One Legacy Donation & Transplantation Symposium

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Partnerships for Success
Corner Medical Examiner:
Preserving Evidence and Saving Lives
Breakout Session A
Presenters:
Allison O’Neal, Orange County Sheriff-Coroner
Anthony Maldonado, ME / Coroner Specialist, OneLegacy
Moderator:
Barbara Anderson, RN, Ronald Reagan UCLA Medical Center
Objectives:
• Demonstrate a basic understanding of the
coroner role and responsibilities in regards to the
donation process
• Discuss CA Coroner Law, Coroner Relationships
and Coroner Case Statistics
• To be able to identify a reportable death
Questions to Run On:
When is it necessary to report
a death to the coroner?
How has the collaboration between
OneLegacy and the coroner
increased donation
in our community?
Allison O’Neal,
Supervising Deputy Coroner
Orange County Sheriff’s Department-Coroner Division
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948 square miles
3 million people
Sheriff-Coroner system
Total Deaths per year: 18,915
Orange County Coroner investigated: 5,093
Autopsies Performed: 1,654
Of autopsy cases:
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Natural 84%
Accident 10%
Suicide 4%
Homicide 1%
Undetermined 1%
The California Government Code 27491 states that the coroner is required to:
• Investigate all unnatural deaths-COD, Manner (homicide, suicide, accident,
natural, undetermined)
• Deaths where the MD is unable to state COD
• When deceased saw MD >20 days prior to death
Responsibilities are all or some of these depending on case. We may not
physically complete the task but need to ensure it gets done:
• Positively identify the deceased
• Examine the deceased to document condition of body
• Determine place, date and time of death
• Locate and notify the next of kin
• Secure personal belongings and residence
• Collect evidence related to the death
• Ensure the body is moved to the appropriate facility
• Communicate with the related law enforcement agency or District Attorney
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The Coroner is governed by California
Government Code Section 27491 and Health
and Safety Code Section 102850. The law
states: “…a physician and surgeon, physician
assistant, funeral director, or other person
shall immediately notify the Coroner when he
or she has the knowledge of a death that
occurred or has charge of a body in which
death occurred under ANY of the following:
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Without medical attendance
Not attended by an MD in 20 days prior
Attending MD unable to give opinion for COD
When homicide is known or suspected
When suicide is known or suspected
When a criminal action is involved or suspected to be
involved in a death
Self-induced or criminal abortion
Related to rape or crime against nature
Known or suspected injury, accident-old or recent
Aspiration, starvation, exposure, drug addiction or
acute alcoholism
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Poisoning
Occupation diseases
Contagious diseases
While in-custody of a law enforcement
agency
All state hospital deaths- Fairview in OC
All Sudden Infant Death Syndrome cases
During or related to surgery, following
surgery or did not wake from anesthesia
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Decline (no case # given); not reportable but
brief report taken.
Reportable, Non-Autopsy case
Sign Out No Autopsy (SONA)
Autopsy case
For Autopsy and SONA cases there is no
difference in the interaction between the
deputy coroner and the OL representative.
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The death is reportable but an autopsy is not
necessary. In this situation the OneLegacy
coordinator or hospital staff reports the death
and receives a coroner case number. OL
notifies OCCO on every potential organ and
tissue donor.
Examples:
Natural death with marijuana or ethanol in
system unrelated to the COD.
Positive for a contagious disease such as
Hepatitis C but died from a ruptured AAA.
Reportable Non-natural deaths that are acute
or delayed but the COD is known, well
documented and a physician can state his/her
opinion on the death certificate
Examples:
 Inpatient MVA with multiple traumatic injuries
 Tylenol overdose with suicide notes found
 Elderly inpatient with recent fall with SDH
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After procurement, the body is picked up by the
coroner and scheduled for coroner autopsy. The
coroner handles the death certificate completelycause and manner.
The OCCO does not perform autopsies over the
weekend however we pride ourselves in
completing our forensic investigation quickly and
releasing the deceased in an average of 48 hours.
Examples: MVA’s, homicides, non-accidental
trauma, competing causes such as accident vs.
suicide overdoses and undetermined cases.
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The OneLegacy coordinator notifies the OCCO
after brain death notes. On DCD it is after
the NOK signs consent.
OL coordinator sends available charting.
OL coordinator and OCCO in constant
communication.
OL reported brain death of a 17 month female
admitted from home with suspected
non-accidental trauma.
Initial story to 911 was that she fell approx.
18 inches off a chair.
 Child was under the care of one parent’s
significant other.
 Admitted in full arrest. Head CT showed
complex skull fx and additional head trauma.
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OneLegacy obtained consent from NOK for all
organs and tissue.
OCCO requested additional studies including
CT chest, abdomen, pelvis, CBC, WBC, chem
panel, long bone study, ocular examination
While awaiting these results we used the time
to obtain information from the handling
police agency, confer with child services and
conduct interviews.
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An additional challenge in this case was that
the incident occurred in an out of county law
enforcement jurisdiction.
Coroner approved recovery of organs.
Stipulation given that transplant recovery
surgeons document any trauma observed
during recovery.
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Based on autopsy, microscopic tests and
neuropathology and toxicology the following was
documented.
Confluent areas of purple-red ecchymosis of
posterior base of head and posterior right ear.
Focal purple contusions of the bilateral posterior
forearms.
Small faint purple contusion of the right cheek.
Internal trauma:
a.
Occipital scalp hematoma.
b.
Diffuse posterior subgaleal hemorrhage.
c.
Complex skull fractures.
d.
Bilateral occipital epidural hematomas.
e.
Bilateral optic nerve sheath hemorrhages.
We at the OCCO are proud to be able to save
lives while still conducting thorough
medico-legal death investigations.
3 Lives saved from this case alone:
 Local 40 y/o received en bloc kidneys
 Local 9 month old received liver
 Local 2 month old received heart
Coroner/Medical Examiner:
Preserving Evidence and Saving Lives
Anthony Maldonado
M.E./Coroner Specialist
The Donation & Transplantation Symposium
October 15, 2013
CA Health & Safety Code
Section 7151.15
• 7151.15. (a) A county coroner shall cooperate
with procurement organizations to maximize
the opportunity to recover anatomical gifts
for the purpose of transplantation, therapy,
research, or education.
CA Health & Safety Code
Section 7151.20 (d)
• (d) If a county coroner is considering withholding
one or more organs of a potential donor for any
reason, the county coroner, or his or her
designee, upon request from a qualified organ
procurement organization, shall be present
during the procedure to remove the organs. The
county coroner, or his or her designee, may
request a biopsy of those organs or deny
removal of the organs if necessary.
Coroner protocols
established and
routinely revised
Coroner may
request photos,
medical
diagnostic testing,
consultations, etc.
Case reviews and
education for
coroner staff and
OneLegacy staff
County
Alleged
Child
Abuse
NonDeath by Drowning/ Hospital
Motor
Motor Unknown/
Alleged Alleged Natural
Near
Death:
Vehicle None of Vehicle Other: See
Homicide Suicide Cause Drowning Inpatient Accident the Above Accident Comments
Kern
0
5
3
1
0
Los Angeles
0
25
14
29
1
Orange
0
3
1
4
0
Riverside
1
1
5
5
1
San
Bernardino
5
4
5
9
0
Santa Barbara
0
0
1
0
Ventura
0
0
2
Grand Total
6
38
31
0
Grand
Total
2
1
0
0
12
28
12
14
1
124
3
5
3
0
19
5
1
3
0
22
1
2
1
6
1
34
0
0
0
0
1
0
2
1
0
0
0
0
3
0
6
49
2
1
40
20
30
2
219
0
County
Alleged
Child
Abuse
Hospital
Death Drowning Death:
Hospital
Motor
Alleged Alleged by Natural or Near
ER or
Death:
Vehicle
Homicide Suicide Cause Drowning Outpatient Inpatient Accident
None
of the
Above
NonUnknown/
Motor
Other:
Vehicle
See
Accident Comments
Grand
Total
Kern
0
1
1
0
0
0
0
3
0
0
0
5
Los Angeles
8
20
13
43
0
0
0
37
16
23
0
160
Orange
0
6
9
7
1
0
0
10
1
5
0
39
Riverside
0
1
5
5
1
0
0
10
0
4
0
26
San
Bernardino
2
5
2
5
0
0
0
8
2
6
1
31
Santa Barbara
0
0
2
0
0
0
0
0
0
0
0
2
Ventura
0
0
3
0
0
0
0
1
1
0
0
5
(blank)
0
0
0
0
0
0
0
1
0
0
0
1
10
33
35
60
2
0
0
70
20
38
1
269
Grand Total
Hospital
Death
Death:
Alleged by Natural
ER or
Suicide
Cause
Outpatient
Alleged
Child
Abuse
Alleged
Homicide
Kern
0
0
1
3
0
0
2
1
1
0
8
Los Angeles
0
33
13
32
0
0
26
10
15
0
129
Orange
2
2
3
8
0
0
9
3
12
0
39
Riverside
0
3
5
12
0
0
11
1
1
0
33
San Bernardino
0
4
6
15
0
0
8
3
4
0
40
Santa Barbara
0
0
0
0
0
0
1
0
0
0
1
Ventura
0
0
1
0
0
0
0
2
0
0
3
Grand Total
2
42
29
70
0
0
57
20
33
0
253
County
Hospital
Motor
Death:
Vehicle
Inpatient Accident
None
of the
Above
Non-Motor Unknown/Othe
Vehicle
r:
Accident See Comments
Grand
Total
County
Alleged
Child
Abuse
Death
Hospital
by
Drowning/ Death:
Hospital
Motor
Alleged Alleged Natural
Near
ER or
Death:
Vehicle
Homicide Suicide Cause Drowning Outpatient Inpatient Accident
None
of the
Above
NonMotor Unknown/Othe
Vehicle
r:
Grand
Accident See Comments Total
Kern
0
4
1
3
0
0
0
1
0
0
0
9
Los Angeles
4
13
10
42
0
0
0
33
6
16
0
124
Orange
0
3
7
3
0
0
0
7
3
6
0
30
Riverside
0
2
1
8
1
0
1
6
2
6
0
27
San
Bernardino
3
3
2
14
0
0
0
11
2
5
0
40
Santa Barbara
0
0
1
0
0
0
0
2
0
0
0
3
Ventura
0
1
3
1
0
0
0
1
0
1
0
7
Grand Total
7
26
25
71
1
0
1
61
13
35
0
240
OneLegacy Organ Cases
Under Coroner Jurisdiction
100%
417
391
400
Organ Cases
350
300
250
90%
75%
349
63%
65%
269
219
65%
253
322
80%
70%
240
60%
50%
200
40%
150
30%
100
20%
50
10%
0
0%
2010
2011
Total Organ Cases
2012
2013 YTD
Coroner's Jurisdiction
% of Total
450
OneLegacy Tissue Cases
Under Coroner Jurisdiction
2000
100%
1800
90%
1400
1644
1600
62%
1200
990
1000
1577
64%
1050
80%
63%
70%
60%
992
50%
800
40%
600
30%
400
20%
200
10%
0
0%
2011
Total Tissue Cases
2012
2013 YTD
Coroner's Jurisdiction
% of Total
Tissue Cases
1600
Questions to Run On:
When is it necessary to report
a death to the coroner?
How has the collaboration between
OneLegacy and the coroner
increased donation
in our community?
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