Houston / Harris County Medical Examiner

information

The HCME'S address is: 1885 Old Spanish Trail, Houston Texas, 77054. We are located near the Astrodome in the southwest area of Houston, between Fannin and Almeda streets. We are across from the Army Reserve building, and down the street from the Veterans Administration Hospital. The HCME main telephone number is: (713) 796-9292.

First you need to select a funeral home and notify the Funeral Director that the death is being handled by the Medical Examiner’s Office. The legal next-of-kin must also sign a Release Form, at the funeral home, authorizing the HCME to release the body to the funeral home that they have selected.

You may contact the Investigators Office at: (713) 796-6740, with any questions that you may have. Each case is assigned to an investigator. The investigator may refer you to a more specific department if necessary. The main switchboard telephone number is: (713) 796-9292.

In most cases visual identification of the body is not necessary. We only require a family member to come to our facility when the remains are those of an unidentified person (“John or Jane Doe”), or when the identification has not been previously confirmed.

To inquire about personal property call the Control Desk during our normal business hours of 8:00 a.m. to 5:00 p.m., Monday through Friday, at (713) 796-6780. Personal property is released to the funeral home of the family’s choice after the funeral home provides us with a signed release form from the next-of-kin.

In most cases an autopsy is necessary. By Texas Law, (CCP Art. 49.25) the Medical Examiner is mandated to determine the cause and manner of death in all cases of accident, homicide, suicide, and undetermined death. In cases of natural death, when the person is NOT under a doctor’s care, or the person passes away in less than 24 hours after admission to a hospital, the Medical Examiner must be notified, as an autopsy may be required.

In about 25% of the cases we receive, there is a high degree of medical certainty as to the cause of death. For example, the person may have a known infection, cancer or heart disease. If the circumstance of this person’s death does not indicate foul play, the pathologist may choose to do only an external examination to assure no violence has taken place.

When a death is reported to the Medical Examiner’s Office, it is assigned a case number. The cases are processed in the order in which they arrive. In the majority of cases, bodies are examined and released within 24 hours or less. However, when the HCME's office has a heavy caseload, it may take as long as 72 hours for a body to be released. Delays tend to happen most frequently on weekends and holidays.

In many cases the cause of death is evident at the time of autopsy. In these cases the death certificate is generated immediately. In other cases the cause of death may not be apparent from anatomic (grossly visible) findings. In these instances the pathologist must await additional studies. For example, in some cases the pathologist may realize that the person has an infection (pneumonia for example) but he may wait for the results of cultures to find which microorganism(s) is involved. In other instances drug toxicity may be suspected and so the pathologist must await results from the toxicology laboratory. In some instances, the cause of death may be readily apparent at the time of autopsy, but the manner of death is not known. An example of the latter is a person dying in a house fire from smoke inhalation and burns. We can see soot in the airway, and we can see burns. However, we cannot tell from autopsy what started the fire. That answer must come from the arson investigation (which is outside the purview of the medical examiner). As manner of death (homicide, suicide or accident) will then hinge on that determination, we must await conclusion of the investigation. Other examples of the latter are head injuries where nobody saw the traumatic incident, and some close range gunshot wounds (where gunshot residue analysis, range determination, firearms examination, and police investigation may all be necessary to arrive at a determination between suicide, homicide or accident).

The need for toxicology studies is one of the most frequent reasons for delay in death certificate completion. Toxicology in the medical examiner setting is different than drug testing that is done in the hospitals. Hospitals will simply do screening tests for types and categories of drugs ("opiates" for example). Because clinicians have the advantage of a living patient with symptoms to evaluate, they do not need to know quantities (if a sedative toxicity is suspected from clinical symptoms and opiates are detected on a drug screen, then the person is treated for opiate toxicity). The medical examiner however will need to know which specific drug(s) within the drug class or category (for example, whether "opiates" is morphine, heroin, hydrocodone, etc) are involved. Also, the medical examiner will need to know the quantity of those drugs in multiple biological samples (blood, liver, gastric contents, etc) in order to put the death into perspective. In other words, postmortem levels must be interpreted in light of tissue distribution/redistribution of drugs, gastric quantity and so forth in order to know 1) is this a toxic level? and 2) is this an accident or suicide? Furthermore, in order for accredited forensic toxicology laboratory results to be considered legally valid the results must be confirmed by two types of tests. Toxicology tests will take longer if multiple drugs are involved, if unusual drugs are involved, or if the person is decomposed.

Finally, one must consider the possibility that the pathologist's initial suspicions are not confirmed. For example, if the pathologist suspects drug toxicity but the initial toxicology report reveals only low levels of drugs or no drugs at all. In these cases, the pathologist may submit additional tissues to reevaluate specific parts of the heart muscle or brain, while at the same time consulting with the toxicologist to pursue testing for more unusual or exotic drugs that weren't originally analyzed, while at the same time asking the police to return to the scene of death to ascertain more information, or perhaps to interview additional witnesses. Each death is different, and the findings in each case are different. Additional follow-up is determined as results are obtained. Obviously in such multi-step investigations the process may be lengthy, and the requisite time necessary may not be entirely under the control of the pathologist.

The Certificate of Death is compiled in two sections; the medical portion is completed by the HCME, the final portion is completed by the funeral home. Once the Certificate of Death is completed, it is the responsibility of the funeral home to file the document with the state of Texas. For additional information regarding Certificates of Death please visit their web page at www.dshs.state.tx.us/vs

The office of the Coroner or “Crowner” dates back to medieval days when the crowner was responsible for looking into deaths to be sure that duties (taxes) were paid to the King. Today, the coroner’s main duty is to inquire into the cause and manner of a death, and to complete the death certificate.

In general, a medical examiner is a physician, trained in death investigation, typically sub-specialized in Forensic Pathology. When one refers to a "medical examiner system" one is usually referring to a system in which the physicians (Forensic Pathologists) are the death investigation authorities for a specified geographic jurisdiction. Within that jurisdiction, the medical examiners review deaths, decide which cases meet their criteria for further investigation, and perform autopsies when indicated.

In Harris County, the Commissioners Court appoint the Chief Medical Examiner. The Chief Medical Examiner must be a physician, licensed to practice medicine in the State of Texas and be certified by the American Board of Pathology in Anatomic and Forensic Pathology. The Chief Medical Examiner serves continuously and can only be removed for cause.

In contrast, a Coroner typically refers to an elected official, who serves as the authority for death investigation, but may not have any medical training. Thus, a coroner typically has to have a contract with some forensic pathologist, or medical examiner office in some nearby jurisdiction to perform autopsies when an autopsy is required. In Texas, some counties rely on Justices of the Peace to fulfill the role of coroner.

Over the years, the terminology has become blurred, in part because of ignorance, and in part because of system evolution issues. So, for example, in Los Angeles, CA the Coroner's Office is, in fact, a medical examiner's office, for all practical purposes.

Each state has different laws and each jurisdiction operates differently, but these are the basic differences between a medical examiner and a coroner.

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