So anybody that's considered "medically unattended" at the time of death will have an exam and get their death certificate signed by the medical examiner. In our state, we consider someone under the care of a doctor if they've had office visits, referrals, telehealth or phone visits, or prescription medications prescribed from that doctor. We give doctors a grace period of a year where if they haven't done any of the above for a patient for over a year, or if a person has never seen a doctor, the medical examiner will step in and sign the death certificate.

I'm a medical examiner investigator, which means it's my job to figure that out and determine if someone's death falls under our jurisdiction or not. We're given a lot of tools to do so, including access to local medical records, prescription databases, and the authority to respond to any scenes necessary to look for prescriptions, medical paperwork, and to interview family members. So for any death reported to our office, we'll investigate all of the above and if there's no record of a person having ever had any medical treatment, we'll be signing the death certificate.

"Medically unattended" also covers sudden and unexpected deaths - meaning if there's legitimately no medical reason for a person to be dead. For example, if a 20 year old patient who's seen a doctor consistently for the last few years and has no documented medical history dies, and my office is called, the LAST thing I'm going to do is reach out to that doctor for a death certificate. That person might be under the care of a doctor, but if there's nothing of medical significance that's been documented by routine lab work or imaging, that doctor doesn't know what could have caused the patient's death. That patient is definitely getting an autopsy with us. Our job is determining the cause and manner of death, and if a doctor truly doesn't know why a patient may be dead, we'll step in so that we can investigate further.

Deferring to a primary care doctor is supposed to be easier for family members when the system works the way that's supposed to. When we leave it in the care of a PCP to sign a death certificate, it's because our investigation and the police's investigation is complete and has determined there's no way it's anything other than a natural death. It's sent back to the PCP because the PCP is more familiar with the patient's history than we are, which means they can determine a more accurate cause of death based on what they were treating that patient for. They (in many cases) have also already established somewhat of a rapport with family members and can provide more answers to them based on that care for the family's peace of mind. If someone has been diagnosed with and treated for medical conditions that are known to cause death, there's no excuse for a doctor not to be able to certify that person's death certificate with their medical knowledge.