What about Deaths in Newfoundland and Labrador
When are deaths in NL investigated by the Office of the Chief Medical Examiner?
A question was posed on Facebook asking when autopsies or when an investigation should be carried out following a death. The question also elaborated on how many autopsies are being performed annually and pointed to other question marks such as why, when, where, who and under what circumstances. This Substack will attempt to answer at least some of the question marks identified here.
First, I have to say that I’m not in the business of writing articles, stories, prose, fiction or reports. I can read but cannot articulate as well as I would like. Let me know if you have found this article informative by leaving a comment.
Now that we have that out of the way, a simple google search of, “what type of death in Newfoundland requires an autopsy” brought up a link to the “Office of the Chief Medical Examiner Activity Plan 2020-2023”. This was a good find as it has provided information to offer context before I drone on talking about legislation. It is interesting the plan has no issue date but I do know it was issued some time after March of 2019 as this is when the newly appointed Chief Medical Examiner, Dr. Nebojsa (Nash) Denic assumed the role. Dr. Denic signed off the Activity Plan (the Plan).
According to the Plan, approximately 700 deaths per year are investigated by the Office of the Chief Medical Examiner, or OCME. The Plan also states that deaths of this nature account for ~30% of deaths within NL.
Deaths which are considered reportable as stated in the Plan are those which are due to violence, accident or suicide, improper or negligent treatment, are sudden and unexpected or when an individual is not under active medical care at the time of death or when the cause of death cannot be determined.
Vision of the OCME is, “An environment where the OCME responds to those deaths that are appropriately reported in accordance with the Fatalities Investigations Act”.
Before I get into the legislation, I want to elaborate further on the OCME as it provides further context of where I am going. Values of the OCME are;
1. Independence – The Chief Medical Officer, or CME, ensures the independence of the office is maintained by acting in a neutral fashion when engaged in investigating and reporting sudden and unexpected deaths;
2. Impartiality & Fairness – The CME and Medical Examiners (ME) perform their work without bias.
3. Empathy – The CME and employees of the OCME deal fairly and respectfully with individuals who are affected by a sudden and unexpected death.
Furthermore, the OCME serves the people by investigating those reportable deaths to determine the cause and manner of death.
The OCME provides statistical information regarding the number and causes of death to various federal and provincial government and non-government agencies.
Fatalities Investigations Act
Under the Fatalities Investigations Act, “the Act”, Section 5 titled, Notice of Death;
A person having knowledge of or reason to believe that a person had died under one of the following circumstances shall immediately notify a medical examiner or investigator;
a) as a result of violence, accident or suicide;
b) unexpectedly when the person was in good health;
c) where the person was not under the care of a physician;
d) where the cause of death is undetermined;
e) as a result of improper or suspected negligent treatment by a person.
Yes I know, this is somewhat a repeat of what I highlighted with regards to what I found in the Activity Plan however I want to be clear (I sound like a politician) of what the law states.
This is a good time to issue an ATIPP request. If anyone doesn’t know what an ATIPP request is, it is similar to the Freedom of Information request however named in NL as the Access to Information and Protection of Privacy Act and it’s here, where citizens of NL can make a request for information from the government on any subject.
There’s no guarantee you will get an answer as I have been finding out, however I digress. If anyone wants to understand further the role and structure of the ATIPP office and affiliates, check out https://www.gov.nl.ca/atipp.
ATIPP Request #1
Provide the number of deaths in NL annually broken down into persons of all ages and of children aged between 5 and 18 years for the time period of 2018 to Q3 of 2022, that were considered to meet the threshold of reportable deaths as defined in the Fatalities Investigations Act. Subsequently, how many Child Death Review Committees has the Lieutenant-Governor established for the same time period. Please reference any reports the committee has issued in this timeframe.
You’re likely asking, what the hell is a Child Death Review Committee. Good question. According to the Act, Section 13.1(1), titled, Child Death Review Committee;
The Lieutenant-Governor in Council shall establish a Child Death Review Committee to review the facts and circumstances of deaths referred to in subsection 13.2(1) for the purpose of…
I will hold back here as anyone can read the rest by going to SNL1995 CHAPTER F-6.1 - FATALITIES INVESTIGATIONS ACT (assembly.nl.ca). I only refer to the section to point out where the Child Death Review Committee comes from. The point is, if a child dies under circumstances defined in the Act, i.e. suddenly or unexpectedly or died while they were in good health, and there are children dying in this province that meet this criteria, then the Child Death Review Committee shall be established.
There are lots of goodies in the Act and I want to point out only a few for the sake of droning on.
Section 10, titled, Duties of medical examiner, subsections (2), (3) & (4) state respectfully;
(2) A medical examiner shall keep a record of all deaths of which he or she is notified under this Act and shall provide to the Chief Medical Examiner a record of all investigations that he or she or an investigator under his or her supervision makes into a death, including the reports, certificates and other documents prescribed by the Chief Medical Examiner.
(3) When a medical examiner is unable to investigate a death of which he or she receives notice, he or she shall
a) notify another medical examiner if the death occurred in a circumstance referred to in section 5, 6, 7 or 8; and
b) record why the death was not investigated by him or her.
(4) When a medical examiner has investigated a death and has determined the manner and cause of death, he or she shall immediately complete the medical certificate portion of the death registration form in accordance with the Vital Statistics Act, 2009.
I have highlighted sections here to show the obligation of the ME in keeping records of all deaths of which he or she is notified under the Act and to record why a death was not investigated by him or her. This leads me to the second ATIPP request.
ATIPP Request #2
How many reportable deaths as defined in the Fatalities Investigations Act, were not investigated by the OCME or any other persons under the OCME authority, for the years 2019, 2020, 2021 and 2022 (or up to the latest records)? In accordance with Section 10(3)(b), of the Fatalities Investigations Act, provide the records as to why the deaths were not investigated.
Getting back to the Child Death Review Committee, after each review, the committee shall report to the minister…[refer to the Act for what comes next]
The minister shall as soon as practicable provide a copy of the report of the committee to the Child and Youth Advocate. Interesting. Perhaps I will leave the Child and Youth Advocate for another Substack someday.
There are obviously other provisions in the Act that some may find interesting. For example, Section 14 is titled, Conduct of autopsy which requires that autopsy reports shall be provided to the ME when authorized or Section 21, titles, Cremation or export of bodies which prevents a body from being cremated or shipped out of province until an ME issues a certificate in the form prescribed by the CME.
I did want to stick with Sections 25 and 26 for a minute. I promise I’m nearly done.
Section 25 allows the CME the discretion to make recommendations to the minister that should it be in the interest of public safety that a public inquiry be held regarding one or more deaths that occurred under a circumstance referred to in Section 5, 6, 7 or 8 of the Act. Note, Section 5 is discussed earlier in this Substack.
Section 26 gives the minister the power to call a public inquiry from the CME recommendations, and to assign a judge to conduct an inquiry. Note this Section does state that so long as the minister is satisfied that an inquiry is necessary for the protection of the public interest, he or she can call for an inquiry.
Sounds like the minister has discretion into what he or she determines to be of the public interest. I wonder how many reports from the OCME or committee which had recommendations to hold a public inquiry for purposes defined in the Act, that did not meet the satisfaction of the minister. Perhaps an ATIPP request should be submitted asking that very question. Well here goes…
ATIPP Request #3
How many recommendations from the Office of the Chief Medical Examiner (OCME) or the committee, as established in accordance with Section 13.1 of the Fatalities Investigations Act, the ‘Act’, have been made in 2019, 2020, 2021 and 2022 to the minister responsible for the administration of the Act, that a public inquiry be held regarding one or more deaths that occurred under a circumstance referred to in Section 5, 6, 7 or 8 of the Act. How many public inquiries have been conducted as a result of the recommendations from the OCME from the same time frame, 2019, 2020, 2021 and 2022?
After all this, I’m not sure whether I answered the Facebook questions that I highlighted at the beginning of this article. Talk about beating around the bush.
This article has explained when a death shall be investigated by the OCME, see Section 5, 6, 7 or 8 of the Act. An investigation by the OCME, in the way I’m reading the Act, doesn’t necessarily require an autopsy to be performed, see Section 14(1). This means that if a circumstance(s) of a death fall within the threshold of the Act for the OCME to investigate, it doesn’t necessarily mean that an autopsy will also be conducted or required. This article has provided the typical number of deaths in a year that the OCME was obligated to investigate, which is 600. Yes, this is correct. Yes, I stated 700 earlier in the article. There are typically 100 deaths a year in NL the OCME investigates for which they are not obligated to.
Autopsies and investigations of deaths are under provincial jurisdiction governed by the Fatalities Investigations Act. The Justice and Public Safety Minister is responsible for administering the Act. Let’s wait to hear back from the ATIPP office and/or the Justice and Safety Department and if and when I get a response, I will be sure to share what they have to say.
Stay Tuned!