Ministry of the Solicitor General Ministere du Solliciteur general

Office of the Chief Coroner Bureau du coroner en chef Forensic Pathology Service Service de medecine legale de I'Ontario Ontario

Forensic Services and Complexe des sciences judiciaires Coroners Complex et du coroner 25 Morton Shulman Avenue 25, Avenue Morton Shulman Toronto ON M3M OB1 Toronto ON M3M OB1

Telephone: (416)314-4000 Telephone: (416) 314-4040 Facsimile: (416)314-4030 Telecopieur: (416)314-4060

July 22,2020 OCCLOG#:C20-133

MEMORANDUM TO: Long-Term Care Home Licensees Long-Term Care Home Administrators Long-Term Care Home Directors of Nursing and Personal Care

FROM: Dirk Huyer, MD Chief Coroner for Ontario

RE: Death Investigation Brochure

On July 31st, 2019, the Public Inquiry into the Safety and Security of Residents in the Long-Term Care Homes System (LTCPI) issued 91 recommendations.

In accordance with the recommendations, the Office of the Chief Coroner (OCC) has prepared an information guide (English and French versions) outlining the death reporting and investigation process in long-term care homes, including when an autopsy or inquest may be required and key OCC contacts. The guide is being provided to all long-term care homes for distribution, specifically for families of residents, when required.

The two versions of the information guide are attached with this memo and will be available for downloading at Itchomes.net for distribution and printing at your convenience.

Implementation of the LTCPI recommendations is a primary component to deliver systemic changes within the long-term care system. Collectively, we will all work towards achieving successful implementation of the recommendations. We look forward to keeping you apprised of our progress and how it will impact the valuable work you do.

Sincerely,

Dirk Huyer, MD Chief Coroner for Ontario End. Ontario ii

Deaths in long-term care homes Organ retention When a person dies in a Long-term care home, the person in In rare circumstances, an organ (usually the brain or heart) may charge of the home must report the death to the Office of the need to be kept after an autopsy for further testing, During the Chief Coroner. If the coroner determines that the death should autopsy, small tissue samples may also be kept for additional be investigated, they will investigate the circumstances of testing, The coroner will notify family members and ask for the death. their direction about how the organ should be treated after this work is complete. Engaging families is essential as their knowledge wilt inform the death investigation process. When deciding whether or not to Organ or tissue donation conduct a death investigation, the coroner will engage with the family to determine if they have any concerns that should be In cases where a coroner is involved, donation of organs or addressed by an investigation. tissues may be possible. Families should advise the coroner of their wishes. This brochure provides a brief overview about the process of reporting a death in a Long-term care home and is meant for Obtaining death investigation results general use only, For a Legal description of coroners' duties, inquests and further information, read the Coroners Act online The results of the death investigation can be shared with at: www.ontario.ca/laws/statute/90c37 immediate family members or a personal representative, upon written request. Families may write to the Regional Supervising Coroner's office or complete and submit a request form. Forms Reporting a death in a long-term care home can be obtained by contacting the applicable Regional Long-term care homes report deaths to the Office of the Chief Supervising Coroner office or by emailing: Coroner by submitting an Institutional Patient Death Record and, OCC.Inquiriesfgiontario.ca. in some cases, by notifying the coroner directly Reports are provided once the death investigation has The Institutional Patient Death Record acts as a screening tool concluded. Each death investigation is unique. The length of to identify deaths in a long-term care home that require time needed to complete an investigation varies depending on investigation by a coroner. its complexity, including the number of tests required. Family members should contact the investigating coroner or if necessary, the Regional Supervising Coroner's office for an Autopsies update, An autopsy, also known as a post mortem examination, is a process performed by a pathologist or forensic pathoLogist to examine a deceased person, including their internal organs, to Obtaining a death certificate help determine cause of death, The coroner, often in Only the Office of the Registrar General of Ontario can issue a consultation with a forensic pathoLogist, will decide if an autopsy copy of a death certificate. In most cases, the Proof of Death is needed. forms prepared by the funeral service provider can serve as documentation if a death certificate is required, such as for The coroner will explain the need for an autopsy to the family financial institutions. To obtain an official death certificate and carefully assess concerns they may have. However, the please visit: www.ontario.ca/deathcertificate or call: coroner will proceed with ordering an autopsy if he or she 416-325-8305 or 1-800-461-2156 (toLLfree, Ontario only). believes it is needed to inform the death investigation. The coroner's decision is Legal and binding. Deaths in long-term care homes information guide

Inquests Regional Offices An inquest may be called if a coroner decides that a public Central Region; Western- Region: hearing on the circumstances of a death through an objective examination of facts would be beneficial. At the conclusion of an Forensic ^Services :and! London OfRce inquest, a five-personjury could make useful recommendations Coroners'Complex1 (Bruce, Chatt-iam-Kenf, Etgin, that may prevent deaths in similar circumstances. 25 Morton Shutman Avenue:: Essex,, Grey, Huron, Lambton, Toronto, Ontario, : Middlesex, Oxford, .Perth) Family Liaison Coordinator M3N08I: 235: North Centre Rd;, St& 303; Fax; ©47-329-2013::: The Family Liaison Coordinator helps families communicate London..OntaFio^ with coroners, forensic pathologists and law enforcement N5X4E7' Central East personnel regarding a loved one's death. They also assist Tel: 519-661-6624 (Durham,: Muskoka,:VbFk): families in navigating through the various stages of the death Fax:519-661-6617 -m ©47-329-1826: investigation process, OCCt-ondondiontario.ca QCG,[email protected] To work with a Family Liaison Coordinator, contact: Hamilton Office CentratWest [email protected]. (Braht, Di-ifferin, Haldimand, (Halton, Peel, Simeoe) HarFiittpn,: Niagara, Norfolk, Questions TeL: 647-3291-I825 Waterloo:, Wellington) [email protected] We're here to help, If you require additional information, please :U9:Kingi:Stfeet West, Floor 13 contact us, If English is not your first Language, please ask the Hamilfon:,: Ontario Toronto East coroner if there are services or information available in your L8P::4¥7i, Language of choice, CTbronto,: eastofVsnge St) Tet:905-54©-8200 Tel: 647-3Z9-IS27 Fax: 9QS-546-8210 Contact OCC.TorontoEasbgiontarib.ea [email protected]

Office of the Chief Coroner & Toronto West Ontario Forensic Pathology Service (Toronto, westofYange:StJ 'Northern; Region 25 Morton ShuLman Avenue, Tel: 647-329-1828. SudburyOfRce Toronto, ON M3M OB1 OCC.TorontoWe5t@ontario,ca (:Algoma:, Coehrane. TeL: 1-877-991-9959 (toU free, Ontario only) Manitoul.ih,:Nipissing,:Parr-y or 416-314-4000 SoUdd,|Sudbt.iry,Timist

Death investigations What happens during a death investigation The sudden and unexpected death of a family member Coroners or forensic pathologists try to understand how and presents one of life's most difficult challenges. While dealing why a person died through a death investigation. A coroner or with grief and loss, people may also have forensic pathologist must answer five questions when questions regarding next steps. investigating a death: • who (identity of the deceased) One of the duties of the Office of the Chief Coroner and the • when (date of death) Ontario Forensic Pathology Service is to investigate sudden and • where (location of death) unexpected deaths. While undertaking a thorough death • how (medical cause of death) investigation, coroners will be sensitive and respectful of diverse • by what means (natural causes, accident, homicide, cultural perspectives, religious beliefs an.d philosophical views. suicide or undetermined)

As police are usually among the first responders at a death Information may be collected from several sources including, scene, the Coroners Act states that coroners may request police but not Limited to family, co-workers, neighbours, doctors, assistance with investigations, health records, police and other emergency service workers. Contact with family is vital as they often have important This brochure provides a brief overview of the death information that can aid the investigation. investigation process and is meant for general use only. For a Legal description of coroners' duties, inquests and further information, read the Coroners Act online at: Reportable deaths www.ontario.ca/Laws/statute/90c37 Under the Coroners Act, certain types of deaths must be reported to a coroner. These reportable deaths include, but are not Limited to: Coroners • deaths that occur suddenly and unexpectedly Coroners are medical doctors with specialized death • deaths at a construction or mining site investigation training, who have been appointed to investigate • deaths while in police custody or while a person is sudden deaths as mandated by the Coroners Act. incarcerated in a correctional facility • deaths that appear to be the result of an accident, A coroner is called to investigate deaths that appear to be from suicide or homicide unnatural causes or deaths that occur suddenly or • deaths while residing in a long-term care home unexpectedly. Additionally, a coroner may become involved when concerns are raised regarding the care provided to an A full explanation of reportable deaths can be found in the individual prior to death, Coroners Act.

Deaths are generally reported to the coroner by health care Pathologists and forensic pathologists workers or the police. However, anyone, including a family PathoLogists are medical doctors who are experts in disease member, should immediately contact the police or a coroner and injury, Forensic pathologists have further training and are when a reportabLe death occurs. experts in disease and injury that result in sudden death. They are the medical doctors who perform autopsies, when required. Death investigations information guide for families and loved ones

Impact on funeral or ceremonial planning Regional Offices Funeral or ceremonial planning may be delayed if an autopsy is Central Region- Western: Region: needed or if the death investigation takes additional time. Coroners and pathologists are aware that religious, spiritual or Forensic Services and: Londonl Office cultural practices may dictate time frames for funeral planning Coroners: Complex: (Bruce, Chatham-Kent, Etgin, and other ceremonies or services. In such cases, families should :25.MortonSht.ilman Avenue Essex, Grey, Huron, Lambton; notify the coroner immediately so that every effort can be made Toronto, Ontario Middlesex, Oxford.Perth) to accommodate these requests. : M3M: OB1 235: North: Centre: Rd,, Sfe.: 303: Fax:647-329-2013:: LoftdoFT,: Onfaricp Transporting the body Central East N5X::4E7: In most cases, it is the family that makes arrangements to have Tel;::519-66I-6624 (DuFl-iaFn, Muskoka,.YoFk): the body transported from the place of death to the funeral ::;Fax; 519-661-6617 Teb 647-329-1826:: service provider chosen by the family. In some instances, the QCC.London(a)bnfario.ca coroner wilt have the body transported to a hospital or forensic [email protected] pathology unit for further examination, such as an autopsy. Hatnitton Office CenfratWest (Brant, DufFerin, HaLdimand, (Haiton,Peelj, Simeoe) Family Liaison Coordinator Mamiltan:,,Niagara, Norfolk, The Family Liaison Coordinator helps families communicate TeL: 647-329-18:25 : •Waterloo,: Wellington) [email protected] with coroners, forensic pathoLogists and law enforcement H9: King Street West, Floor 13 personnel regarding a loved one's death, They also assist Hamilton,: Ontario families in navigating through the various stages of the death Toronto East L8P4Y7 investigation process. (Toronto, east of Yonge St) Tel: 905-546-8200 TeL: 647-329-I827: :Fax;:SQ5-546-8210 To work with a Family Liaison Coordinator, contact: OCC.TorontoEasttgiontario.ea [email protected] [email protected]. Toronto West Questions (Toronto, wesf ofYongeSt) Northern:: Region We're here to help, If you require additional information, please Tel: 647-329-18:28 Sudbury Office contact us. If English is not your first Language, please ask the OCC.TorontoWestfgiontario.ca :(Atgoma. CochFane,: coroner if there are services or information available in your ManitouUn, Nipissing:,:: Parry Language of choice. :S6und, Sudburyi|Timjst

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