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R Hanzlick

Publications and source records attributed to R Hanzlick.

At least 55 records · Page 3Linked to original sources
PubMed1997

Lawsuits against medical examiners or coroners arising from death certificates.

A data base search through Westlaw was conducted to ascertain lawsuits in which a medical examiner or coroner (ME/C) was sued because of the cause or manner of death stated on the death certificate. Sixteen reported cases were found between 1948 and 1995, with 10 of the cases occurring since 1985. The frequency of reported cases is approximately 1/400,000 ME/C death certificates, but based on certain assumptions, the actual frequency may be estimated at 1/40,000 ME/C death certificates. Nine cases involved plaintiffs who contested when the manner of death was indicated as suicide. In 15 of the 16 cases, the lower court decision favored the ME/C viewpoint. Five of the 15 decisions were ultimately reversed by a higher court, but the ultimate outcomes of these cases were not available. Overall, it appears that most courts and decisions have recognized ME/C actions as discretionary or immune and that ME/Cs have been at low risk for such suits to date. This seems especially true if the ME/C position is defensible and the ME/C has acted in accordance with statute and without evidence of corruption, incompetence, arbitrariness, capriciousness, abuse of discretion, or outrageous conduct.

Cause of Death↗
PubMed1997

Mind your manners. Part II: General results from the National Association of Medical Examiners Manner of Death Questionnaire, 1995.

More than 700 physician medical examiner/coroners (ME/Cs) were surveyed to assess differences in manner of death classifications for typical but often controversial death scenarios: 198 physicians participated by choosing the manner of death (homicide, suicide, accident, natural, undetermined) for 23 such scenarios. Sixteen questions related to death certificate training, work location, and manner of death issues were also asked. The classification of manner of death by ME/Cs was highly variable. For some challenging death scenarios, majority agreement was lacking. Agreement was > or = 80% for only 11 of the 23 scenarios and was 100% for only 1. Manner of death classification method was not influenced by forensic pathology board certification status, by whether or not the physician actually completed death certificates, or by previous threats of lawsuits over manner of death classification. However, there were some differences by state. No textbook or individual was widely recognized as authoritative on manner of death issues. Few ME/Cs had formal death certification training in medical school or residency. The data lend credence to the practice of the National Center for Health Statistics (NCHS) of classifying manner of death for statistical purposes by using coding and classification rules and selection criteria rather than solely on the basis of the classification of manner chosen by ME/Cs. The data also indicate that caution is in order when one compares manner of death statistics of one ME/C with those of another Published guidelines and more uniform training are needed so that ME/Cs may become more consistent in their manner of death classifications. Further information is presented in Part I (history of manner of death classification) and in Part III (individual death scenarios and their analysis) companion articles in this issue of the Journal.

Autopsy↗
PubMed1997

Mind your manners. Part III: Individual scenario results and discussion of the National Association of Medical Examiners Manner of Death Questionnaire, 1995.

In 1995, a questionnaire was distributed to the > 700 physician medical examiner/coroners (ME/Cs) who are members of the National Association of Medical Examiners (NAME, St. Louis, MO, U.S.A.). The questionnaire consisted of 23 death scenarios for which individual responders were asked to assign a manner of death (homicide, suicide, accident, natural, or undetermined); 198 questionnaires were completed and analyzed. The distribution of manner of death responses was tabulated. In addition, a nosologist from the National Center for Health Statistics was provided with a cause-of-death statement based on each scenario and was asked to assign an International Classification of Diseases (ICD) code for the underlying cause of death, from which a manner of death was inferred from the ICD code's literal text description. Overall, agreement on a given manner of death in a single scenario was > 90% in only 4 of 23 scenarios and > 70% in only 12 of 23 scenarios. However, in 21 scenarios, the most common response comprised a majority. The manner of death inferred from the ICD code that was assigned by the National Center for Health Statistics (NCHS) matched the most common response of participants in 18 of the 23 scenarios. The questionnaire results show that there is substantial disagreement among experienced MEs concerning the manner of death classification that is preferred for selected types of death. Encouraging, however, is the fact that the manner of death coded for statistical purposes generally agreed with the most common classification of manner made by ME/Cs. Highlights from the discussion of each scenario that occurred during the NAME interim meeting (Nashville, Tennessee, February 1996) are also included. Other portions of the program including history of manner of death concepts and results of questions regarding responder training and characteristics are published separately in this issue of the Journal. Information derived from the questionnaire should be useful to those planning strategies to improve the consistency of manner of death classifications by ME/Cs.

Autopsy↗
PubMed1997

Death registration: history, methods, and legal issues.

This article includes a brief discussion of the evolution death registration as it changed from records of church burial ceremonies to the recording of vital events by government in defined registration areas; today's death registration system in the United States; classification and coding procedures; limitations of data derived from death registration; educational materials; legal issues involving death certificates; and the re-engineering of the death registration process.

Death Certificates↗
PubMed1997

Principles for including or excluding 'mechanisms' of death when writing cause-of-death statements.

OBJECTIVE: To develop principles and refined definitions designed to improve the content of cause-of-death statements regarding inclusion or exclusion of so-called mechanisms of death. DATA SOURCES: Survey of readily available instruction manuals and other literature regarding mechanisms of death and instructions for death certificate completion. DATA SYNTHESIS: Definitions and principles contained in the information sources were reviewed, and a set of specific principles, criteria, and definitions were written. These principles are consistent with, but are more extensive and practically applicable than, those found in each of the information sources surveyed and may be used to decide which conditions to report in cause-of-death statements. CONCLUSIONS: Mechanisms of death include a defined list of terminal events (such as asystole) and a larger group of nonspecific physiologic derangements (such as portal hypertension) and are differentiated by definition from nonspecific anatomic processes (such as cirrhosis). Three principles may be applied in individual cases. Principle 1 states that terminal events are not reported in cause-of-death statements. Principle 2 states that a nonspecific physiologic derangement or a nonspecific anatomic process should be reported if (1) it is a recognized, potentially fatal complication of the underlying cause of death; (2) it constitutes part of the sequence of conditions that led to the death of the patient in question; (3) it is not a symptom or sign; (4) its existence in the patient would not be apparent unless included and explicitly stated in the cause-of-death statement; (5) its inclusion does not constitute an oversimplification of the facts; and (6) an etiologically specific underlying cause of death is also reported. Principle 3 states that if the existence of the complication is obvious based on the underlying cause of death or another reported complication, it need not be reported.

Autopsy↗
PubMed1997

The Centers for Disease Control and Prevention's Medical Examiner/Coroner Information Sharing Program (MecISP)

In 1986, the Centers for Disease and Prevention established the Medical Examiner and Coroner Information Sharing Program (MecISP) with four primary goals: 1) To improve the quality of death investigations in the United States and to promote more standardized practices concerning when and how to conduct these investigations; 2) to facilitate communication among death investigators, the public health community, federal agencies, and other interested groups. 3) to improve the quality, completeness, management, and dissemination of information regarding investigated deaths; and 4) to promote the sharing and use of medical examiner/coroner death investigation data. Major MecISP projects have included periodic production of a directory of death investigators in the United States and Canada, creation of standard and generic death investigation report forms, development of death investigation data sets, and collection of death investigation data from medical examiner/coroner offices. MecISP also conducts site visits to assist in office computerization, supports educational meetings and the development of training materials for death investigators, facilitates ongoing projects of relevant professional organizations, contributes publications to the death investigation literature, conducts surveillance of selected types of deaths, and responds to specific inquiries from medical examiners and coroners about administrative and practical death investigation issues.

Centers for Disease Control and Prevention, U.S.↗
PubMed1997

The impact of homicide trials on the forensic pathologist's time--the Fulton County experience.

Subpoenas received for criminal trials related to homicides in Fulton County (Atlanta) Georgia were tracked in a computer database for an 18 month period in order to determine the proportion of forensic pathologist worktime required for testimony in homicide cases. The number of subpoenas received annually amounted to 64% of the average number of homicides occurring annually. Testimony was required in about 33% of cases in which a subpoena was received, and, therefore, the number of testimony appearances per year was about 21% of the average annual number of homicides. Assuming a 40 hour work week for 52 weeks per year and an average of 3 hours of time preparing for, traveling to, and testifying in court, the time required of the forensic pathologist to testify in homicide trials amounted to about 2% of a full-time-equivalent. Although the time required for testimony in homicide cases may vary among jurisdictions because of the nature of its homicides, distance and travel time to court, and other factors, the data presented here may be used to estimate the impact of homicide trial court time on forensic pathology practice.

Coroners and Medical Examiners↗
PubMed1996

Coroner training needs. A numeric and geographic analysis.

OBJECTIVE: To define geographically and numerically the need for coroner training programs. DESIGN: Survey and literature review. SETTING: States in the United States that have coroners. MAIN OUTCOME MEASURES: Which states have coroners; which states require coroners to be physicians or have mandated training requirements; and the number of coroners potentially requiring training on an annual basis. RESULTS: Twenty-nine states have coroners in some or all counties with coroner states being located throughout most of the United States except for New England and the Mid-Atlantic states. Four states (Louisiana, Kansas, North Dakota, and Ohio) require coroners to be physicians. Seven states (Georgia, Illinois, Kentucky, Mississippi, Montana, Pennsylvania, and Wyoming) have mandated training requirements. At any given time, there are approximately 2759 individuals serving as coroners. Nationwide, the annual number of newly elected or appointed coroners ranges from 159 to 1546. CONCLUSIONS: It is feasible to provide training to all newly elected or appointed coroners annually. The use of existing training programs, development of state-specific training programs, and the development of a standard national training curriculum may be useful strategies. Funding sources for coroner training need to be explored.

Coroners and Medical Examiners↗
PubMed1996

The abdominal diameter index and sudden coronary death in men.

Alternative anthropometric indexes were compared for their ability to discriminate between 35 Atlanta men with sudden coronary death and 81 male controls. With or without adjustments for age, race, and body mass index, the abdominal diameter index (supine sagittal abdominal diameter divided by midthigh circumference) was associated with sudden coronary death more strongly than the waist/hip ratio or waist/thigh ratio of circumferences.

Abdomen↗
PubMed1996

National Association of Medical Examiner's Pediatric Toxicology (PedTox) Registry.

In 1985, the National Association of Medical Examiners (St. Louis, MO) established a Pediatric Toxicology (PedTox) Registry to collect case reports of drugs and substances detected in children. For many drugs and substances detected in children, to date, the medical and toxicology literature contain little useful information regarding toxic and lethal concentrations, and the PedTox Registry was established to provide additional information to those who must interpret observed concentrations of drugs and substances in children. This article includes a description of the development of the PedTox Registry, its management, and a brief summary of data that have been published, including information for acetaminophen, benzene, carboxyhemoglobin, codeine, desipramine, dextromethorphan, ethanol, phenobarbital, phenylpropanolamine, and pseudoephedrine.

Adolescent↗
PubMed1996

Protocol for writing cause-of-death statements for deaths due to natural causes.

The purpose of this article is to describe a protocol that provides suggestions and guides the clinical practice of writing cause-of-death statements for death certificates, autopsy reports, and other medical documents. The 16 members of the Autopsy Committee of the College of American Pathologists (CAP), Northfield, Ill, were appointed by the CAP officers based on demonstrated interest and expertise in autopsy performance and reporting. The committee perceived a need for specific instructions aimed at promoting consistency, accuracy, and completeness when writing cause-of-death statements. Development of a protocol was supported by CAP after approval by the CAP board of governors. The framework for the protocol was based on recommendations of the National Center for Health Statistics, Hyattsville, Md, with additional concepts added by the autopsy committee. The protocol for writing cause-of-death statements for natural causes is expected to foster consistency, accuracy, and completeness in the writing of cause-of-death statements. The quality of individual death certificates, autopsy reports, and national mortality data may improve through protocol usage. Application of the protocol principles should impose no ongoing costs at any user level because no new products or personnel are required for its application.

Autopsy↗
PubMed1996

The relevance of queries and coding procedures to the writing of cause-of-death statements.

A cause-of-death statement may result in a query by the vital records registrar to clarify cause of death information or to educate the certifier of death in recommended death certification procedures. The level of querying depends on local need and resources, and is usually conducted at one of six query priority levels. When applying International Classification of Disease (ICD) coding to cause-of-death information, nosologists use a General Rule and 12 additional rules, as needed, to identify an underlying cause of death for statistical purposes. Incorrectly or poorly written cause-of-death statements, and even well-written ones, may result in queries that could have been avoided, or in codes for the underlying cause of death that differ from those intended by either the certifier of death. In an attempt to foster improvement in cause-of-death statements and to facilitate coding, this article presents basic information about queries and coding rules so that certifiers of death will be aware of potential problems and coding issues. In general, cause-of-death statements that are complete, specific, timely, correct in temporal sequence, and written according to guidelines reduce the need for queries and facilitate the ICD coding process.

Cause of Death↗
PubMed1996

The role of medical examiners and coroners in public health surveillance and epidemiologic research.

The role of medical examiners and coroners (ME/Cs) in public health surveillance and epidemiologic research is reviewed. Definitions are offered, and discussion centers on the advantages of, and obstacles to the use of ME/C data; existing surveillance systems relevant to ME/Cs; studies assessing the usefulness of ME/C data; newly emerging tools for ME/C surveillance and epidemiologic research; and recommendations for the future. ME/C data have been used quite successfully in some settings and are potentially very useful for surveillance and epidemiologic research on a large scale, but the data have limitations that need to be addressed in the future.

Cause of Death↗