Annotated Code of Maryland, Health General Section

THE MARYLAND POST MORTEM EXAMINERS COMMISSION

Health-General Article

Title 5. Death

Subtitle 3

&&sec5-301. Definitions.

(a) In general. - In this subtitle the following words have the meanings indicated.

(b) Commission. - "Commission" means the State Postmortem Examiners Commission.

(c) Medical examiner's case. - "Medical examiner's case" means a death that a medical examiner is required by law to investigate.

&&sec5-302. Commission established.

There is a State Postmortem Examiners Commission in the Department.

&&sec5-303. Membership; officers.

(a) Composition; appointment of members. - The Commission consists of the following 5 members:

(1) The Baltimore City Commissioner of Health;

(2) The head of the Pathology Department of the University of Maryland School of Medicine;

(3) The head of the Pathology Department of Johns Hopkins University School of Medicine;

(4) The Secretary of the Maryland State Police; and

(5) A representative of the Department, chosen by the Secretary.

(b) Officers -

(1) From among its members, the Commission shall elect a chairman and a vice chairman.

(2) The manner of election of officers and their terms of office shall be as the Commission determines.

(3) The vice chairman shall act as chairman when the

&&sec5-304. Meetings; compensation.

(a) Meetings. - The Commission shall determine the times and places of its meetings.

(b) Compensation. - A member of the Commission may not receive compensation.

&&sec5-305. Staff.

(a) In general. - (1) The Commission may employ a staff in accordance with the State budget.

(2) The staff shall include:

(i) 1 chief medical examiner;

(ii) 1 deputy chief medical examiner;

(iii) 4 assistant medical examiners;

(iv) 1 toxicologist;

(v) 2 assistant toxicologists;

(vi) 1 serologist;

(vii) 4 resident medical doctors who are training in forensic pathology; and

(viii) 1 chief traffic investigator.

(3) The Commission may employ any physician on a contract basis for part-time services.

(b) Qualifications of medical examiner. - Each medical examiner appointed under subsection (a)(2) of this section shall be a physician with at least 2 years postgraduate training in pathology.

(c) Compensation. - With the approval of the Secretary of Personnel, the Commission shall set the compensation for personnel appointed under subsection (a)(2) of this section.

(d) Location. - The Chief Medical Examiner, Deputy Chief Medical Examiner, and assistant medical examiners shall have an office in Baltimore City.

(e) Equipment. - For the use of these medical examiners, the Commission shall:

(1) See that proper equipment is provided; or

(2) Arrange for use of the laboratory and other equipment of the Department, the Baltimore City Health Department, the Department of State Police, or the Baltimore City Police Department.

(f) Duty hours. - The Chief Medical Examiner, the Deputy Chief Medical Examiner, or an assistant medical examiner shall be on call at all times to perform the duties set forth in this subtitle.

(g) Budget. - The State budget shall include an appropriation to carry out this subtitle, including provisions for the fee for an authorized pathologist and the necessary expenses for transportation of a body for examination by a medical examiner or for autopsy.

&&sec5-306. Deputy medical examiners and forensic investigators.

(a) Scope of section. - This section does not apply to Baltimore City.

(b) Appointment. -

(1) The Commission may appoint one or more deputy medical examiners for each county.

(2) The Commission shall appoint a deputy medical examiner for a county from a list of qualified individuals submitted to the Commission by the medical society of the county. The number of names on the list shall be at least twice the number of vacancies. However, if a county does not have a medical society or if the medical society does not submit a list of names, the Commission may appoint a deputy medical examiner for the county without a list.

(d) Acting deputy medical examiner. - If necessary, a deputy medical examiner may deputize another physician in the county to act as deputy medical examiner.

(e) Compensation. - Each deputy medical examiner is entitled:

(1) For each medical examiner's case that the examiner investigates, to at least $60 and not more than $80, as provided in the State budget;

(2) If the examiner is called as a witness before a grand jury or in a criminal case, to the fee that the court sets; and

(3) To any additional compensation that a county provides.

&&sec5-307. Rules and regulations of Commission.

The Commission may adopt rules and regulations to carry out the provisions of this subtitle.

&&sec5-308. Limitations of Secretary.

(a) Plans, proposals, and projects. - The power of the Secretary over plans, proposals, and projects of units in the Department does not include the power to disapprove or modify any decision or determination that the Commission makes under authority specifically delegated by law to the Commission.

(b) Staff, functions, and funds. - The power of the Secretary to transfer by rule, regulation, or written directive, any staff, functions, or funds of units in the Department does not apply to any staff, function, or funds of the Commission.

&&sec5-309. Medical examiner's cases.

(b) Notification of medical examiner. - If a medical examiner's case occurs, the police or sheriff known facts concerning the time, place, manner, and circumstances of the death.

(c) Investigation by medical examiner. - Immediately on notification that a medical examiner's case has occurred, the medical examiner or an investigator of the medical examiner shall go to and take charge of the body. The medical examiner or the investigator shall investigate fully the essential facts concerning the medical cause of death and, before leaving the premises, reduce these facts and the names and addresses of witnesses to writing, which shall be filed in the medical examiner's office.

(d) Evidence. - The medical examiner or the investigator shall take possession of and deliver to the State's Attorney or the State's Attorney's designee any object or article that, in the opinion of the medical examiner or the investigator, may be useful in establishing the cause of death.

(e) Personal property. -

(1) If the next-of-kin of the deceased is not present at the investigation, the police officer or sheriff at the investigation or, if a police officer or sheriff is not present, the medical examiner or the investigator shall:

(i) Take possession of all property of value found on the body;

(ii) In the report of the death, make an exact inventory of the property; and

(iii) Deliver the property to the appropriate sheriff or police department.

(2) The sheriff or police department shall surrender the property to the person who is entitled to its possession or custody.

&&sec5-310. Autopsies.

(a) When cause of death established. - If the cause of death is established to a reasonable degree of medical certainty, the medical examiner who investigates the case shall file in the medical examiner's office a report on the cause of death within 30 days after notification of the case.

(b) Autopsy required; exception. -

(1) If the medical examiner who investigates a medical examiner's case considers an autopsy necessary, the Chief Medical Examiner, the Deputy Chief Medical Examiner, an assistant medical examiner, or a pathologist authorized by the Chief Medical Examiner shall perform the autopsy.

(2) If the family of the deceased objects to an autopsy on religious grounds, the autopsy may not be performed unless authorized by the Chief Medical Examiner or by the Chief Medical Examiner's designee.

(1) A medical examiner shall conduct an autopsy of any fire fighter and any sworn personnel of the State Fire Marshal's Office who dies in the line of duty or as a result of injuries sustained in the line of duty.

(2) The autopsy shall include:

(i) A toxicological analysis for toxic fumes;

(ii) Gross and microscopic studies of heart, lung, and any other tissue involved;

(iii) Appropriate studies of blood and urine; and

(iv) Appropriate studies of body fluids and body tissues.

(3) If the medical examiner determines toxic fumes were the cause of death, the medical examiner shall:

(i) Investigate to the extent possible the source of the fumes; and

(ii) Prepare a written report on the specific effects of the fumes on human tissue.

(4) The autopsy and analysis shall be sufficient to determine eligibility for benefits under the federal Public Safety Officers' Benefits Act of 1976.

(d) Findings; correction of findings and conclusions. -

(1) The individual who performs the autopsy shall prepare detailed written findings during the progress of the autopsy. These findings and the conclusions drawn from them shall be filed in the office of the medical examiner for the county where the death occurred. The original copy of the findings and conclusions shall be filed in the office of the Chief Medical Examiner.

(2)(i) Except in a case of a finding of homicide, a person in interest as defined in &&sec10-611(e)(3) of the State Government Article may request the medical examiner to correct findings and conclusions on the cause and manner of death recorded on a certificate of death under &&sec10-625 of the State Government Article within 60 days after the medical examiner files those findings and conclusions.

(ii) If the Chief Medical Examiner denies the request of a person in interest to correct findings and conclusions on the cause of death, the person in interest may appeal the denial to the Secretary, who shall refer the matter to the Office of Administrative Hearings. A contested case hearing under this paragraph shall be a hearing both on the denial and on the establishment of the findings and conclusions on the cause of death.

(iii) The administrative law judge shall submit findings of fact to the Secretary.

(iv) After reviewing the findings of the administrative law judge, the Secretary, or the Secretary's designee, shall issue an order to:

1. Adopt the findings of the administrative law judge; or

2. Reject the findings of the administrative law judge, and affirm the findings of the medical examiner.

(v) The appellant may appeal a rejection under subparagraph (iv)2 to a circuit court of competent jurisdiction.

(vi) If the final decision of the Secretary, or the Secretary's designee, or of a court of competent jurisdiction on appeal, establishes a different finding or conclusion on the cause or manner of death of a deceased than that recorded on the certificate of death, the medical examiner shall amend the certificate to reflect the different finding or conclusion under &&sec&&sec4-212 and 4-214 of this article and &&sec10-625 of the State Government Article.

(vii) The final decision of the Secretary, or the Secretary's designee, or of a court under this paragraph may not give rise to any presumption concerning the application of any provision of or the resolution of any claim concerning a policy of insurance relating to the deceased.

(viii) If the findings of the medical examiner are upheld by the Secretary, the appellant is responsible for the costs of the contested case hearing. Otherwise, the Department is responsible for the costs of the hearing.

(e) Fee for pathologist. - The Chief Medical Examiner shall set a reasonable fee for performing an autopsy by an authorized pathologist.

&&sec5-311. Records.

(a) Content. -

(1) The Chief Medical Examiner and, as to their respective counties, each of the deputy medical examiners shall keep complete records on each medical examiner's case.

(2) The records shall be indexed properly and include:

(i) The name, if known, of the deceased;

(ii) The place where the body was found;

(iii) The date, cause, and manner of death; and

(iv) All other available information about the death.

(b) Report of medical examiner and autopsy. - The original report of the medical examiner who investigates a medical examiner's case and the findings and conclusions of any autopsy shall be attached to the record of the medical examiner's case.

(c) Delivery to State's Attorney. - The Chief Medical Examiner or, if the Chief Medical Examiner is absent or cannot act, the Deputy Chief Medical Examiner or an assistant medical examiner, and each deputy medical examiner promptly shall deliver to the State's attorney for the county where the body was found a copy of each record that relates to a death for which the medical examiner considers further investigation advisable. A State's attorney may obtain from the office of a medical examiner a copy of any record or other information that the State's attorney considers necessary.

(d) Evidence. -

(1) In this subsection, "record":

(i) Means the result of a view or examination of or an autopsy on a body; and

(ii) Does not include a statement of a witness or other individual.

(2) A record of the Office of the Chief Medical Examiner or any deputy medical examiner, if made by the medical examiner or by anyone under the medical examiner's direct supervision or control, or a certified transcript of that record, is competent evidence in any court in this State of the matters and facts contained in it.

(e) Fees. -

(1) A medical examiner shall charge a reasonable fee for making insurance and other similar reports.

(2) A deputy medical examiner may keep any fee collected by the deputy medical examiner.

&&sec5-312. Oaths, Affidavits and Examinations.

Subject to the limitations in &&sec5-311(c) of this subtitle, a medical examiner may administer oaths, take affidavits, and make examinations as to any matte with the medical examiner's jurisdiction.

Title 10

DEPARTMENT OF HEALTH AND

MENTAL HYGIENE

Subtitle 35

POSTMORTEM EXAMINERS COMMISSION

Chapter 01 Medical Examiner's Cases

Authority: Health-General Article, &&sec&&sec5-301 et seq., 10-714, 18-213;

Estates and Trusts Article, &&sec&&sec4-509 and 4-509.1; Annotated Code of Maryland

.01 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) Medical Examiner.

(a) "Medical examiner" means a Chief Medical Examiner, Deputy Medical Examiner, or Assistant Medical Examiner who is a pathologist authorized to carry out the provisions of Health-General Article, &&sec5-301, Annotated Code of Maryland.

(b) "Medical examiner" also means a:

(i) Deputy Medical Examiner who assists those examiners in &&secB(1)(a) of this regulation, and who is appointed by the Postmortem Examiners Commission in accordance with Health-General Article, &&sec5-306, Annotated Code of Maryland;

(ii) Physician authorized by the State to investigate deaths defined as medical examiner's cases in Health-General Article, &&sec5-301, Annotated Code of Maryland.

(2) Medical Examiner's Case.

(a) "Medical examiner's case" means any death which is the result, wholly or in part, of a casualty or accident, homicide, poisoning, suicide, criminal abortion, rape, therapeutic misadventure, drowning, or a death of a suspicious or unusual nature, or of an apparently healthy individual, or a case which is dead on arrival at the hospital.

(b) "Medical examiner's case" does not mean:

(i) A stillbirth or a neonatal death, or accident room or hospital death in which the cause of death has been established by the hospital physician and is due to disease, and free of evidence of criminal or accidental nature;

(ii) A case which is dead on arrival at the hospital and the physician who pronounces death has been in previous attendance on the patient; or

(iii) A death which occurs in a hospital within 24 hours of admission merely because the death occurred within 24 hours.

(3) "Secretary" means the Secretary of the Department of Health and Mental Hygiene.

.02 Report of Medical Examiner's Cases to the Police or Sheriff.

Whenever a physician, funeral director, or other person has knowledge of the occurrence of a death that may have been the result of violence or suicide, or may have occurred by casualty or suddenly when the person was in apparent health, or not attended by a physician, or when the death may have occurred in any suspicious or unusual manner, the physician, funeral director, or other person having this knowledge shall report it without delay to the police or sheriff who has jurisdiction in the city or county where the death occurred.

.03 Medical Examiner.

An individual dying in Maryland as a result of a homicide, poisoning, suicide, criminal abortion, rape, drowning, or dying in a suspicious or unusual manner, or a death of an apparently healthy individual or a case which is dead on arrival at the hospital shall be examined by the medical examiner in the Office of the Chief Medical Examiner in Baltimore, or in any other place as may be approved by the Chief Medical Examiner

.04 Deaths Due to Fire.

A. Fire Fighters and State Fire Marshal Personnel. The medical examiner shall perform an autopsy and complete toxicological examination of any fire fighter or sworn personnel of the State Fire Marshal's Office who dies in the line of duty or whose death appears to have been caused by:

(1) Fire;

(2) Toxic gases;

(3) Toxic fire conditions; or

(4) Fire-related circumstances.

B. Other Fire-Related Deaths. If a death occurs in a fire or is related to a fire, the medical examiner shall thoroughly investigate the circumstances of the death and report the death to the Center for the Study of the Health Effects of Fire in the Office of the Chief Medical Examiner for Maryland.

.05 Completion of the Death Certificate.

A. When the medical examiner has made a determination of the cause and manner of death, the medical examiner shall complete the death certificate.

B. On the death certificate the medical examiner shall enter the:

(1) Name of the deceased;

(2) Cause of death and medical certification;

(3) Date and hour of death;

(4) Place where death occurred; and

(5) Place where the body was found.

C. The Medical Examiner shall record the manner of death under the section of the certificate designated as the medical certification.

D. If the cause of death has not been established with reasonable medical certainty and further investigation is being conducted, the cause of death is left pending.

E. If the cause of death has not been established with reasonable medical certainty, and the investigation has been completed, the certificate shall be completed to reflect that the cause of death was "undetermined", and the manner of death was "undetermined".

.06 Establishing a Hospital Death as a Medical Examiner's Case.

A. The hospital physician shall be guided by the history and other circumstances in judging whether or not a death is under the jurisdiction of the medical examiner.

B. Cases which are not bona fide medical examiner's cases may not be made such simply because autopsy permission has been refused.

C. Authentic medical examiner's cases may not be withheld from the medical examiner's jurisdiction and autopsied by the hospital pathologist because permission for autopsy has been obtained.

.07 Hospital Autopsy of Certain Medical Examiner's Cases.

A. The following types of medical examiner's cases may be autopsied by the hospital pathologists with the authorization of the Chief Medical Examiner:

(1) Death from acute or chronic alcoholism without manifestation of trauma;

(2) Death from accidental burns occurring in the home;

(3) Death, or sudden death, associated with a therapeutic procedure;

(4) Death following a fracture in an elderly person and resulting from a simple fall in the home.

B. In the cases listed in &&secA of this regulation, permission from next-of-kin is not required since these are under the medical examiner's jurisdiction and the hospital pathologist is acting pursuant to this jurisdiction.

C. The hospital agent shall complete the death certificate, and each death certificate shall be countersigned by the medical examiner.

D. In non-medical examiner cases, a hospital shall require proper autopsy permission in accordance with Maryland Autopsy Law, Health-General Article, &&sec5-501, Annotated Code of Maryland.

.08 The Hospital Agent.

A. Appointment.

(1) Each hospital shall appoint a responsible agent, office, or individual with whom the medical examiner can communicate at any hour regarding medical examiner's cases in the hospital, after receiving notification of them from the police authority.

(2) Each hospital shall notify the medical examiner of the agent so appointed.

B. Responsibilities.

(1) If, during routine autopsy by a hospital pathologist, evidence is encountered which indicates that the death should be under the jurisdiction of the medical examiner, the death then shall become a medical examiner's case, and the hospital agent immediately shall notify the police or sheriff, who will in turn notify the medical examiner.

Agency note: The hospital pathologist shall discontinue the autopsy pending the arrival of the medical examiner.

(2) Notification of Police. Whenever a hospital in Maryland has a medical examiner's case, the hospital agent shall report the case to the local law enforcement agency with jurisdiction in that subdivision of the State. The local enforcement agency so notified shall transmit the information to the Medical Examiner's investigator on duty.

(3) Preliminary Hospital Reports. The hospital agent designated in accordance with Regulation .08 of this chapter shall submit promptly to the medical examiner information on the name and age, if known, of each medical examiner's case, with the date and time of admission; time of death; diagnosis, if made; place, date, time, and manner of accident, or violence, if any; and other relevant information, on forms to be provided by the Chief Medical Examiner, in order to allow the Chief Medical Examiner to decide the disposition of each case.

(4) Clinical and Autopsy Reports from Hospitals. Whenever a medical examiner's case is autopsied in a hospital, the hospital agent shall submit to the medical examiner, without delay, a clinical summary report, preferably filled out by the physician most familiar with the case, and a provisional anatomical diagnosis, and later a copy of the autopsy protocol.

.09 Anesthetic Deaths.

In the case of any anesthetic death occurring in Maryland, the hospital in which the death occurred shall notify immediately, by telephone, the Chief Medical Examiner or a Deputy Chief Medical Examiner, an Assistant Medical Examiner, or the Deputy Medical Examiner of the county in which the death occurred.

.10 Entry to Storage or Autopsy Room at Office of the Chief Medical Examiner.

An individual, other than a member of the staff of the Chief Medical Examiner, may not enter the storage room or the autopsy room while work is being carried on there, except with the permission of the Chief Medical Examiner or the medical examiner performing the work.

.11 Cornea Tissue Removal.

Whenever an authorized eye bank has informed the Chief Medical Examiner or the Chief Medical Examiner's Deputy or Assistant Medical Examiner that there is need for corneal tissue for research or transplantation, the Chief Medical Examiner shall allow the authorized eye bank to make a removal if:

A. A Certification of Need has been provided to the medical examiner;

B. The body has been tested to determine its suitability for transplantation;

C. An autopsy is going to be performed and the removal does not interfere with the subsequent investigation or examination; and

D. The medical examiner does not know of an objection to the autopsy or donation of tissue by the next-of-kin.

.12 Donation of Internal Organs for Transplantation.

A. Whenever there is an immediate need for an internal organ as a transplant, that is heart, lung, kidney, liver, pancreas, spleen, lymph nodes, or adrenal gland, medical examiner may provide the organ, if requested by a transplant surgeon, under the following conditions:

(1) The medical examiner has jurisdiction over the body of a decedent;

(2) The body has been tested to determine its suitability;

(3) The hospital representative and treating physician have completed a Certificate of Need for this decedent;

(4) The hospital and treating physician have been unable to contact the next-of-kin:

(5) No objection by the next-of-kin is known or reasonably foreseen by the medical examiner; and

(6) The removal of the organ requested for transplant does not interfere with an investigation or autopsy.

B. Whenever a medical examiner on duty determines that an organ cannot be removed for one of the reasons stated in &&secA of this regulation, the transplant surgeon may request that this decision be reviewed by the Chief Medical Examiner, a Deputy Chief Medical Examiner, or their designee.

C. Whenever a decedent is determined to have died by some violent means, the medical examiner may not authorize removal of the requested organs without direct supervision of the medical examiner or the medical examiner's agent.

.13 Administrative Review of Correction of Findings and Conclusions.

A. Except in a case of a finding of homicide, a person in interest as defined in State Government Article, &&sec10-611(e)(3), Annotated Code of Maryland, may request the Office of the Chief Medical Examiner to correct

findings and conclusions on the cause and manner of death recorded on a certificate of death under State Government Article, &&sec10-625, within 60 days after a medical examiner files those findings and conclusions.

B. A person in interest is defined as the spouse, adult child, parent, adult sibling, grandparent, or guardian of the person of the deceased at the time of the deceased's death.

C. The request to correct the findings and conclusions on a death certificate shall:

(1) Be in writing to the Chief Medical Examiner;

(2) Describe the requested change precisely; and

(3) State the reasons for the change.

D. Within 60 days after receiving the request in &&secC of this regulation, the Chief Medical Examiner shall provide the person in interest written notice of the action taken.

E. If the Chief Medical Examiner denies the request to correct findings and conclusions on the cause of death, the person in interest may appeal the denial in writing within 15 days to the Secretary. The Secretary shall refer the matter within 15 days of receipt to the Office of Administrative Hearings.

F. An administrative law judge shall conduct a hearing both on the denial and on the establishment of the findings and conclusions on the cause of death.

G. Upon reviewing the findings of fact submitted by an administrative law judge, the Secretary or the Secretary's designee shall issue an order within 60 days to:

(1) Adopt the findings of the administrative law judge; or

(2) Reject the findings of the administrative law judge and affirm the findings of the medical examiner.

H. If the Secretary or Secretary's designee rejects the findings of an administrative law judge, the person in interest may appeal that rejection to a circuit court of competent jurisdiction under Maryland law.

I. If the final decision of the Secretary or the Secretary's designee, or of a court of competent jurisdiction on appeal establishes a different finding or conclusion on the cause or manner of death of a deceased than that recorded on the certificate of death, the medical examiner shall amend the certificate to reflect the different finding or conclusion.

J. The medical examiner shall send a change letter to the Division of Vital Records to amend the certificate of death, to reflect the final decision of the Secretary or Secretary's designee, or a court of competent jurisdiction.

K. The final decision of the Secretary or the Secretary's designee, or of a court in an appeal under this regulation, may not give rise to any presumption concerning the application of any provision of or the resolution of any claim concerning a policy of insurance relating to the deceased.

L. If the findings of the medical examiner are upheld by the Secretary, the appellant is responsible for the costs of the contested case hearing, based on the billing rate established by the Office of Administrative Hearings. Otherwise, the Department is responsible for the costs.

14 Release of Medical Examiner's Records.

A. Individual files of the Chief Medical Examiner are not public records but are private medical records protected from disclosure under the provisions of State Government Article, &&sec10-611 et seq., Annotated Code of Maryland.

B. An exception to these confidential medical records is the official medical examiner's autopsy report. This report is a public record and is generally subject to disclosure under State Government Article, &&sec10-611 et seq., Annotated Code of Maryland, unless the case is subject to an ongoing investigation, or other appropriate reason for denial of disclosure exists.

C. A reasonable administrative fee of $10 for families and $40 for private institutions may be charged for providing requested certified and prepared medical examiner's reports.

D. An individual, other than the custodian of the records of the Office of the Chief Medical Examiner or a designee, may not copy or distribute a copy of the official report of the Office of the Chief Medical Examiner.

.15 Communicable Disease.

If, during the investigation of a death under the jurisdiction of the Office of the Chief Medical Examiner, a communicable disease is identified, it shall be reported by the medical examiner in writing within 24 hours to the health officer in the appropriate jurisdiction and to the deputy State health official, on the forms supplied by the Department of Health and Mental Hygiene, in accordance with COMAR 10.06.01.04.

.16 Child Abuse or Neglect, or Both.

A death that is investigated by the Office of the Chief Medical Examiner that is found to be caused by or related to child abuse or neglect shall be reported by a medical examiner orally and in writing to local departments of social services and the local law enforcement agency of the subdivision in which the child last resided, in accordance with Family Law Article, &&sec5-704, Annotated Code of Maryland.

.17 Notification of Exposure to Contagious or Infectious Disease.

Whenever it is required that the Office of the Chief Medical Examiner notify a firefighter, emergency medical technician, rescue squad member, law enforcement officer, correctional officer, etc. of exposure to contagious disease or virus, and pursuant to Health-General Article, &&sec18-213, Annotated Code of Maryland, the following procedures shall be followed:

A. A medical examiner shall review information gathered in the course of the postmortem examination, including testing for contagious disease or viruses;

B. If evidence of contagious disease or virus, as defined in Health-General Article, &&sec18-213, Annotated Code of Maryland, is identified in the test carried out in the postmortem examination, this information shall be provided by the Office of the Chief Medical Examiner to the officially designated agency representative of the appropriate firefighter, emergency medical technician, rescue squad member, law enforcement officer, correctional officer, etc., with a copy to each of these.

C. The Office of the Chief Medical Examiner shall verbally notify the agency-designated representative within 48 hours after confirmation of the diagnosis, and subsequently confirm that notice, in writing, and in a manner that protects the confidentiality of the patient; and

D. The agency representative shall notify the individual believed to have been exposed to the contagious disease or virus.

.18 Deaths in a State-Funded or State-Operated Facility.

A. Deaths in a State-funded or State-operated facility which constitute a medical examiner's case, as defined in Health-General Article, &&sec5-309, Annotated Code of Maryland, shall be investigated by the Office of the Chief Medical Examiner.

B. Notification and Investigation. The sheriff, police, or chief law enforcement officer, in the jurisdiction where a death occurs, shall notify the medical examiner whenever a death that constitutes a medical examiner's case occurs in a State-funded or State-operated facility. If the death may have occurred by violence, by suicide, by casualty, suddenly when the person was in apparently good health, not attended by a physician, or in any suspicious or unusual manner, the medical examiner or investigator shall:

(1) Respond directly to the administrative head of the facility;

(2) Conduct an investigation;

(3) Complete the investigation report; and

(4) Arrange to have the body sent to the Office of the Chief Medical Examiner for an autopsy, if necessary.

C. Completion of Investigation Report.

(1) A medical examiner or investigator shall document in an investigation report all of the information regarding the death that was:

(a) Gathered in the course of the investigation; and

(b) Provided by the administrative head of the facility to the sheriff, police, chief law enforcement official, or health officer in the jurisdiction where the death occurred.

(if the death occurs in the jail, detention center, etc.), the administrative officer in charge of the facility will immediately secure the scene and maintain its security until a full investigation is complete.

(2) A medical examiner or investigator shall append to an investigation report the written report of the death that the administrative head of the facility provided to the sheriff, police, chief law enforcement official, or health officer in the jurisdiction where the death occurred.

(3) Required Contents of Report. The report of the administrative head of a facility where the death occurred shall contain all the information set out in Health-General Article, &&sec10-714, Annotated Code of Maryland. The report:

(a) May be oral, if followed by a written report within 5 working days from the date of the death, or written; and

(b) Shall contain the following relevant information:

(i) The name, age, and sex of the deceased,

(ii) The time of discovery of the death,

(iii) The deceased's place of residence at the time of death,

(iv) If the death occurred in a place other than the residence of the deceased, the location of the body at the time of discovery,

(v) The place where the body was found,

(vi) The name of the person who took custody of the body,

(vii) The name of the person evaluating the death, if known,

(viii) Whether an autopsy is being performed, if known,

(ix) The name, address, and telephone number of the next-of-kin or legal guardian, if known, and

(x) Other information the administrative head of the facility determines should be provided to the medical examiner.

(4) The report of the investigation by the Office of the Chief Medical Examiner constitutes an individual file of the Chief Medical Examiner not subject to disclosure under State Government Article, &&sec10-611 et seq., Annotated Code of Maryland.

.19 Deputy Medical Examiners/Forensic Investigators.

A. The Postmortem Examiners Commission shall appoint one or more deputy medical examiners and forensic investigators for each county.

B. The Postmortem Examiners Commission shall appoint a deputy medical examiner from a list of qualified individuals submitted by the county medical society. However, the Commission may appoint a deputy medical examiner for the county without a list if there is no county medical society or if the medical society does not submit a list of names.

C. Each deputy medical examiner appointed shall be a physician. If necessary, a deputy medical examiner may deputize another physician in the county to act as deputy medical examiner.

D. The Chief Medical Examiner shall select a forensic investigator from a list provided by the Deputy Chief Medical Examiner for Statewide services.

E. For each medical examiner's case investigated, the examiner is entitled to a fee of not less than $60 and not more than $80, as provided in the State budget. In counties with forensic investigators, the investigator receives $55 for each medical examiner's case investigated and the deputy medical examiner is entitled to $25 for certifying the death and completing the death certificate. If the deputy medical examiner, or forensic investigator as the examiner's designee, is called as a witness before a grand jury or in a criminal case, the examiner or investigator is entitled to:

(1) The fee that the court sets; and

(2) Any additional compensation that a county provides.

.20 Body Transportation Reimbursement.

A. The deputy medical examiner or forensic investigator shall arrange for body transportation services of human remains from a scene of death in Maryland to a specified body transportation service providers within their jurisdiction, on a rotational basis, to arrange for body transportation services.

C. Funeral directors and body transportation service providers are eligible to transport human remains for the Office of the Chief Medical Examiner. However, it is the responsibility of each local funeral director or body transportation service to notify the Deputy Medical Examiner or forensic investigator if they are interested in providing this service for the State.

D. Providers of body transportation services shall be available 24 hours a day, 7 days per week, 365 days per year to provide body transportation services, as needed, and shall provide their own equipment to transport human remains.

E. Human remains shall be accorded the proper dignity expected under accepted mortuary standards and practices, and shall be handled in accordance with universal precautions as defined in "Control of Communicable Diseases in Man," which is incorporated by reference in COMAR 10.06.01.01, as well as the Office of the Chief Medical Examiner guidelines to protect remains and evidence.

F. Payment.

(1) Providers of body transportation services shall be paid $1.75 per mile, one way, or a minimum charge of $52, plus any tolls, whichever rate is higher, as provided in the State budget, from the scene of death to a designated location.

(2) The provider is responsible for completing the Office of the Chief Medical Examiner's Transportation of Bodies Report for payment.

(3) The Office of the Chief Medical Examiner is responsible for providing a replacement body pouch when the body is transported to that office.

Administrative History

Effective date: July 13, 1939

Amended:December 22, 1950; February 27, 1951; May 15, 1951; June 26, 1951; January 15, 1963; October 22, 1963. -----

Chapter revised effective August 2, 1993 (20:15 Md. R. 1220)