ONELEGACY AND ONELEGACY AND CORONER’S CASESCORONER’S CASES

Christopher Rogers, M.D.Christopher Rogers, M.D.

Los Angeles County CoronerLos Angeles County Coroner

OBJECTIVESOBJECTIVES

OneLegacy-Coroner protocolOneLegacy-Coroner protocol

Building trust and developing relationshipBuilding trust and developing relationship

Organ and tissue procurement legislationOrgan and tissue procurement legislation

Case studiesCase studies

Coroner vs. Medical Examiner Coroner vs. Medical Examiner What is the difference?What is the difference?

All California counties have a Coroner All California counties have a Coroner In most California counties, the Coroner is an elected In most California counties, the Coroner is an elected

official, either the Sheriff or the Public Administratorofficial, either the Sheriff or the Public Administrator In Los Angeles, San Francisco, San Diego and Ventura In Los Angeles, San Francisco, San Diego and Ventura

Counties the Coroner is an appointed forensic Counties the Coroner is an appointed forensic pathologist (a medical examiner)pathologist (a medical examiner)

Three components ofThree components ofCoroner relationshipCoroner relationship

1.1. Establishment of protocols for the timely Establishment of protocols for the timely notification of donors suitable for notification of donors suitable for donation who may come under medical donation who may come under medical examiner or Coroner jurisdiction. examiner or Coroner jurisdiction.

2.2. Written and photographic documentation Written and photographic documentation of procedures and findings during the of procedures and findings during the organ procurement. organ procurement.

3.3. Documentation and collection of Documentation and collection of evidence.evidence.

California Health & Safety California Health & Safety Code Section 102850Code Section 102850

A physician and surgeon, physician A physician and surgeon, physician assistant, funeral director, or other person assistant, funeral director, or other person shall immediately notify the coroner when shall immediately notify the coroner when he or she has knowledge of a death that he or she has knowledge of a death that occurred or has charge of a body in which occurred or has charge of a body in which death occurred under any of the following death occurred under any of the following circumstances:circumstances:

Health & Safety 102850Health & Safety 102850

(a)(a) Without medical attendance Without medical attendance (b)(b) During the continued absence of the attending During the continued absence of the attending

physician and surgeonphysician and surgeon(c)(c) Where the attending physician and surgeon or Where the attending physician and surgeon or

the physician assistant is unable to state the the physician assistant is unable to state the cause of deathcause of death

(d)(d) Where suicide is suspectedWhere suicide is suspected(e)(e) Following an injury or an accidentFollowing an injury or an accident(f)(f) Under circumstances as to afford a reasonable Under circumstances as to afford a reasonable

ground to suspect that the death was caused ground to suspect that the death was caused by the criminal act of anotherby the criminal act of another

National Association of Medical National Association of Medical Examiners Position PaperExaminers Position Paper

It is the position of the National Association of Medical Examiners (NAME) that the procurement of organs and/or tissues for transplantation can be accomplished in virtually all cases without detriment to evidence collection, postmortem examination, determination of cause and manner of death, or the conducting of criminal or civil legal proceedings

OneLegacy Coroner ProtocolOneLegacy Coroner Protocol OneLegacy follows a specific coroner OneLegacy follows a specific coroner

protocol.protocol. Any and all hospital medical Any and all hospital medical

documentation is shared with the documentation is shared with the coroner’s office in an attempt to obtain coroner’s office in an attempt to obtain clearance for the organs and tissues to be clearance for the organs and tissues to be recoveredrecovered

Coroner may request additional diagnostic Coroner may request additional diagnostic testing from OneLegacytesting from OneLegacy

Law Enforcement InvolvementLaw Enforcement Involvement

There may be law enforcement involvement There may be law enforcement involvement in the casein the case

The Coroner’s office will consult with law The Coroner’s office will consult with law enforcement about organ and tissue enforcement about organ and tissue procurementprocurement

The coroner has jurisdiction over the body The coroner has jurisdiction over the body and is the final decision-maker on which and is the final decision-maker on which organs and tissues to release for donationorgans and tissues to release for donation

Forensic Pathologists in the Forensic Pathologists in the Operating RoomOperating Room

In rare instances, the Coroner’s office will In rare instances, the Coroner’s office will send their forensic pathologist to attend send their forensic pathologist to attend the organ recovery in the operating roomthe organ recovery in the operating room

This is most often the case with alleged This is most often the case with alleged child abuse caseschild abuse cases

California Health & Safety California Health & Safety Code Section 7151.15 (a)Code Section 7151.15 (a)

A county coroner shall cooperate with A county coroner shall cooperate with procurement organizations to maximize procurement organizations to maximize the opportunity to recover anatomical gifts the opportunity to recover anatomical gifts for the purpose of transplantation, therapy, for the purpose of transplantation, therapy, research, or education.research, or education.

California Health & Safety California Health & Safety Code Section 7151.20 (d)Code Section 7151.20 (d)

If a county coroner is considering withholding If a county coroner is considering withholding one or more organs of a potential donor for any one or more organs of a potential donor for any reason, the county coroner, or his or her reason, the county coroner, or his or her designee, upon request from a qualified organ designee, upon request from a qualified organ procurement organization, shall be present procurement organization, shall be present during the procedure to remove the organs. The during the procedure to remove the organs. The county coroner, or his or her designee, may county coroner, or his or her designee, may request a biopsy of those organs or deny request a biopsy of those organs or deny removal of the organs if necessary.removal of the organs if necessary.

CASE STUDY #1CASE STUDY #1

14-month-old female with non-accidental 14-month-old female with non-accidental subdural hemorrhage and bruising on the subdural hemorrhage and bruising on the legs and armslegs and arms

Law enforcement and Child Protective Law enforcement and Child Protective Services involvedServices involved

Mother’s boyfriend allegedly responsible Mother’s boyfriend allegedly responsible for injuriesfor injuries

CASE STUDY #1CASE STUDY #1

What are the challenges in child abuse What are the challenges in child abuse cases?cases?

Law enforcement and Child Protective Law enforcement and Child Protective Services have a stake in the outcomeServices have a stake in the outcome

Hospital staff trying “to do the right thing”Hospital staff trying “to do the right thing” Concerns about valid consent if the next of Concerns about valid consent if the next of

kin is also the alleged abuserkin is also the alleged abuser

CASE STUDY #1CASE STUDY #1Case ConclusionCase Conclusion:: Heart, liver, and kidneys were recovered Heart, liver, and kidneys were recovered

and transplantedand transplanted The Coroner attended the recovery in the The Coroner attended the recovery in the

operating room as part of the forensic operating room as part of the forensic investigationinvestigation

Law enforcement was present during the Law enforcement was present during the autopsyautopsy

CASE STUDY #2CASE STUDY #2

Middle-aged male LatinoMiddle-aged male Latino Auto vs. pedestrianAuto vs. pedestrian No identification No identification Hospitalized for four days and then Hospitalized for four days and then

progressed to brain deathprogressed to brain death

Case Study #2Case Study #2

What are the challenges when the decedent What are the challenges when the decedent is unidentified?is unidentified?

Identify the person with authority to Identify the person with authority to consent to organ and tissue donationconsent to organ and tissue donation

Make a “reasonable effort” to locate that Make a “reasonable effort” to locate that personperson

California Health & SafetyCalifornia Health & SafetyCode Section 7151.40 (a)Code Section 7151.40 (a)

Anatomical gift can be made by (in order):Anatomical gift can be made by (in order):1) An agent of the decedent at the time of death 1) An agent of the decedent at the time of death

who could have made an anatomical gift who could have made an anatomical gift immediately before the decedent's deathimmediately before the decedent's death

2) The spouse or domestic partner2) The spouse or domestic partner3) Adult children 3) Adult children 4) Parents 4) Parents 5) Adult siblings 5) Adult siblings 6) Adult grandchildren 6) Adult grandchildren 7) Grandparents 7) Grandparents

Health & Safety 7151.40 (a)Health & Safety 7151.40 (a)

8) An adult who exhibited special care and concern for the 8) An adult who exhibited special care and concern for the decedent during the decedent's lifetimedecedent during the decedent's lifetime

9) The persons who were acting as the guardians or 9) The persons who were acting as the guardians or conservators of the person of the decedent at the time of conservators of the person of the decedent at the time of deathdeath

10) Any other person having the authority to dispose of the 10) Any other person having the authority to dispose of the decedent's body, including, but not limited to, a coroner, decedent's body, including, but not limited to, a coroner, medical examiner, or hospital administrator, provided medical examiner, or hospital administrator, provided that reasonable effort has been made to locate and that reasonable effort has been made to locate and inform persons listed in paragraphs (1) to (9), inclusive, inform persons listed in paragraphs (1) to (9), inclusive, of their option to make, or object to making, an of their option to make, or object to making, an anatomical giftanatomical gift

CASE STUDY #2CASE STUDY #2 Hospital Social Services conducted a diligent Hospital Social Services conducted a diligent

search with the assistance of local law search with the assistance of local law enforcementenforcement

Fingerprints were taken but no match came backFingerprints were taken but no match came back Once the patient was declared brain dead, Once the patient was declared brain dead,

hospital administrative consent was obtainedhospital administrative consent was obtained Coroner released organs. Note: By policy, the Coroner released organs. Note: By policy, the

Coroner does not give administrative consent in Coroner does not give administrative consent in this situationthis situation

CASE STUDY #2CASE STUDY #2

Case ConclusionCase Conclusion::

Liver and kidneys were recovered and Liver and kidneys were recovered and transplantedtransplanted