NATIONAL ASSOCIATION OF MEDICAL EXAMINERS

ACCREDITATION CHECKLIST
FIRST REVISION ADOPTED SEPTEMBER 2003

*Amended 13 September 2004 #Amended 13 October 2006 +Amended 20 February 2007

Effective Date: Date of Expiration:

January 2004 January 2009

CONTENTS 1. Facilities..............................................................1 A. Body Handling Areas ................................................1 B. Autopsy Suites .....................................................1 C. Administrative Space..... ..........................................3 D. Storage Space .....................................................3 E. Radiologic Facilities. .............................................4 F. Histologic Laboratory Space... .....................................4 G. Toxicologic Laboratory Space.............. .........................4 H. Maintenance ........................................................4 I. Security ...........................................................5 Safety..................................................................5 Personnel...............................................................6 A. Medical Examiners ..................................................7 B. Toxicologists ......................................................9 C. Consultants ........................................................9 D. Medical Investigators .............................................10 E. Other Personnel ...................................................10 Notification, Acceptance of, and Declining of Cases....................10 Investigations.........................................................11 A. Scene Investigations ..............................................12 Body Handling..........................................................12 Postmortem Examinations................................................13 Identification.........................................................14 Evidence & Specimen Collection.........................................15 A. Toxicology Specimens ..............................................16 B. Evidence Collection from Scenes ...................................17 C. Chain of Custody ..................................................17 Support Services.......................................................17 A. Photography .......................................................18 B. Radiology .........................................................19 C. Histology .........................................................20 D. Toxicology ........................................................20 E. Clinical Chemistry ................................................21 F. Microbiology ......................................................21 G. Criminalistics/Forensic Science Exams .............................21 H. Consultations .....................................................21 Reports and Records....................................................22 A. Investigative Reports .............................................22 B. Death Certificates ................................................23 C. Reports of Postmortem Examinations ................................23 D. Consultation & Laboratory Reports .................................24 E. Annual Statistical Reports ........................................24 F. Records Keeping ...................................................25 G. Release of Information ............................................25 H. Organ and Tissue Donations ........................................26 Mass Disaster Plan.....................................................26 Performance Improvement................................................27 A. Professional Credentials & Privileges .............................27 B. Training and Continuing Education .................................27 C. Performance Evaluation & Monitoring ...............................28

2. 3.

4. 5. 6. 7. 8. 9.

10.

11.

12. 13.

PHASE NAME ACCREDITATION CHECKLIST 1. FACILITIES II

YES

N/A

NO

1.1 Does the office have sufficient space, equipment, and facilities to support the jurisdiction's volume of medicolegal death investigations? 1.2 Are private and secure lockers, changing areas, and shower facilities available for male and female employees? 1A BODY HANDLING AREAS

___

___

___

___

___

___

1A.1 Is the body receiving area adequate in size and designed to accommodate the usual volume of incoming and outgoing bodies with safety and security? 1A.2 Are body receiving and handling areas sequestered from public view? 1A.3 Is there a method by which family or friends can make positive identification of decedents, (e.g. a viewing room, instant photography, closed circuit television, digital photography, etc.)? 1A.4 Is refrigerated storage space sufficient to accommodate the number of bodies and their handling during usual and peak loads? 1A.5 Is the refrigerated storage space easily accessible to the autopsy room and to the body release area? 1A.6 Are temperature monitoring devices present on each refrigerator and freezer space, and is there an alarm system to warn of deviations from the acceptable range, and are monitoring records kept? 1B AUTOPSY SUITES

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

___

___

___

___

___

___

1B.1 Can the autopsy room accommodate the usual and peak case load, including the typical number of autopsies and external examinations, the normal complement of autopsy and laboratory personnel, official participants and observers from cooperating agencies, and other authorized personnel? 1B.2 Does the ventilation system control odor and fumes and prevent them from entering and leaving the autopsy and body storage areas?

II

___

___

___

___

___

___

PHASE 1B.3 Do the heating and cooling systems maintain a working environment conducive to effective work performance? 1B.4 Is the lighting adequate? II

YES ___

N/A ___

NO ___

II I

___ ___

___ ___

___ ___

1B.5 Is a body scale located in or near the autopsy room, the body reception, or pre-autopsy preparation area? 1B.6 Is suction available at the autopsy stations? 1B.7 Are sufficient autopsy stations available for the usual case volume? 1B.8 Is there a stable surface for dissection at each station (either table stand or permanent structure; not e.g., merely a loose cutting board)? 1B.10 Are floor, sink, and table drains able to handle autopsy waste and small particulate matter, with clean-out traps easily accessible? 1B.11 Are surfaces for preparation of documents and records far enough removed from the examination areas to avoid inadvertent contamination? 1B.12 Are surfaces in the autopsy room nonporous and easily cleaned? 1B.13 Is dictation equipment or other means of recording postmortem findings available in the autopsy room, adjacent to the autopsy room, or in physicians offices? 1B.14 Are x-ray view boxes present to permit concurrent viewing during the autopsy? 1B.15 Is a separate or functionally isolated room or area available for the storage of decomposed and known infectious bodies that is in accord with principles, regulations, and laws regarding universal precautions and infectious disease hazards? 1B.16 Is/are (a) separate or functionally isolated room(s) or area(s) available for the autopsies of decomposed and known infectious bodies? 1B.17 Are HEPA filters utilized, where appropriate, to reduce biohazard risks? 1B.18 Are appropriate personal protective devices available to staff so as to reduce biohazard risks? 2

___

___

___

II

___

___

___

___

___

___

II

___

___

___

___

___

___

___

___

___

II

___

___

___

___

___

___

___

___

___

___

___

___

___

___

___

___

___

___

PHASE 1C ADMINISTRATIVE SPACE II

YES

N/A

NO

1C.1 Is sufficient office space available for medical examiners, investigators, and administrative and other office staff? 1C.2 Is each pathologist's office furnished with a desk, shelves, file cabinets, microscope, and dictation equipment? 1C.3 Are facilities available to support individual and group employee functions, including, where applicable, break/dining area, meeting/conference area, and library? 1C.4 Is the administrative area separate from the autopsy rooms, laboratories, and body receiving area so that it is freely accessible to visitors who have legitimate business with the office without visual, auditory, or olfactory exposure to autopsy activity? 1D STORAGE SPACE

___

___

___

___

___

___

___

___

___

II

___

___

___

1D.1 Is there sufficient general storage space available for the needs of the office? 1D.2 Is there sufficient record storage space available for a minimum of five years of current reports and records? 1D.3 Is appropriate storage space available and secured for decedent personal effects, evidence recovered during investigations, tissues and evidence recovered from bodies, and specimens held for additional laboratory analysis? 1D.4 Is space available for examination of clothing, personal effects, and other items or evidence discovered on or about the body with a work area or provision that prevents cross contamination of specimens and provides for effective preservation of each items integrity? 1D.5 Are tissue storage areas ventilated and free of formaldehyde, putrefied tissue, and other unpleasant odors? 1D.6 Is there separate and safe storage space for reagent gases, solvents, and chemicals?

II

___

___

___

II

___

___

___

II

___

___

___

___

___

___

___

___

___

II

___

___

___

PHASE 1E RADIOLOGIC FACILITIES I

YES

N/A

NO

1E.1 Is radiographic equipment installed in a convenient location in or near the autopsy room? 1E.2 Is the radiographic equipment shielded in accord with the radiation safety standards promulgated by state and federal regulations? IE.3 has been transferred to 10B 1F HISTOLOGIC LABORATORY SPACE

___

___

___

II

___

___

___

1F.1 Is adequate space and equipment provided for tissue cutting and for histologic preparation of microscopic slides, including an area for special staining methods? 1F.2 Is each work station supplied with electricity and water and properly vented to remove solvent and fixative fumes? 1G TOXICOLOGIC LABORATORY SPACE

II

___

___

___

II

___

___

___

1G.1 Does the toxicology laboratory have suitable space, equipment, scientific instrumentation, reagents, and supplies to manage the caseload? 1G.2 Is there an appropriate and safe storage system in place for chemicals and reagents, and is there provision for recognition and proper disposal of outdated and expired items? 1G.3 Is there a properly ventilated and periodically maintained fume hood in the laboratory for handling dangerous or unpleasant samples or reactions? 1H MAINTENANCE

II

___

___

___

___

___

___

___

___

___

1H.1 Does the office have a written and implemented policy or standard operating procedure, signed within the last two years covering facility maintenance? 1H.2 Are the facilities and all work areas clean, structurally sound, and well maintained? 1H.3 Are public access areas comfortable, clean, and free from odor? 1H.4 Are autopsy tables and dissection areas disinfected with bactericidal/virucidal solutions on a daily basis if they have been used? 1H.5 Is the scientific equipment on a documented periodic maintenance schedule? 4

II

___

___

___

II

___

___

___

___

___

___

___

___

___

___

___

___

PHASE 1H.6 Is there a policy and documentation that all scales are periodically calibrated with known weights? 1H.7 Are the heating/ventilation/air conditioning, plumbing, and electrical systems of the physical plant scheduled for periodic routine inspection and preventive maintenance? 1I SECURITY II I

YES ___

N/A ___

NO ___

___

___

___

1I.1 Does the office have a written and implemented policy or standard operating procedure, signed within the last two years covering facility security? 1I.2 Is access to the facility controlled?

___

___

___

I II

___ ___

___ ___

___ ___

1I.3 Is access to body receiving and handling areas limited and controlled? 1I.4 Is the record storage space secure, with controlled access to ensure the integrity of the reports? 1I.5 Are laboratories physically separate from other work areas, and do they have controlled access? 1I.6 Is an after-hour locked storage area or depository available for evidentiary material? 1I.7 If the office has a computerized information management system, is there an appropriate security system in place to prevent intrusion; unauthorized release of information; or unauthorized addition, deletion, or alteration of data? 2. SAFETY

___

___

___

___

___

___

___

___

___

II

___

___

___

2.1 Does the office have a written and implemented policy or standard operating procedure, signed within the last two years addressing safety, that comports with federal and state regulations with regard to injury and illness prevention, repetitive motion injuries, and biohazard and chemical exposure? 2.2 Are employees and visitors safe from physical, chemical, electrical and biologic hazards? 2.3 Are safety policies and procedures written and posted or readily accessible? 2.4 Is a written blood-borne pathogen control program in place?

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

PHASE 2.5 Are standard precautions ("universal precautions") used when performing autopsies and handling biological specimens? 2.6 Are all potentially exposed or at-risk office staff offered vaccination for hepatitis B? 2.6.1 Is yearly tuberculosis testing offered to at-risk office staff? 2.6.2 Are office staff with a history of positive skin tests offered yearly follow-up evaluation? 2.7 Are first-aid kits, safety showers, and eye washes strategically located in the laboratories? 2.8 Are dedicated and marked specialized safety containers used for disposing of hazardous chemicals and biologic waste that comport with federal, state, and local regulations regarding chemical and biological waste disposal? 2.9 Are safety cabinets or explosion-proof rooms in use for storage of volatile solvents? 2.10 Are electrical outlets and equipment properly grounded and ground fault circuit interrupters utilized in areas where water may pose an added risk? 2.10.1 Are the electrical outlets and ground fault circuit interrupters tested for safety and proper functioning on at least a yearly basis? 2.11 Are autopsy dissecting sinks equipped with back flow protection devices? 2.12 Are "MSDS" (Material Safety Data Sheets) readily available in areas where potentially hazardous materials are stored or in use? 2.13 Are building evacuation diagrams available and posted in prominent locations throughout the facility? 3. PERSONNEL II II

YES ___

N/A ___

NO ___

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

___

___

___

II

___

___

___

___

___

___

3.1 Does the office have a written and implemented policy, signed within the last two years covering personnel issues? 3.1.1 Has a copy of the personnel policies been distributed to all personnel? 3.2 Are there written and implemented procedures for discipline and removal of staff for cause? 6

___

___

___

___

___

___

II

___

___

___

PHASE 3.3 Is there sufficient technical staff coverage to handle the routine daily caseload for the following areas: A. B. C. D. E. F. autopsy assistance? histology? forensic photography? x-ray? toxicology? investigations? II I I I II II

YES

N/A

NO

___ ___ ___ ___ ___ ___

___ ___ ___ ___ ___ ___

___ ___ ___ ___ ___ ___

3.4 Is there sufficient nontechnical staff coverage to handle the routine daily caseload for the following areas: A. B. C. D. E. F. G. 3A administration? visitor reception? medical transcription? records keeping? data analysis? body handling and transportation? maintenance and cleaning? II II II II I II II ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

MEDICAL EXAMINERS II ___ ___ ___

3A.1 Is the Chief Medical Examiner or the Coroners autopsy surgeon a pathologist granted, by the American Board of Pathology, a certificate of qualification for the practice of Forensic Pathology, and does he or she have at least two years of forensic pathology work experience beyond forensic pathology residency/fellowship training? 3A.2 Is the chief medical examiner licensed to practice medicine or osteopathy by the appropriate state or jurisdictional authority granting such licenses where the office is located? 3A.3 Is the chief medical examiner employed full time, and are the office duties his or her primary professional obligation? 3A.4 When the chief medical examiner is not available, is a deputy chief medical examiner or an associate medical examiner who possesses qualifications similar to those of the chief medical examiner available in an alternate capacity?

II

___

___

___

___

___

___

II

___

___

___

Note: In small offices staffed by one or a few physicians, the practicalities of coverage should be considered. At times when regular physician coverage is, of necessity, unavailable, is there a policy or practice specifying reasonable alternative autopsy and decision-making responsibility? 3A4.1 When the chief medical examiner is not available, is there a deputy chief medical examiner or an associate medical examiner who is licensed to practice medicine or osteopathy by the appropriate state or jurisdictional authority granting such licenses where the office is located? 7 II ___ ___ ___

PHASE 3A.5 Are all associate/deputy medical examiners or physicians responsible for autopsies pathologists who have completed a training program in anatomic pathology accredited by the Accreditation Council for Graduate Medical Education (ACGME) or equivalent? 3A5.1 Are all associate/deputy medical examiners or physicians responsible for postmortem examinations and autopsies licensed to practice medicine or osteopathy by the appropriate state or jurisdictional authority granting such licenses where the office is located? 3A.6 Are all associate/deputy medical examiners or physicians ultimately responsible for autopsies pathologists who are board certified in anatomic pathology by the American Board of Pathology and who have completed at least one year of supervised training under the supervision of a forensic pathologist certified by the American Board of Pathology, or are they themselves so certified? Note: One Phase I for each unqualified physician II II

YES ___

N/A ___

NO ___

II

___

___

___

___

___

___

#3A.7 Is the medical staff of sufficient size that no autopsy physician is required to perform more than 325 autopsies/year? (See note after 3A.8) 3A.8 Is the medical staff of sufficient size that no autopsy physician is required to perform more than 250 autopsies/year?

___

___

___

___

___

___

Note 1: In considering compliance with items 3A.7 and 3A.8, it should be recognized that within a working team, duties and activities are often divided in such a way that one or more team members might perform in excess of the permitted number of autopsies. This is not a per se deficiency unless the autopsy load and the size of the pathology workforce would make it inevitable that the limit would be exceeded. Note 2: For the purpose of calculating the autopsies per pathologist in 3A.7 and 3A.8, fellows may be counted as one-half a pathologist position, but residents in training should not be included in the fractional denominator. Note 3: For the purpose of calculating autopsy load in items 3A.7 and 3A.8, the workload from external examinations should also be considered. Three to five formal (dictated or written) external examinations (depending on their complexity) should be considered to be equivalent to one complete autopsy. For example, a workload of 200 complete autopsies and 150 external examinations would be equivalent to 250 autopsies. Further consideration should be given to autopsy coverage that entails travel to a separate facility. The inspector should adjust the calculation to reflect the time required. For example, two hours of travel time should be considered equivalent to one autopsy. Note 4: For the purpose of calculating the autopsies per pathologist in 3A.7 and 3A.8, the administrative and leadership duties of the department chief should be considered. In large and complex offices, the chief may spend almost all of his or her time in non-autopsy activities; in such instances, that position should be

PHASE

YES

N/A

NO

eliminated from the fractional denominator. By contrast in a small office or in an office organized so that administrative duties are not a substantial burden, it may be appropriate to make only a modest reduction of the fractional denominator. Note 5: For the purpose of calculating the autopsies per pathologist in 3A.7 and 3A.8, other significant responsibilities should be taken into consideration. For example, pathologists with significant collateral responsibilities in academic, surgical pathology, laboratory work, research, consulting, or other assignments should be reflected by an appropriate readjustment of the fractional denominator. 3A.9 Are all medical staff licensed to practice medicine in all jurisdictions covered by the office? 3B TOXICOLOGISTS II ___ ___ ___ II ___ ___ ___

3B.1 Does the chief toxicologist have formal training and experience in forensic toxicology? 3B.2 Does the chief toxicologist hold a relevant doctoral degree from an accredited institution? %3B.3 Is the chief toxicologist certified by the American Board of Forensic Toxicology (ABFT)or certified in toxicological chemistry by the American Board of Clinical Chemistry (ABCC)? 3C CONSULTANTS

___

___

___

___

___

___

3C.1 Is the office affiliated with a forensic anthropologist board certified by the American Board of Forensic Anthropology (ABFA)? 3C.2 Is the office affiliated with a forensic odontologist board certified by the American Board of Forensic Odontology (ABFO)? 3C.3 Are other consultants (e.g., neuropathologists, pediatric pathologists, radiologists, etc.) formally trained in their respective specialties. 3C.4 Are copies of the currently applicable statutes governing the operation of the office available and on file in the office? 3C.5 Does the office have ready access to legal advice and consultation in matters relating to the interpretation and implementation of its governing statute or statutes and on other (civil) legal matters? 3C.5.1 Does the office maintain a file documenting the legal advice and consultation that has been received? Note: See also 11G.3

___

___

___

___

___

___

___

___

___

II

___

___

___

___

___

___

___

___

___

% changed 9/13/04 9

PHASE 3D MEDICAL INVESTIGATORS II

YES

N/A

NO

3D.1 Are there written and implemented qualifications established for medical investigators? 3D.2 Have medical investigators received specific training in the policies and procedures of the office? 3D.3 Is the offices chief investigator or is at least one principal investigator a Registered Diplomat of the American Board of Medicolegal Death Investigators? 3D.4 Are a majority of the medical investigators who have worked in the office for over 5 years Registered Diplomats or Certified Fellows of the American Board of Medical Death Investigators? 3E OTHER PERSONNEL

___

___

___

II

___

___

___

___

___

___

___

___

___

3E.1 Does the office have written and implemented policies for the qualifications and training necessary for all technical staff (e.g. histotechnologists, radiology technicians, etc.)? 4

___

___

___

NOTIFICATION ABOUT ACCEPTANCE OF AND DECLINING OF CASES II ___ ___ ___

4.1 Does the office have a written and implemented policy or standard operating procedure, signed within the last two years covering case notification, acceptance of, and declining of cases? 4.2 Is there an existing law (state, federal, county, or city) covering the medical examiners (or coroners) geographical area of jurisdiction that requires that deaths falling under the medical examiners jurisdiction be reported promptly to the medical examiners office by law enforcement agencies, physicians, hospital personnel, funeral directors, or other persons who become aware of a reportable case? 4.3 Does the medical examiner accept notification from any person who has become aware of a death that might fall under the jurisdiction of the office? 4.4 Is at least one published telephone number for the medical examiner's office in telephone books covering the jurisdiction?

II

___

___

___

II

___

___

___

II

___

___

___

10

PHASE 4.5 Is the phone number staffed 24 hours a day by a person able to arrange a disposition at all times? 4.6 Are at least 25% of the deaths occurring within the office jurisdiction reported to the office annually? 4.7 Does the medical examiner, if it is required, arrange for a formal pronouncement of death? 4.8 Does the office attempt to notify the next-of-kin as soon as possible, if notification by another agency or individual cannot be confirmed? 4.9 Has been incorporated into 11A.1. I I

YES ___

N/A ___

NO ___

___

___

___

___

___

___

___

___

___

4.10 Is the case reviewed by a medical examiner when or soon after jurisdiction is released? 4.11 Is there a written and implemented procedure in place to assure the release of the correct body and personal effects to the funeral home? 5 INVESTIGATIONS

___

___

___

II

___

___

___

5.1 Does the office have a written and implemented policy or standard operating procedure, signed within the last two years, covering office investigations, that addresses activities and responsibilities in the office and at death scenes? 5.2 Is there a written and implemented office policy requiring a medical examiner or investigator to obtain the initial history of the fatal event, ascertain the essential facts and circumstances, elicit any pertinent medical history, and make a record of the names and addresses of any witnesses? 5.3 Is a history of past medical illness and current treatment verified with the attending physician or by review of the decedent's medical and emergency treatment records in applicable cases? 5.4 Are emergency medical technicians interviewed when it is likely to be of benefit? 5.5 Are the run sheets of emergency medical technicians, emergency room records, and hospital charts available to the medical examiner in accepted cases? 5.6 In criminal cases and violent deaths, does the medical examiner have access to and obtain as needed the investigative findings of the police, fire department, and other investigative agencies? 11

II

___

___

___

II

___

___

___

II

___

___

___

___

___

___

___

___

___

II

___

___

___

PHASE 5A SCENE INVESTIGATIONS II

YES

N/A

NO

5A.1 Is there a written and implemented policy identifying which cases require scene investigations? 5A.2 Is a medical examiner or investigator available on a 24-hour basis to respond for a scene investigation? 5A.3 Are medical examiner investigation response times recorded and monitored? 5A.4 Does the medical examiner or investigator respond to the scene of those cases deemed necessary by the chief medical examiner? 5A.5 When a body has been removed from the scene or a person has been removed for treatment, are follow-up scene investigations conducted where appropriate and feasible? 5A.6 Are diagrams or photographs or digital images prepared to clarify essential spatial relationships between the body, its environment, and any significant investigative facts, such as blood, evidence, weapons/instruments, etc., where appropriate? 5A.7 Are significant circumstantial and physical observations noted and recorded regarding the time of death, (including the presence, location, and degree of rigor; the location, fixation, and color of postmortem livor; and, when indicated, the temperature of body and environmental temperature and climatic conditions)? 5A.8 Are office investigations autonomous and independent of law enforcement investigations? 5A.9 Are deaths of children investigated in accordance with any applicable local or nationally recognized protocol? 6. BODY HANDLING

___

___

___

II

___

___

___

___

___

___

II

___

___

___

___

___

___

___

___

___

___

___

___

___

___

___

___

___

___

6.1 Does the office have a written and implemented policy or standard operating procedure, signed within the last two years, covering body transportation and handling? 6.2 Does the body transport system reflect due respect for the decedent and the concerns of families? 6.3 Are the stretchers and carts used to move the body sturdy and in good repair and free of sharp edges?

II

___

___

___

II

___

___

___

II

___

___

___

12

PHASE 6.4 Are body transport vehicles mechanically sound, clean, secure, dignified, and private? 6.5 Do office body transport vehicles have regularly scheduled and documented maintenance, and are they kept in good repair? 6.6 Is the interior of each body transport vehicle regularly cleaned and disinfected? 6.7 Do body handling procedures ensure the integrity of evidence by the use of sealed body bags or by other similarly effective means? 6.8 Do body handling procedures include precautions against the biohazards associated with body handling? 6.9 Is there a system to document the acquisition, custody, integrity, and release of personal effects? 7. POSTMORTEM EXAMINATIONS II II

YES ___

N/A ___

NO ___

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

7.1 Does the office have a written and implemented policy or standard operating procedure, signed within the last two years, covering postmortem examination procedures? 7.2 Is there written documentation of a physical examination of the decedent's unclothed body prepared for every decedent whose body is examined? 7.3 Is there a written and implemented policy which specifies the criteria for the determination of when complete autopsies, partial autopsies, or external examinations are to be performed? 7.4 Are autopsies performed in greater than 95% of all cases suspected of homicide at the time of death? 7.5 Are autopsies performed in greater than 95% of all cases in which the manner of death is undetermined at the time an autopsy decision is made? (Some inspector discretion allowed) 7.6 Are the circumstances of death, if known, reviewed prior to autopsy? 7.7 Are clothing and personal effects examined and inventoried in all cases brought into the office for postmortem examination? 7.8 Does the medical examiner/autopsy physician personally examine all external aspects of the body in advance of dissection? 13

___

___

___

II

___

___

___

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

PHASE 7.9 Is a medical examiner/autopsy physician responsible for the conduct of each postmortem examination, the diagnoses made, the opinions formed, and any subsequent opinion testimony? 7.10 Are all autopsy ex-situ dissections personally performed by a medical examiner/autopsy physician? 7.11 Is all assistance rendered by pathology assistants, autopsy technicians, dieners, or others without medical training performed in the physical presence of and under the direct supervision of a medical examiner/autopsy physician? 7.12 Are written notes taken for each autopsy that, along with review of photographs and other records, could be used as a basis for report generation if dictated tapes become lost or damaged? 7.13 Are specimens routinely retained for toxicologic and histologic examination during autopsies? 7.14 Is there a written and implemented office policy which defines when radiographic examinations are to be performed? 7.15 Is there a written and implemented office policy that defines when ancillary tests or procedures are to be undertaken, (e.g., outlining when histologic, toxicologic, microbiologic, biochemical, genetic [including DNA], anthropological, and odontologic specimen collection, testing, or consultation is to be done or sought)? 7.16 Does the office have a written policy or standard operating procedure, implemented and signed within the last two years, covering the retention and disposition of organ and tissue specimens taken at autopsy, that addresses whether, or under what circumstances, next-of-kin are to be notified of each retention or disposition? II

YES ___

N/A ___

NO ___

II

___

___

___

II

___

___

___

___

___

___

II

___

___

___

___

___

___

___

___

___

II

___

___

___

Note: NAME recognizes the complexity and sensitivity of this issue, and acknowledges that either decisionto notify family members, or to avoid intrusion upon a family, is accepted and appropriate in the practice of death investigation. 8. IDENTIFICATION II ___ ___ ___

8.1 Does the office have a written and implemented policy or standard operating procedure, signed within the last two years, covering identification procedures?

14

PHASE 8.2 Is there a case body numbering system in place for labeling all bodies? 8.3 Is the method of identification recorded? II

YES ___

N/A ___

NO ___

II

___

___

___

8.4 Does the office have access to the following for identification of bodies: A. fingerprint comparison? B. dental examination? C. body x-rays? D. forensic anthropology? E. forensic serology and DNA analysis? II II II I I ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

8.5 Prior to disposition of unidentified II bodies, does the medical examiner's office perform the following tasks, as applicable in order to permit potential future identification: fingerprint the body; photograph the body; examine and chart the dentition; take x-rays; store specimens for DNA analysis; and register the case with the FBI's National Crime Information Center (NCIC) or other central registry and any mandated state or local registry? 9. EVIDENCE AND SPECIMEN COLLECTION II

9.1 Does the office have a written and implemented policy or standard operating procedure, signed within the last two years, covering evidence collection? 9.2 Does the office have a written and implemented policy or standard operating procedure, signed within the last two years, covering tissue and body fluid specimen collection? 9.3 Does the office have a written and implemented policy or standard operating procedure, signed within the last two years covering evidence and specimen disposition and destruction? 9.4 When collected, are autopsy tissue and fluid specimens individually collected; adequately packaged; properly labeled; appropriately preserved; and archived using a consistent and logical specimen numbering system? 9.5 Are specimen containers labeled with the case number and the date collected; the type of contents; the name of the deceased; the name of the medical examiner or the responsible physician; and the name of the person securing the specimen?

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

___

___

___

15

PHASE 9.6 Are formalin-fixed or paraffin-embedded tissues stored for at least one year in cases in which microscopic slides are not prepared? I

YES ___

N/A ___

NO ___

Note: In cases involving skeletonized remains and other remains not suitable for embedding or microscopy, this checklist item would not apply. 9.7 Are specimens collected for microbiological evaluation placed into appropriate transport media or sterile containers? 9.8 Are microbiologic specimens promptly transported to the service laboratory? 9.9 In cases of suspected sexual contact: A. are control hair samples collected from the decedent by plucking a representative number of hairs from various body areas, e.g. scalp and pubic areas? B. is the pubic area lightly combed to obtain loose and foreign hairs, and are native control hairs plucked and packaged separately? C. are swabbings of body orifices obtained and examined for the presence of spermatozoa, the presence of seminal fluid, and DNA and/or serologic markers? 9.10 Are bite marks processed according to an established procedure? II ___ ___ ___ II ___ ___ ___

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

9A

TOXICOLOGY SPECIMENS II ___ ___ ___

9A.1 Does the office have a written and implemented policy or standard operating procedure, signed within the last two years, for the collection of toxicology specimens? 9A.1.1 Is peripheral blood rather than central blood used for toxicological testing whenever possible and preferable? 9A.1.2 Is the site of collection (peripheral, central [heart/great vessels], dural sinus, chest cavity, subdural hematoma, etc.) of blood used for toxicology recorded? 9A.2 Are specimens for toxicology promptly delivered to the toxicology laboratory or stored in a secure refrigerator or freezer until delivery is effected?

___

___

___

___

___

___

II

___

___

___

16

PHASE 9A.3 When toxicology is requested, is the toxicologist made aware of the circumstances surrounding the death and any medications which may have been taken by the decedent? 9A.4 for at 1 year by the Are toxicological specimens retained least two months in routine cases and in homicide cases after receipt of report medical examiner? I

YES ___

N/A ___

NO ___

___

___

___

9A.5 In cases of delayed death in hospitalized victims, does the office attempt to obtain the earliest available specimen from the hospital when appropriate? 9A.6 In deaths associated with the possible inhalation of toxic gases, are airway and lung specimens collected and stored in containers suitable for headspace analysis? 9B EVIDENCE COLLECTION FROM SCENES

II

___

___

___

___

___

___

9B.1 Are the hands protected in cases of homicides and suspicious deaths to safeguard evidence when indicated? 9B.2 Is it the written and implemented policy of the office to take charge of the body, the clothing on the body, and any evidence on the body which may aid in determining the identification of the deceased and the cause and manner of death? 9C CHAIN OF CUSTODY

II

___

___

___

II

___

___

___

9C.1 Are forms for chain of custody receipt in use? 9C.2 Do chain of custody forms include the case number and/or name; description of the evidence; the persons involved in the transfer; the date and time of change of custody; and appropriate signatures? 9C.3 Is the medical examiner able to assure the integrity of the chain of custody of evidentiary items, while under his or her control? 10. SUPPORT SERVICES

II

___

___

___

II

___

___

___

II

___

___

___

10.1 Does the office have written and implemented policies or standard operating procedures, signed within the last two years, covering each of the below (A-H) support services including toxicology, radiology, histology, forensic sciences, and criminalistics? Note: One Phase I deficiency for each missing policy 17

___

___

___

PHASE 10A PHOTOGRAPHY I

YES

N/A

NO

10A.1 Is there a designated staff member responsible for the inventory, care, and maintenance of the photographic equipment and supplies? 10A.2 Is an identifying label included in each photograph such that the label does not obscure the identifying features of the decedent; or alternatively, does at least one photograph per set of photographs in a given case include a label to permit post process labeling of film? 10A.3 Is at least one identification photograph taken of all bodies brought to the office? 10A.4 Is there photographic documentation of pertinent findings in suspected homicides? 10A.5 Does the office generally photographically document pertinent findings? 10A.6 Are photographs taken prior to examination or processing of trace evidence, foreign material, blood patterns, and other items important for determining the cause and manner of death or necessary for medicolegal interpretation or presentation? 10A.7 Are orientation photographs (photographs of the same area from a distance or with a frame of reference) taken when close-up photographs are taken? 10A.8 Is at least one measurement scale included in close-up photographs, with evidence photographs, and in those cases when no frame of reference is present in the field of view? 10A.9 Is an American Board of Forensic Odontology (ABFO) scale included in all bite mark photographs? 10A.10 Are all photographs and any negatives labeled and filed in a retrievable manner? 10A.11 In cases of homicide or suspected homicide, if digital photographic imaging is used, is a backup system employed such as supplementary film photography, or is collateral photography performed by law enforcement personnel or by another agency?

___

___

___

II

___

___

___

___

___

___

II

___

___

___

___

___

___

___

___

___

___

___

___

II

___

___

___

___

___

___

II

___

___

___

___

___

____

18

PHASE 10A.12 If digital photographic imaging is employed, are all images "redundant" or backed up in a timely fashion, so that a computer failure would not result in their permanent loss? 10A.13 Are electronic photograph files copied and stored in at least two locations to prevent loss from a computer malfunction? 10B RADIOLOGY II II

YES ___

N/A ___

NO ___

___

___

___

10B.1 Does the office have access to radiographic equipment or services? 10B.2 Are the quality of radiographs commensurate with the purpose of the x-ray examination? 10B.3 Is a written schedule of exposures (i.e., an x-ray technique chart) on hand, or is there an alternative system in place so as to ensure proper x-ray film exposures. 10B.4 Are radiographs labeled with case number and right/left designation on each film? 10B.5 Are radiographs filed so as to be readily retrievable? 10B.6 When performed in-house, are the x-ray development equipment and reagents routinely maintained according to a set schedule and is this documented? 10B.7 Is in-house x-ray equipment periodically assessed for performance improvement, radiation protection, x-ray beam collimation, and biomedical safety, and are records of these evaluations maintained? 10B.8 Is the x-ray film development subject to effective quality control and are x-ray films of good diagnostic quality? 10B.9 Is there a documented program in place to assure that all personnel exposed to x-ray or other radiation sources are monitored for radiation exposure; as part of this policy, is there a mechanism in place to identify persons who are approaching, have reached, or have exceeded their exposure limits and to take appropriate actions? 10B.10 Is X-ray equipment properly and currently licensed and maintained?

___

___

___

II

___

___

___

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

___

___

___

II

___

___

___

II

___

___

___

19

PHASE 10C HISTOLOGY II

YES

N/A

NO

10C.1 Does the office have access to histology services? 10C.2 Are microscopic slides retained for at least 10 years? 10C.3 Are paraffin blocks stored in a cool area and retained for at least five years? 10C.4 In addition to routine H&E staining, are special stains available for microorganisms, iron, fat, and connective tissue? 10C.5 Are special stains returned with appropriate control slides? 10C.6 Is a cryostat available for rapid diagnosis and for fat stains? 10C.7 Are microscopic slides prepared, examined, and reported in all sudden infant deaths, and where feasible, in unexplained deaths, and where necessary to establish a tissue diagnosis? 10C.8 Is a written list/catalog of histology sections taken, designating the organ or anatomic site from which the section was obtained, made for each autopsy that includes histology? 10C.9 Are diagnoses or conclusions arrived at by microscopic examination (histology) included in the final autopsy reports list of diagnoses or summary of case findings or opinion section? 10D TOXICOLOGY

___

___

___

II

___

___

___

II

___

___

___

___

___

___

II

___

___

___

___

___

___

II

___

___

___

___

___

___

___

___

___

10D.1 Does the office have access to a forensic toxicology laboratory? 10D.2 Is the toxicology laboratory in compliance with the guidelines of the Society of Forensic Toxicologists (SOFT), or accredited by the American Board of Forensic Toxicology (ABFT), the College of American Pathologists (CAP), or a state reference laboratory? 10D.3 Is testing routinely available for ethanol and volatiles; carbon monoxide; major drugs of abuse; major acidic drugs; and major basic drugs? 10D.4 Does the office have access to stat carbon monoxide testing?

II

___

___

___

___

___

___

II

___

___

___

___

___

___

Note: Toxicology by itself should not be used as a substitute for a forensic autopsy or as a substitute for a careful search of a death scene for health and safety hazards. 10D.5 Are tests performed according to written standard operating procedures? 20 II ___ ___ ___

PHASE 10D.6 Does the toxicology laboratory participate in external drug proficiency testing for drugs of abuse, and are appropriate corrective actions undertaken and recorded when the results of this testing are outside of compliance limits? 10D.7 Is there active monitoring of the laboratory for quality assurance, and are corrective actions taken when indicated? 10D.8 Are 95% of negative toxicology examinations completed within 30 calendar days of case submission? 10D.9 Are 95% of positive toxicology examinations completed within 60 calendar days of case submission? 10D.10 Is there a system to monitor and track overdue toxicology reports? 10E CLINICAL CHEMISTRY II II

YES ___

N/A ___

NO ___

II

___

___

___

II

___

___

___

II

___

___

___

___

___

___

10E.1 Are routine diagnostic clinical chemistry tests available for analysis of postmortem specimens? 10E.2 Is the clinical chemistry testing performed by a laboratory accredited by the College of the American Pathologists (CAP) or does it have equivalent certification? 10F MICROBIOLOGY

___

___

___

___

___

___

10F.1 Does the office have microbiology laboratory services available? 10F.2 Is the microbiology laboratory accredited by the College of American Pathologists (CAP) or equivalent? 10G CRIMINALISTICS/FORENSIC SCIENCE EXAMINATIONS

II

___

___

___

___

___

___

10G.1 Are laboratory services available to perform fingerprinting; serologic and/or DNA testing; ballistics; and trace evidence examination? 10G.2 Is the crime laboratory accredited by the American Society of Crime Laboratory Directors Laboratory Accreditation Board (ASCLD-LAB)? 10H CONSULTATIONS

___

___

___

___

___

___

10H.1 Does the office arrange for the availability of expert consultants in neuropathology; forensic dentistry/odontology; forensic anthropology; and radiology?

II

___

___

___

21

PHASE 10H.2 Are the consultative services responsive, complete, reliable, reputable, and credible in court? 11. REPORTS AND RECORDS II I

YES ___

N/A ___

NO ___

11.1 Does the office have a written and implemented policy or standard operating procedure, signed within the last two years, covering reports and records keeping? 11.2 Are records kept in an orderly fashion for easy retrieval of data? 11.3 Are the original reports kept under the custody of the office? 11.4 Does each report prepared under the authority of the office include the name of the deceased, if known, and the case accession number? 11.5 Are there forms for initial notification of death; scene investigation; requests for autopsy reports; chain of custody; and authorization for release of reports and records if required by law? 11.6 Does the office have a procedural method of keeping track of unfinished or overdue case reports? 11A INVESTIGATIVE REPORTS

___

___

____

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

11A.1 Are records of the initial case investigative contact available on every death reported to the office, whether or not jurisdiction is accepted? 11A.2 Is there a routine reporting form to be filled out by death investigators for case acquisition? 11A.3 Does the office maintain a log of each official case investigation performed by office investigators? 11A.4 Is a written scene investigation report prepared by the office for every scene visited?

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

11A.5 Do investigation reports include, as II applicable, the history obtained from investigators and witnesses; past medical history; circumstantial history; scene observations; pertinent body findings; and notations regarding photographs taken and evidence recovered? 11A.6 Are investigative reports routinely available to the pathologist prior to the beginning of any autopsy, external examination, or certification of death? II

___

___

___

___

___

___

22

PHASE 11B DEATH CERTIFICATES II

YES

N/A

NO

11B.1 Does the office, in certifying the cause and manner of death, conform with the format of the death certificate prescribed by the local authorities? 11B.2 Is standardized terminology of recognized disease nomenclature such as ICD 9/10 used in the filling out of death certificates? 11B.3.1 (Medical Examiner Jurisdictions) Is the death certificate prepared and signed by the autopsy physician, the chief medical examiner, or his or her (the medical examiners) designee? 11B.3.2 (Coroner Jurisdictions) Is there a system in place so that the death certificates conclusions and wording reflect the findings and reasoning of the autopsy surgeon? 11B.4 manner of the by the Are death certificates filed in a timely in keeping with the legal requirements jurisdiction or jurisdictions covered office?

___

___

___

___

___

___

II

___

___

___

II

___

___

___

___

___

___

11B.5 When a death certification has been deferred or left pending, is there a mechanism in place that ensures that requisite information, tests, or data is sought, and that the certification is then completed in a reasonable time? 11B.6 Does the office keep a current and up-todate list of pending cases that includes unsigned and incomplete death certificates? 11C REPORTS OF POSTMORTEM EXAMINATIONS

II

___

___

___

II

___

___

___

11C.1 Is a written narrative autopsy report prepared in every autopsied case? 11C.2 Does the autopsy report include a description of external and internal findings, external and internal evidence of injury, review of organ systems, listing of diagnoses or summary of case findings, and opinions regarding the cause and manner of death? 11C.3 Does the forensic pathologist sign the autopsy report after it has been transcribed, proofread, and corrected? 11C.4.1 Are 95% of the reports of postmortem examinations completed within two months from the time of autopsy in homicide cases? 11C.4.2 Are 95% of reports of postmortem examinations completed within three months from the time of autopsy in all cases (homicides excluded, see 11C.4.1)? 23

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

PHASE 11C.5 Is the cause and manner of death listed in the autopsy report consistent with that stated on the death certificate? II

YES ___

N/A ___

NO ___

Note: In coroner jurisdictions, is there a system by which the cause and manner of death placed on the death certificate are made available to the autopsy surgeon? (See also 11B.3.2) 11 CONSULTATION AND LABORATORY REPORTS I ___ ___ ___

11D.1 Are the reports of consultations and laboratory tests pertinent to determining cause and manner of death (ballistics, trace evidence, etc.) incorporated into the official records of the case whenever such tests are performed and when such inclusion is permitted by the consultants policies and state or local regulations or statutes? 11D.2 Are request forms available for supplemental laboratory and consultative services? 11D.3 Are consultations and laboratory tests tracked and monitored by the office for chain of custody; status of completion; expected return time; billing information; and return of residual specimens, as applicable? 11D.4 Moved to 11H.1 11E 11E.1 ANNUAL STATISTICAL REPORT

___

___

___

___

___

___

Does the office annually compile statistical data on: A) deaths reported? I B) cases accepted? I C) manners of death? I D) scene visits by medical examiners or I medical examiner investigators? E) bodies transported by office or I by order of the office? F) external examinations I G) complete autopsies? I H) partial autopsies? I I) hospital autopsies retained under I ME jurisdiction? J) cases where toxicology is performed? I K) bodies unidentified after examination? I L) organ and tissue donations? I M) unclaimed bodies? I N) exhumations? I O) bodies transported to the office I

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

A maximum of five Phase One deficiencies can be assigned under this item. Note: Mere availability of data from a computerized information management system does not satisfy this checklist item. A major rationale for the compilation of such data is the value they provide for analyzing and understanding the workload and short and long term trends that may affect an office.

24

PHASE 11E.2 Does the office have a computerized information management system? 11E.3 Does the office prepare an annual report tabulating total cases reported, accepted, examined and autopsied, and the major causes of death sorted by each manner of death category? 11E.4 Does the office maintain a cross index of categories of cause and manner of death for statistical data retrieval? 11F RECORDS KEEPING I I

YES ___

N/A ___

NO ___

___

___

___

___

___

___

11F.1 Are all paper components of the death investigation in a given case filed in the same place, including investigative reports, scene reports, body examinations, supplemental laboratory reports and consultations, and follow-up information? 11F.2 Are the original case reports retained under the care, custody, and control of the office? 11F.3 Are completed records located in a central record storage area? 11F.4 If long term archival records are stored in a location off premises, are they secure and retrievable? 11F.5 Do written and implemented guidelines detail the archiving and destruction times for all records? 11F.6 Does the office have a written and implemented policy or standard method for filing, to include how, where, and which records are stored? 11F.7 Where the office records are computerized, are they adequately backed up to prevent loss in case of computer malfunction or failure?

___

___

___

II

___

___

___

II

___

___

___

II

___

___

___

___

___

___

___

___

___

II

___

___

___

11G

RELEASE OF INFORMATION II ___ ___ ___

11G.1 Are copies of official reports available to those individuals having a legitimate right to them? 11G.2 Is there a written and implemented procedure regarding distribution of records and information?

___

___

___

25

PHASE 11G.3 Are copies of the applicable law, regulations, guidelines and, legal opinions available in regard to the release of records and information? Note: See also 3C.5.1 I II

YES ___

N/A ___

NO ___

11G.4 Does the office have a written and implemented policy regarding media contact? 11G.5 Does the office have a primary person designated to release or to oversee the release of public information? 11H ORGAN AND TISSUE DONATIONS

___

___

___

___

___

___

*11H.1 Does the office have a written and implemented policy or standard operating, procedure signed within the last two years covering organ and tissue donation? Moved from 11D.4 12. MASS DISASTER PLAN

II

___

___

___

12.1 Does the office have a written and implemented mass disaster (multiple fatality) plan, signed within the last two years, that includes consideration of weapons of mass, destruction protective clothing and equipment, body handling decontamination and disposal, and which mandates appropriate preparatory staff training? 12.2 Has the plan been promulgated with the participation of jurisdictional law enforcement, fire, and rescue, emergency agencies and hospitals? 12.3 Has the office coordinated with surrounding jurisdictions regarding mass disaster planning? 12.4 Has the office participated in local or regional mass disaster exercises? 12.5 Is a contact list of pertinent officials, offices, phone numbers, and email addresses readily available? 12.6 Are alternative morgue sites designated?

II

___

___

___

___

___

___

___

___

___

___

___

___

II

___

___

___

I I

___ ___

___ ___

___ ___

12.7 Is there a plan for a chemical mass disaster? 12.8 Is there a plan for a biological mass disaster? 12.9 Is there a plan for a radiation/nuclear mass disaster?

___

___

___

___

___

___

26

PHASE 13. QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT II

YES

N/A

NO

13.1 Does the office have a written and implemented policy or standard operating procedure, signed within the last two years, covering quality assurance? 13.2 Is the quality assurance program a planned and regularly scheduled activity? 13.3 Is the quality assurance program sufficient and adequate to assure the quality of the office or system work product? 13.4 Is there documentation of corrective action taken for identified deficiencies? 13.5 Does the office participate on a regular basis in the local Child Death Review Committee activities? 13A PROFESSIONAL CREDENTIALS AND PRIVILEGES

___

___

___

___

___

___

II

___

___

___

II

___

___

___

___

___

___

13A.1 Is licensure of the medical staff verified at the time of initial employment? 13A.2 Does the chief medical examiner evaluate the performance of each member of the professional staff at least once each year if such evaluations are permissible under local statutes or labor contracts? 13B TRAINING AND CONTINUING EDUCATION

II

___

___

___

___

___

___

13B.1 Are all new personnel provided information on the written policies of the office during orientation? 13B.2 Is each licensed professional employee required to and given time to participate in continuing education? 13B.3 Is there continuing education available for all medical investigators? 13B.4 Are operators of radiologic equipment properly trained? 13B.5 Are all staff members, medical and nonmedical, who perform duties in a training capacity continually supervised and monitored by a qualified practitioner? 13B.6 Is there a mechanism whereby the signed reports of trainees in forensic pathology are reviewed and approved in writing by a faculty pathologist?

II

___

___

___

II

___

___

___

___

___

___

___

___

___

II

___

___

___

II

___

___

___

27

PHASE 13B.7 Are the reports of trainees in forensic pathology who are not licensed to practice medicine in the state where they are training cosigned by a faculty pathologist? 13B.8 If the office has a training program for forensic pathologists, is the program accredited by the American Council for Graduate Medical Education (ACGME)? 13C PERFORMANCE EVALUATION AND MONITORING II II

YES ___

N/A ___

NO ___

II

___

___

___

13C.1 Do in-house laboratories participate in external proficiency tests? 13C.2 Does the medical staff participate in external check samples or proficiency surveys? 13C.3 Are staff sign-out conferences regularly scheduled for discussion and disposition of pending and problem cases?

___

___

___

___

___

___

___

___

___

Note: At an inspectors discretion, in small offices, scheduled formal discussions may be replaced by evidence of readily available informal consultation among staff or with outside consultants. 13C.4 Is there a system in place for regular systematic review of autopsy reports and the quality of autopsy performance? I ___ ___ ___

28