certificate - sometimes several months or more. We do not operate a toxicology laboratory on site and are reliant on outside laboratories for such testing, which may take considerable time (weeks to months).

This does not mean that burial will be delayed until the death certificate can be completed. A certificate of death is maintained in the Medical Examiner's Office with certain sections of the certificate placed on hold until the results of follow-up investigations are complete. The pending sections of the certificate are then completed and the certified copy can be obtained from the Vital Statistics Registrar of the Fulton County Health Department. Prior to completion of the pending sections of a death certificate, a letter certifying death (Proof of Death) may be obtained from the Medical Examiner's Office to use in the initiation of benefits such as burial insurance, social security claims, etc. The "Proof of Death" form is furnished by the FCMEC at no charge to families.

We are aware of the importance of the death certificate to families in bringing death-related issues to closure, and we make every effort to complete the death certificate in a timely manner. In most cases, the certificate is completed within one or two days. But, as described above, there are instances in which the procedure may take several months or more. Most such delays occur because information is needed from other agencies over which we have no control.

The medical records of the deceased are frequently an integral element in determining the cause and manner of death. In conjunction with the investigation of sudden, unexpected, or violent death, the Medical Examiner has the authority by statute to issue subpoenas for medical and dental records and other documents that are necessary for the full investigation of any case.

In the vast majority of Medical Examiner cases, the investigator in charge will request and be given a copy of the records. Ordinarily, the investigator will call the hospital, doctor or nursing home, request a copy of the deceased's records and inquire as to when the copies will be available. A subpoena for records will be issued if the custodian of the records fails to respond to the original request. When needed, the medical examiner may require the personal appearance of the custodian of such records. In most cases, however, delivery of the requested records via mail, courier, or via one of our investigators is adequate,   and personal appearance of the custodian is not required.

TRANSPORT OF BODIES

Bodies are usually transported to the FCMEO from hospitals and other scenes of death by employees of the FCMEO or contracted body transport services. Hospitals and other health care facilities are involved by having to participate in release of the body from their facility, but are not usually involved with the transport of the body from their facility to the FCMEO. The designated funeral home transports the body from the FCMEC to the funeral home after any needed examinations have taken place.

The Fulton County Medical Examiner's Office does not routinely test for HIV or other communicable diseases unless it is pertinent to determining cause and manner of an individual's death. However, if a law enforcement officer, fire fighter, health care provider, health care facility staff person, or other employee may have been at risk of substantial exposure to HIV through contact with bodily fluids in the course of his or her employment and contact with the deceased, he/she may request a state or local public health officer to provide pretest counseling, HIV testing and post-test counseling.

Proper procedures to follow when personnel are exposed to HIV or other communicable disease are as follows;

• The individual concerned is to contact his/her department's health director/officer.

• If the department's health director/officer feels that there has been a significant

  exposure to one of their personnel then he/she is to contact the Medical

  Examiner's Office immediately and express their concern. (This enables us to

  collect the proper samples at autopsy, while they contact the Health Department.)

• The department health director/officer will then contact the Fulton Health Officer

  and inform him of the concern.

• The Fulton Health Officer will make a determination as to whether or not the

  exposure fits within the testing guidelines and then if appropriate, direct the Fulton County Medical Examiner to

  turn over the samples collected to the health department for appropriate testing.

DISPOSITION OF UNCLAIMED HUMAN REMAINS

State Law requires the County to provide for the disposition of remains of an indigent person who dies within the county and whose body is unclaimed by relatives or church organizations. This service is arranged by the Medical Examiner's Office through the Fulton County Department of Family and Children’s Services.

Fulton County applies a rather narrow interpretation of the legislative language. Indigent deceased means a deceased individual for whom there is no next-of-kin who can assume the cost of preparation, care and disposition of the body-- and assets sufficient to cover such costs cannot be obtained from the estate or other source. Unclaimed deceased is defined by the County as whenever anyone shall die within Fulton County without making prior plans for the disposition of his or her body and there is no other person willing to provide for disposition of the body.

Whenever any person meets the criteria of being both unclaimed and indigent, and has died within Fulton County, the Medical Examiner's Office will take jurisdiction over the body and see that the body is entrusted to a funeral home in Fulton County for disposition in accordance with County Policy.

When a body has been at the medical examiners center for more than five days and it has not been identified or claimed, we arrange for embalming to preserve the body. If a body remains unidentified or unclaimed for more than 30 days, we then arrange to obtain any information needed for identification purposes and proceed with arrangements for county-provided burial.

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