What is the primary function of the Johnson County Medical Examiner Department?

The primary function of the Johnson County Medical Examiner Department is to determine a scientifically based cause and manner of death for every death that falls within its jurisdiction.

Cause of death is defined as the disease or injury which set in motion the chain of events that ultimately results in the death of an individual.

Manner of death describes the circumstances surrounding the death. In Iowa, manner of death is classified into five categories: natural, accident, suicide, homicide and undetermined.

What types of death fall under the medical examiner's jurisdiction?

Iowa Code §331.802 clearly defines which cases fall under the jurisdiction of medical examiners. Medical examiner cases include sudden, unexpected, violent or unnatural deaths, and other deaths “affecting the public interest.” Deaths which are outlined in §331.802 must be reported to and investigated by medical examiners. Any death in which the manner of death is not natural or any death in which the decedent was not seen by a physician with 30 days when the decedent had a diagnosed terminal or bedfast conditions must be reported to and investigated by a medical examiner. These deaths must occur in Johnson County.

What is the difference between a medical examiner and a coroner?

In Iowa, the County Medical Examiner must be a licensed physician, appointed by the Board of Supervisors in each county and approved by the Iowa State Medical Examiner. His/her official responsibility is to investigate any death that is described in Iowa Code §331.802(3). A coroner is an elected official and does not have to be a licensed physician. Iowa does not utilize the coroner system.

What is the difference between a medical examiner and medical examiner investigator?

A medical examiner is an appointed physician who conducts investigations necessary to determine the cause and manner of death of individuals who die under violent, sudden, suspicious, unknown and unexpected circumstances. Medical examiner investigators are trained medicolegal death investigators who assist the ME in performing these duties.

If a death appears natural, why is the Johnson County Medical Examiner Department involved?

The medical examiner may take jurisdiction over an apparent natural death if (1) the death was unexpected, (2) the cause of death was uncertain, (3) the decedent was unattended by a physician, (4) the death might be due to a virulent or contagious disease, and/or (5) the manner of death is not clear.

What is an autopsy?

A medical examiner autopsy is a detailed medical/surgical examination of a person’s body and individual internal organs after death. The function of the autopsy is to identify and document the presence or absence of diseases and/or injuries that can explain an individual’s death. Diseases and injuries are interpreted in the context of an accompanying investigation of the patient’s circumstances of death, the medical history, and toxicologic testing. The cause and manner of death are determined by synthesis of investigative, historical and autopsy information.

A medical examiner autopsy is performed or supervised by a forensic pathologist (a pathologist with specialized training and board certification in the practice of autopsy pathology and medicolegal death investigation). Medical examiner autopsies performed by the Johnson County Medical Examiner Department are conducted in a respectful medical environment that is very similar to a hospital operating room. Surgical techniques are used to remove and examine each organ, while tissues and blood samples are selected for microscopic examination and toxicology testing.

In some cases it may be necessary to retain larger portions of tissues or even whole organs, such as when the brain needs to be examined in detail. After this examination, which may require many weeks, the residual tissues are retained in a manner similar to the retention of other autopsy specimens. If family members want those tissues returned after examination, it will be necessary for them to contact the Medical Examiner Department to arrange for the tissues to be sent to their funeral service provider. For a more detailed explanation of an autopsy, please visit the autopsy section of our website.

When and why is an autopsy needed and who determines this?

An autopsy may be ordered by the medical examiner based upon his/her medical opinion that an autopsy is needed to assist in determining the cause and manner of death. In some cases an autopsy may be required by law due to the circumstances surrounding the death. Even when the cause of death may appear to be obvious, such as in a gunshot wound, an autopsy can provide details necessary for determining the manner of death and information required for insurance purposes and legal proceedings.

May a family refuse an autopsy ordered by the medical examiner?

No. Autopsies are performed in order to answer medicolegal questions. We try to accommodate the individual wishes and beliefs of all families to the best of our abilities, while at the same time fulfilling any legal obligations that may be presented by an individual’s death.

Who pays for the autopsy?

There is no cost to the family for an autopsy that is ordered by the Johnson County Medical Examiner.

Does an autopsy affect funeral services?

Generally, an autopsy does not delay funeral services or prevent the option of embalming and viewing the decedent.

How do I choose a funeral service provider?

Iowa law prohibits the Johnson County Medical Examiner Department from recommending a funeral service provider. We suggest contacting your local funeral service providers to inquire about their services.

Where will the autopsy take place?

The Johnson County Medical Examiner Department primarily utilizes the University of Iowa Hospitals and Clinics Department of Pathology Autopsy Service in Iowa City, IA, as its primary autopsy consulting service. On rare occasions, an autopsy may occur at the Iowa Office of the State Medical Examiner in Ankeny, IA. The medical examiner investigator in charge of the case will be able to inform you where the autopsy will occur.

Who may obtain copies of the autopsy report?

The information contained within an autopsy report is confidential and treated as a medical record. The final report is available at no charge to the immediate and legal next-of-kin (power of attorney, spouse, adult child, parent, adult sibling, grandparent, guardian, in that order) and to those with written permission from the immediate and legal next-of-kin. Others who may receive copies of the autopsy report include treating physicians, law enforcement agencies and county attorneys investigating the death. The cause and manner of death are public records and can be released unless release of such information will jeopardize an investigation or pose a clear and present danger to the public safety or the safety of an individual (Iowa Code §22.7(41)).

How may I obtain a copy of the autopsy report?

The final autopsy report is available at no cost to the immediate and legal next-of-kin (power of attorney, spouse, adult child, parent, adult sibling, grandparent, and guardian). Final autopsy reports will only be provided to persons who are legally entitled to the report. You may obtain a copy of the final autopsy report by contacting the Johnson County Medical Examiner Department at 319-339-6197, or by mailing a completed Autopsy Report Request Form, or by printing and scanning a completed copy of the Autopsy Report Request Form and e-mailing it to: [email protected].

Requests for a copy of the final autopsy report from someone other than those who are legally entitled (e.g., an insurance company, a private attorney) must be submitted on company letterhead, include a release of information form signed by the legal next-of-kin and must include a $20 check made payable to the “Johnson County Medical Examiner Department.”

How long does it take to receive a copy of an autopsy report?

It generally requires at least 8 weeks for the autopsy report to be available. However, this may be extended if additional testing is ordered by the forensic pathologist. The issuance of the death certificate may or may not be affected by any delay in the autopsy report. Every effort is made to accurately complete the death certificate as soon as possible.

What is a death certificate and how do I obtain a copy?

The death certificate is an official, legal document and vital record that is signed by a licensed physician. It includes the decedent’s demographic data and states the cause and manner of death. The death certificate provides legal proof that death has occurred. The death certificate is needed to settle the estate of the deceased and provides information to public health agencies at the local, state, and federal levels to track statistical trends in health. These statistics are used to alert government health agencies of trends in natural and infectious diseases, risky behaviors, and unsafe equipment and vehicles which contribute to deaths.

The Johnson County Medical Examiner Department cannot issue copies of death certificates. The completed death certificate is filed by the funeral service provider. To obtain copies of the death certificate, please contact the funeral service provider who coordinated the services for your loved one. Death certificates of persons who die in Johnson County are filed in the Johnson County Recorder’s Office. The phone number is 319-356-6093.

I would like to have my loved one's organs/tissues donated. Will medical examiner involvement keep this from happening?

The Johnson County Medical Examiner Department notifies the Iowa Donor Network of reported deaths. We fully support organ, tissue, and eye donation and work closely with Iowa Donor Network and Iowa Lions Eye Bank.

How do I get the personal effects of my loved one?

Personal property that was held by the medical examiner investigator will usually be returned to your funeral service provider when it is no longer needed for the investigation. Please contact your funeral service provider in order to collect your loved one’s belongings. If law enforcement retained any personal property, you will need to contact the appropriate agency directly.

What is the best way to dispose of my loved one's leftover prescription medication?

Prescription medications belong to the individual they were prescribed to. Upon the death of that individual, these medications may be confiscated and disposed of by the Johnson County Medical Examiner Department (based on the type of medications). The department disposes of medications in accordance with FDA guidelines. Disposal options are available to families. These options are described on the FDA website.

Are there grief-counseling services available?

The Medical Examiner Department does not offer grief counseling. A list of resources is available on our website under the grief section.

Where can I get help cleaning a residence after a death?

Iowa law prohibits the Johnson County Medical Examiner Department from recommending a cleanup service. However, we can provide you with a list of companies we are aware of that provide biohazard cleanup services. The list can be found here.

What is a cremation permit and how can I obtain one?

Iowa Code §331.805(3) states that the Johnson County Medical Examiner Department is responsible for authorizing all cremations that occur in Johnson County. This is in order to ensure that potential medical examiner jurisdiction deaths have been thoroughly reviewed, and that no cases have been missed. Funeral service providers must obtain a permit to cremate from the Johnson County Medical Examiner Department. A permit may be obtained by calling our office telephone during normal business hours, or by paging the on-call medical examiner investigator. Our contact information can be found here. The fee for cremation permit is $75.

Are there any rules concerning the moving of a deceased person prior to the arrival of the medical examiner investigator?

Iowa Code §331.805 states that when a death falls within the jurisdiction of the medical examiner, the body shall not be disturbed or removed from the position in which it is found without authorization from the county or state medical examiner except for the purpose of preserving the body from loss or destruction or permitting the passage of traffic on a highway, railroad, or airport, or unless the failure to immediately remove the body might endanger life, safety, or health. A person who moves, disturbs, or conceals a body in violation of this subsection of the Iowa Code is guilty of a simple misdemeanor. The purpose of this rule is to ensure that the medical examiner investigator is able to understand the exact circumstances that existed at the time of a person's death.

Who is legally required to report a death to the Johnson County Medical Examiner Department?

Iowa Code §331.802(1) requires any attending physician, law enforcement officer, embalmer, or any other person present at the time of the death report that death to the Medical Examiner Department when the death affects the public interest as specified in Iowa Code §331.802(3).

How does HIPAA effect a medical examiner's ability to access protected health information?

There is a specific exemption within HIPAA that allows medical examiners access to patient information during the course of a death investigation. This is for the purpose of determining the cause and manner of death, including identification of the decedent.