Why does it take so long to get a death certificate?

Q: If the Medical Examiner can do an autopsy and release the body to a funeral home for burial within 72 hours, why does it take a month (or more) to get the pathology report and death certificate?

The simple answer is: because that is how long it takes.  Things are not always simple so here is a more complete answer.

Let’s consider the final pathology report first because that is generally where hold-ups arise.  There is a lot more that goes on during a forensic autopsy than simply examining organs or charting foreign body trajectories.  Depending on the jurisdiction or the Medical Examiner (ME) assigned the case, tests such as toxicology or genetics may be needed to rule out, or confirm, some of the ME’s suspicions.

Toxicology is special testing performed by certified labs to determine the presence of drugs, poisons, and/or their metabolites.  During an autopsy fluids such as blood, urine, bile, cerebral spinal fluid, and vitreous humor are collected and preserved in special tubes.  If fluids are unavailable, testing may be done using tissues such as liver and brain. The tubes are sealed in a transport container to prevent tampering and shipped to the lab that will perform the tests.  There are a number of national labs that receive samples from across the country.  Some larger cities have their own in-house toxicologists but this is not common.  Depending on the tests ordered, toxicology results can take weeks to be completed.  The toxicology report is delivered to the pathologist who then correlates the report with findings of the medical-legal death investigator and the autopsy.

Other specialized testing or examination may be ordered by the ME as well.  It is routine to do histology evaluation of the major organs to identify disease, especially in organs that have obvious indications that warrant further evaluation such as fatty liver, enlarged heart, heavy lungs, sclerotic kidneys, or brain hemorrhages.  If the pathologist identifies certain abnormalities they may order special studies or staining to confirm a diagnosis.  Depending on the size of the office and workload of the histologist that prepare the tissue for evaluation, this testing could take a week or more.

In some cases the forensic pathologist may want to consult with a specialist.  A neuropathologist for example.  These specialists may come in as needed, may require an appointment be made, or have a regular schedule for consults such as every other Wednesday; for example.

All of this: toxicology, special studies, and consults take time and are (generally) beyond  control of the ME.

The death certificate is another story; one that is more within control of the ME or Coroner.  The death certificate is a legal document that lists the cause and manner of death.  In some instances it is required to file a life insurance claim, receive social security benefits, or even cremate a body.  As described above, it can take weeks to finalize all the information.  However, it is possible for MEs and Coroners to issue a certificate of death with cause and manner listed as pending and undetermined respectively.  This may allow the decedent’s  family to proceed with some legal filings.  Many pathologists, however, do not like to issue pending reports for professional and legal reasons.

If a family member has died and the death certificate is needed urgently it is best to contact the chief ME or Coroner where the death occurred and explain your situation.  Provided there is no legal reason to withhold  a certificate, the office may be willing to assist.

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