Medical Examiner

1. Overview

District Twenty Medical Examiner
Collier County - Naples, Florida

The responsibility for medicolegal death investigation in Collier County rests with the District Twenty Medical Examiner, in accordance with Florida Statute 406, Florida Administrative Code 11G and the Guidelines of the Florida Association of Medical Examiners.

2. Medical Examiner Law

Medical Examiner jurisdiction is determined by Florida Statute 406, The Medical Examiner Law. In particular, Florida Statute 406.11 lists the circumstances that will require medical examiner involvement, which are as follows: 

1. Of criminal violence; 
2. By accident; 
3. By suicide; 
4. Suddenly, when in apparent good health; 
5. Unattended by a practicing physician or other recognized practitioner; 
6. In prison or penal institution; 
7. In police custody; 
8. In suspicious or unusual circumstance; 
9. By criminal abortion; 
10. By poison; 
11. By disease constituting a threat to public health; 
12. By disease, injury or toxic agent resulting from employment; 

    b) When a dead body is brought into the state without proper medical certification; 
    c) When a body is to be cremated, dissected or buried at sea.

3. Death Certification

The Department of Health Bureau of Vital Statistics, in cooperation with the Florida Medical Association and the Florida Association of Medical Examiners, has developed an online tutorial for physicians that provides information to properly complete the death certificate. 

The tutorial provides sample case histories, an explanation of the physician's, medical examiner's and funeral director’s responsibilities in death certification, and also explains how mortality data is used and the importance of the death record. 

The Florida Medical Association approves this activity for AMA PRA Category 1 Credit. Visit Cause of Death Tutorial For Florida Physicians for more information.

The two essential elements of the death certificate are the cause of death and the manner of death. The immediate cause is the disease or the injury that causes the death of a person. The proximate cause is the disease or injury that initiates the series of events that eventually leads to death. The two may be the same, but not always. For example, a person may suffer a myocardial infarct due to coronary artery disease. The immediate cause of death is the infarct, the proximate cause of death is coronary artery disease, and the manner of death is natural. The initiating event is the most important factor in determining the cause of death.

A concept that is often misunderstood by physicians is the mechanism of death, such as ventricular fibrillation, cardiac arrest, pulmonary arrest, etc. The Office of Vital Statistics requests that these mechanisms of death NOT be entered as causes of death on the death certificate. The mechanism of death should not be confused with the cause of death.

Florida law states that attending physicians may only sign death certificates when the manner of death is natural. The death certificate shall be completed and signed by the physician in charge of the decedent’s care for the illness or condition that resulted in death, or by the physician in attendance either at the time of death or immediately before or after. The cause of death should be the physician’s best medical opinion and terms such as “possible” or “probable” can be used when the certifier is not comfortable making an exact diagnosis. The cause of death is best explained as a probability and the death certificate does not have to be completed with 100% certitude in all cases.

Physicians who come to Florida from other states often site the "24-hour rule" as the reason for reporting a death to the Medical Examiner. Florida does not have such a rule. A patient who dies less than 24 hours following admission to the hospital does not automatically come under Medical Examiner jurisdiction, unless they meet other criteria outlined in F.S. 406.

A death certificate is a very important document for families, funeral directors, the State's Vital Statistics Office and the medicolegal community and should be simple to complete. However, if the physician has a reasonable doubt about the manner of death or has concerns as to how to properly certify a death, we encourage him/her to contact the Medical Examiner.

4. Mass Casualty Incidents

The District Twenty Medical Examiner's goal is to provide safe, high quality, cost efficient forensic services to the citizens and visitors of Collier County, regardless of the nature or extent of the incident. Disasters and associated hardships notwithstanding, we will always strive to meet this goal.

Natural disasters that are most likely to affect our area include severe thunderstorms, hurricanes, tornadoes, floods, flash floods, earthquakes, wildfires, drought and extreme heat. These situations do not generally result in the loss of many lives. Hazardous materials incidents, structural fires and explosions, and radiological accidents present different challenges, as do national security emergencies. Each of these events will be handled professionally and with regard for the safety of all living persons concerned.

As with any other death, the main focus of major vehicular accidents such as aircraft, bus or ships/boats require determination of causation and identification of the deceased to the extent possible.

5. Obtaining an Autopsy Report

To request an autopsy report:

Please be aware that not every death will come under the jurisdiction of the Medical Examiner. Deaths due to homicide, suicide and accidents come under the jurisdiction of the Medical Examiner where the death occurred, which may not necessarily be where the incident that led to the death occurred.

Deaths due to natural disease come to the attention of the Medical Examiner if there is no prior documented history of an illness that may reasonably result in death, such as high blood pressure, heart disease, lung disease or cancer, to name but a few.

If you are certain that the Collier County Medical Examiner's Office investigated the death, send a request to: 

    District Twenty Medical Examiner 
    3838 Domestic Ave. 
    Naples, Florida 34104

   If you prefer, you may e-mail your request to: naplesme@d20me.net.

The request must include your name, the name of the decedent and the date of death. If the requesting party is not a family member or a private citizen, the request should be written on your company's letterhead.

You will receive an invoice for any charges which may apply, pursuant to Florida Statute 119, Public Records Law. Once we have received your payment, the information will be mailed to you.

An autopsy report may not be available if awaiting test results or other information.

Any autopsy report that contains information which may jeopardize the outcome of a criminal investigation is not available for public scrutiny until the State Attorney advises that the report may be made public.

6. FAQ's

The District Twenty Medical Examiner is required by Florida Statute 406 to conduct an investigation of all sudden, unexpected, natural, suspicious or violent deaths. Additionally, when a deceased person is to be cremated, dissected or buried at sea or brought into the state without proper medical certification, the Medical Examiner is called to investigate. The purpose of the investigation is to determine the cause and the circumstances of the death.