Reporting a Case
Reportable Death Criteria
OCME has jurisdiction over deaths occurring under the following circumstances:
- All forms of criminal violence or from an unlawful act or criminal neglect
- All accidents (motor vehicle, industrial, home, public place, etc.)
- All suicides
- All deaths that are caused or contributed to by drug and/or chemical overdose or poisoning
- Sudden death of a person in apparent good health
- Deaths which occur unattended by a physician and where no physician can be found to certify the cause of death; in this context, "unattended by a physician" shall mean not treated by a physician within 31 days immediately preceding death
- Deaths of all persons in legal detention, jails or police custody
- This category also includes any prisoner who is a patient in a hospital, regardless of the duration of hospital confinement
- Deaths which occur during diagnostic or therapeutic procedures or from complications of such procedures
- When a fetus is born dead in the absence of a physician or midwife
- Stillbirths in the hospital need not be reported to OCME unless there is a history of maternal trauma or drug abuse, or the case has some other unusual or suspicious circumstance
- Neonatal deaths from prematurity and its complications must be reported if the premature delivery was caused by maternal trauma or drug abuse
- Deaths due to disease, injury, or toxic agent resulting from employment
- When there is an intent to cremate or dispose of a body in any fashion other than interment in a cemetery
- Dead bodies brought into the City without proper medical certification
- Deaths which occur in any suspicious or unusual manner
OCME also investigates any case that may present a threat to public health.
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Procedures for Reporting Deaths
Deaths should be reported promptly to avoid delays in official investigations.
Police precincts and hospitals throughout the City telephone a Report of Death to OCME's Communications Department by dialing 212-447-2030, 24 hours a day, 7 days a week; the Communications Specialist on duty records basic information concerning the circumstances of injury or death, and of hospitalization. The Communications Specialist then notifies an available OCME MedicoLegal Investigator (MLI).
The MLI will respond to the scene and obtain additional facts from family, friends, and police. If there are reasons for further examination or autopsy, the MLI will direct that the body be transported to an OCME facility. When death has occurred in a hospital, a field investigation is generally not conducted; instead, the investigation routinely consists of a review of hospital records with the reporting physician. Health care facilities reporting cases to OCME Communications must present the following completed and competent documentation:
- Medical Examiner (ME) Clinical Summary Worksheet
- Admission Face Sheet
- Discharge Summary (if unavailable, then the Admission History and Physical examination)
- Emergency Medical Services Patient Care Report/Ambulance Call Report (PCR/ACR)
- Completed death certificate (for claim-only decedents, not ME jurisdiction cases)
- Exception: in cases of Induced Terminations, health care facilities do not have access to the "Certificate of Induced Termination." Therefore, the requirement for a competent death certificate is waived
- Completed burial permit (for claim-only decedents, not ME jurisdiction cases)
- Signed authorization for City burial (if being requested by decedent's family/next-of-kin)
Deaths occurring in health care facilities which do not meet the Reportable Death Criteria in 1 above need not be reported to OCME.
Deaths occurring within 24 hours of hospitalization from natural causes in which the diagnosis has been made with reasonable medical probability need not be reported, despite the fact that the patient survived less than 24 hours in the hospital; there is no "24-hour rule" in New York City.
Deaths due exclusively to natural disease need not be reported to OCME.
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Notes and Definitions for Physicians
- Cause, Mechanism and Manner of Death
The cause of death is the disease or injury responsible for initiating the lethal sequence of events. A competent cause of death should be etiologically specific.
The mechanism of death is the altered physiology and biochemistry whereby the cause exerts its lethal effect. Mechanisms of death lack etiology specificity and are unacceptable as substitutes for underlying causes of death. Common mechanisms of death include congestive heart failure, cardiac arrhythmias, asphyxia, sepsis, exsanguinations, renal failure, and hepatic failure. The term "cardio-respiratory arrest" is, as a rule, meaningless for the purposes of death certification; it is a description of being dead, not a cause of death.
The manner of death explains how the cause arose: natural or violent (accident, homicide, suicide or undetermined). Natural deaths are defined as those which are caused exclusively (100%) by disease. If an injury of any sort causes or contributes to death no matter how minor the contribution, the manner of death cannot be natural. OCME never uses mixed classifications of the manner of death (eg., natural/accident).
- Proximate versus Immediate Cause of Death
The underlying or proximate cause of death is that which, in a natural and continuous sequence unbroken by an efficient intervening cause, produces the fatality, and without which the end result would not have occurred.
Intermediate causes of death are the complications and sequelae of the underlying cause. There may be one or more immediate causes, and they may occur over a prolonged interval, but none absolves the underlying cause of its ultimate responsibility.
- For example, a man sustains a transabdominal gunshot wound with perforation of the colon. In spite of treatment over a period of three months, he develops peritonitis, septicemia, disseminated intravascular coagulation, hepatic and renal failure, bronchopneumonia, and adult respiratory distress syndrome. The gunshot wound is still the underlying or proximate cause of death, and such fatality must be reported to OCME.
- As another example, if a person dies from complications of quadriplegia 10 years after an automobile accident in which (s)he sustained a cervical fracture with contusions of the spinal cord, the fatality must be reported because the injuries caused by the accident are the proximate cause of death.
- In any instance of suspected poisoning or drug overdose, it is essential that the samples of blood, urine and gastric lavage, obtained at or about the time of admission to the hospital, be retained for appropriate chemical testing.
- All indwelling tubes, intravascular catheters and drains should remain undisturbed in situ following a death which qualifies as an OCME case.
- All organ or tissue donations from decedents in OCME cases should be cleared with OCME.
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Training Resources to Improve Cause of Death Reporting
Clinical physician staff needing assistance in completing death certificates for deaths in health care facilities should refer to the New York City Department of Health and Mental Hygiene (DOHMH) training materials. If you have never previously completed training in Death Certificate completion, please click on "Training and Resources for Providers" and then "more information" under "Death Reporting" to find information about how to complete the cause of death. OCME should not be contacted for purposes of assistance with death certification.
The memorandum from the DOHMH Assistant Commissioner, Bureau of Vital Statistics documents resources available for completing cause of death on New York City death certificates.
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