SUDC Bereavement Series Topic 3

At this time, you are probably still working with a coroner or medical examiner to determine the cause of death of your child.  Often, these titles can be confusing or seem to be used interchangeably.  The autopsy process can also be overwhelming and lengthy.  We will attempt to make it more understandable. 

An investigator collects information to assist the coroner or medical examiner.  He/she may investigate the places where your child lived and died.  He/she may interview the parents/caregiver to gain a better understanding of the child’s life and the events that occurred up to the time of the death. They may have the title of medicolegal investigator, medical investigator, or may be a police officer who is specially trained to investigate deaths. 

A coroner may be a physician but often is not.  A coroner is generally elected or appointed by a governmental jurisdiction.  Sometimes the coroner is the chief of police or sheriff in a sheriff/coroner situation.  Generally, the coroner is a lay person and their background can vary. They may be a mortician, former law enforcement officer or an attorney. Coroners have the authority to convene a court to determine a cause of death. They often call on medical examiners to complete the postmortem investigation. 

A medical examiner (ME) is a licensed physician who is responsible for the autopsy to determine why a person has died. They are trained in pathology and possibly forensic pathology, a branch of medicine that deals with the diagnosis of disease and causes of death through laboratory examination. This person can be appointed by a county, state, or the state medical board.  A medical examiner may oversee other pathologists in the state or county or supervise investigators.   

Both the medical examiner and coroner are tasked with determining the cause and manner of why a person died but their role may vary by jurisdiction. (More on this later.) 

States and countries vary on how investigations are carried out and which of the described professionals are utilized.  Jurisdictions may also have different requirements for releasing documents and information to a family. Differences in practice can make tracking national statistics for SUDC and standardizing autopsy protocols difficult. Case advocacy services at the SUDC Foundation are available to you. Our Family Advocate or Executive Director can contact the authorities on your behalf. 

Usually, in a case of sudden unexpected pediatric death, a full autopsy is required to understand why the child died.  Sometimes, the medical examiner/coroner will have specific information to share with a family in the first few days following the autopsy.   

Often the medical examiner/coroner will explain that he/she needs to do more tests to understand why your child died.  At that time, he/she will release your child to a funeral home with a preliminary death certificate that may state “pending further investigation.”   

This will be amended when the tests are complete, and the report is finalized.  Further tests may include examining whole organs and/or small tissue samples (collected during autopsy) with a microscope.  The health or disease of an organ can be evaluated in this way.  During this time, lab tests are sent for review and second opinions from a medical expert in a particular field of medicine may be obtained.  It is important that the medical examiner/coroner completes this thorough evaluation in order to make a proper diagnosis. 

The full investigation will usually take a few months before the assessment is complete. The wait time does not mean that there is something wrong, but only that it takes time for the results to be obtained. 

Medical examiners/coroners are charged with determining the cause and the manner of death. They are tasked with determining medical and legal reasons for a person’s death. 

The cause of death is something that is found by autopsy; an infection, cancer or injury, etc., that is responsible for the death.  In cases where a final cause could not be found, your medical examiner/coroner may write his understanding in the best way possible: i.e..: “unexplained sudden death of a 2-year-old child (cause), undetermined (manner).” 

In terms of describing the manner of death (or how the death occurred) the medical examiner/coroner usually has 5 options for coding purposes: Natural, Homicide, Suicide, Accidental and Undetermined.  In terms of our children, we know that suicide in toddlers is not an option. There are four other possibilities. By reviewing the evidence and the actual cause of death as well as the circumstances, medical examiners/coroners decide what that manner type should be. The same cause may have different manners of death. For example, a person who died due to trauma from a fall could have an accidental manner of death, or it could be homicide if it was intentional at the hands of another person.   

Unfortunately, medical examiners/coroners deal with all types of tragedies every day.  Children, like ours, are a rarity in their offices and take a prolonged in-depth investigation. 

If there is not an actual cause for a death determined, then it is impossible for the medical examiner/coroner to say for certain that the manner of death is natural. The term natural means that a death did not occur due to outside forces, but due to a physiological cause. If the medical examiner/coroner is unable to determine a natural cause, then “undetermined” manner is often utilized. They may use the terminology of “undetermined” or “cannot exclude external causes”. This means that he/she cannot rule out an environmental, accidental or natural reason for a child’s death.    

If your child is under one year of age and the final cause of death could not be determined, it may be classified as Sudden Infant Death Syndrome (SIDS). If your child is over the age of 12 months and a cause could not be determined, it may be classified as Sudden Unexplained Death in Childhood (SUDC), or other terminology that describes a death that could not be clearly explained, such as “undetermined” or “unexplained sudden death.” 

The death investigation process is emotionally difficult for families. Intense grief compounds the difficulty of dealing with such traumatic aspects of our child’s death. The assistance from a family member, your child’s pediatrician, other trusted medical persons may be helpful. Family advocacies services at the SUDC Foundation are always available to you. We would be happy to assist on your behalf by being a liaison for you with the medical examiner or coroner.   

When it is time to receive your child’s autopsy report, you are not required to read it and many families do not.  

Our family resource guide expands on the consideration of this decision which is indeed personal. We advise you to review that advice in advance to avoid further stress and confusion as you try to understand the results of the investigation.  

The SUDC Foundation can receive the report for you, review it with you, share it with your trusted medical providers on your behalf, help to attain a second opinion of the report and assist you with questions that arise. If the cause of your child’s death fails to be understood by the investigation, you have options to pursue additional testing and analysis through the SUDC Registry and Research Collaborative. To learn more- go to www.sudc.org> Advocate for Research > SUDC Registry and Research Collaborative.