Audit of the Office of the Chief Medical Examiner Overview of Audited Entity

This section describes the makeup and responsibilities of the Office of the Chief Medical Examiner.

Overview

The Office of the Chief Medical Examiner (OCME), established under Chapter 38 of the Massachusetts General Laws, is a state agency within the Executive Office of Public Safety and Security. Its primary mission is to investigate the cause and manner of death in cases that fall under its jurisdiction.¹ The Chief Medical Examiner has jurisdiction over cases in which the death was a result of violence; of another unnatural cause; or of a natural cause that, in the Chief Medical Examiner’s opinion, requires further investigation. OMCE is Headquartered in Boston with its main regional offices located in Westfield, Sandwich, and Worcester.

OCME Responsibilities

OCME’s website states that it does the following:

Investigates the cause and manner of death for deaths that occur under violent, suspicious, or unexplained circumstances. . . . We work with families and funeral homes to provide information to those affected by sudden or traumatic loss. We also provide forensic services to assist law enforcement and public health.

According to its most recent internal control plan, OCME’s mission is the following:

To release work products, namely certifications of death and autopsy reports in a timely manner. The OCME relies upon forensic pathologists and medical examiner assistants to meet this mission, along with additional support from medicolegal investigators, as well as administrative, fiscal, legal, and managerial staff.

Autopsy Reports

An autopsy is a comprehensive medical examination of a dead body, including the internal organs, performed by a physician trained in pathology in order to determine how or why a person died. This examination results in a final autopsy report that documents the cause and manner of death.

According to its medical examiner policy guidelines, OCME medical examiners are responsible for finalizing 90% of their cases and issuing an autopsy report within 90 days of an autopsy.

Autopsies are performed at the OCME facility. The Chief Medical Examiner creates a case roster each day for the medical examiners. Typically, autopsy cases are from deaths that occurred the prior day. Each medical examiner performs the autopsy and, depending on the complexity of a case, issues a summary of autopsy findings or a more detailed report for internal records. OCME also discloses autopsy reports to external entities, such as next of kin or law enforcement, if certain conditions are met.

External Views

An external view is an external examination of the body; it includes photographing the front and back of the body and documenting all signs of injury or disease. An external view is done when an autopsy is not required to determine the cause and manner of death to a reasonable degree of certainty.

District Medical Examiner Views

District medical examiner views are performed by physicians on contract, whose medical training may be something other than forensic pathology. District medical examiners perform views in hospitals and funeral homes to certify the cause and manner of death when the death was not the result of foul play and the cause and manner is apparent from the circumstances of the death and the available medical history.

Chart Reviews

Chart reviews are performed on cases identified during cremation authorization views for which the cause and manner of death are not properly certified, the body is no longer available, or the cause and manner of death is obvious from inspection of medical and other records and no further information would be obtained by transporting the body to OCME.

Death Certificates

A death certificate is the official document, signed by a physician, attesting to a person’s death. It includes the time, place, and cause of death, as well as pertinent identifying information, such as the age and sex of the deceased. In some cases, a pending death certificate is issued initially, and when all test results are available, a final, amended death certificate is prepared. According to OCME policy guidelines, initial death certificates are to be signed on the day of examination with a final death certificate signed 90 days after the examination.

Breakdown of OCME Death Certificate Cases^*

	Autopsy	External View	District Medical Examiner View	Chart Review	Total
Fiscal Year 2022	1,897	4,715	209	1,530	8,351
Fiscal Year 2023	1,945	4,713	167	1,782	8,607
Total	3,842	9,428	376	3,312	16,958

*    These cases do not include 230 human or non-human bone or tissue cases that OCME accepted, as these cases do not require death certificates.

Next of Kin Communications

OCME medical legal investigators are required to follow the Medicolegal Investigators section (3.01[B][1–2]) of the Office of the Chief Medical Examiner: Policy Manual to ensure that legal next of kin have been notified of a decedent’s death and that communication has been established with investigating agencies. OCME medicolegal investigators are assigned a case and communicate with the decedent’s next of kin to establish the family tree and determine whether a funeral home has been decided on. All communications are logged in the OCME Case Management Tracking System (CMTS).

Decedent Release Responsibilities

In accordance with Section 13 of Chapter 38 of the General Laws, OCME must ensure that the decedents’ bodies are released to appropriate parties, such as a surviving spouse or next of kin. There are a number of forms that need to be completed to process a decedent release, including a Statement of Identification and Funeral Home Authorization and Acknowledgment Forms.

During the audit period, there were 36,835 reported² deaths in OCME’s CMTS. See the Appendix a list of deaths that must be reported to OCME according to Section 3 of Chapter 38 of the General Laws. OCME accepted jurisdiction over 17,188 of these deaths. OCME accepts jurisdiction of a case when it is of the opinion that a death was because of violence, unnatural means, or natural causes that require further investigation.³ The table below summarizes the reported deaths by fiscal year and total number of accepted cases resulting in a death certificate.

OCME Caseload of Reported Deaths

	Accepted	Declined	Total Reported
Fiscal Year 2022	8,463	9,889	18,352
Fiscal Year 2023	8,725	9,758	18,483
Total	17,188	19,647	36,835

During the audit period, OCME received appropriations of $12,862,676 and $16,971,920 for fiscal years 2022 and 2023, respectively. As of July 1, 2023, OCME employed 169 individuals in its four offices of Boston, Westfield, Sandwich, and Worcester.

Coronavirus Emergency Supplemental Funding Program

In response to the COVID-19 pandemic, OCME was awarded a total of $186,034⁴ through the Coronavirus Emergency Supplemental Funding Program and expended $131,300 of these funds during the audit period. The Coronavirus Emergency Supplemental Funding Program was intended to address a department’s greatest needs with respect to preventing, preparing for, and responding to the COVID-19 pandemic. OCME was to follow the Office of the Comptroller of the Commonwealth’s Revenue and Grants Directive, effective April 1, 2020, when accounting for these funds. The following table provides a breakdown of the four purchases made during the audit period.

Item Purchased	Description	Amount
Call Center Furnishings	Desks, chairs, dividers	$24,287
Call Center Furnishings	Shelfing with heavy-duty roll-out drawers	$58,634
Call Center Furnishings	Office walls and windows	$20,036
Call Center Furnishings	Materials and glass walls for office spaces	$28,343

The following table provides a breakdown of COVID-19 funds received by fiscal year.

Fiscal Year	Amount Received
2021	$   52,303
2022	131,299
Total	$ 183,602

1.    After a review of the facts and circumstances of a reported death, OCME either accepts or declines the assignment (jurisdiction) of a death investigation.

2.    A death can be reported by hospitals, medical professionals, or law enforcement.

3.    According to OCME, natural causes that require further investigation involves the process of a medical examiner ruling out other contributing factors to a death.

4.   The funds award letter was signed on August 25, 2020.

Date published:	December 19, 2024