In this chapter, the following terms have the meanings indicated. Terms Defined. “Autopsy report” means a written document detailing the medical findings and conclusions of a postmortem examination performed by a medical examiner. “First degree relative” means a surviving spouse, parent, grandparent, sibling, and child of the deceased. “Forensic investigator” means a chief forensic investigator, deputy chief forensic investigator, lead forensic investigator, or forensic investigator who: Is employed under or appointed by the authority of the Maryland Department of Health; Assists those medical examiners in §B(4)(a) of this regulation; Has education, training, or experience in trauma or death investigation; and Is appointed in accordance with Health-General Article, §5-306, Annotated Code of Maryland. Medical Examiner. “Medical examiner” means a Chief Medical Examiner, Deputy Chief Medical Examiner, or assistant medical examiner who is a pathologist authorized to carry out the provisions of Health-General Article, §5-308, Annotated Code of Maryland. “Medical examiner” also means a deputy medical examiner who: Assists those examiners in §B(4)(a) of this regulation; Is a physician; and Is appointed by the Maryland Department of Health in accordance with Health-General Article, §§5-305 and 5-306, Annotated Code of Maryland. Medical Examiner Case. “Medical examiner case” means any death which occurs as described in Health-General Article, §5-308(a), Annotated Code of Maryland. “Medical examiner case” does not mean: A stillbirth or a neonatal death, or accident room or hospital death in which the cause of death has been established by the hospital physician and is due to disease, and free of evidence of criminal or accidental nature; A case which is dead on arrival at the hospital and the physician who pronounces death has been in previous attendance on the patient; or A death which occurs in a hospital within 24 hours of admission merely because the death occurred within 24 hours. “Procurement organization” has the meaning stated in Estates and Trusts Article, §4-501, Annotated Code of Maryland. “Secretary” means the Secretary of Health. Whenever a physician, funeral director, or other person has knowledge of a death that may fall under the jurisdiction of the Office of the Chief Medical Examiner in accordance with Health-General Article, §5-308(a), Annotated Code of Maryland, the physician, funeral director, or other person having this knowledge shall report it without delay to the police or sheriff law enforcement agency who has jurisdiction in the city or county where the death occurred. The medical examiner or forensic investigator may, in conjunction with law enforcement or under court authority, investigate any location believed to be associated with the death to gather essential facts to determine cause of death or manner of death. A health care facility may not refuse the medical examiner access to a body which is the subject of a medical examiner investigation at any time. Any death in accordance with Health-General Article, §5-308(a), Annotated Code of Maryland, in the State shall be investigated and examined by the medical examiner in the Office of the Chief Medical Examiner in Baltimore, or in any other place as may be approved by the Chief Medical Examiner. Fire Fighters and State Fire Marshal Personnel. The medical examiner shall perform an autopsy and complete toxicological examination of any fire fighter or sworn personnel of the State Fire Marshal's Office who dies in the line of duty or whose death appears to have been caused by: Fire; Toxic gases; Toxic fire conditions; or Fire-related circumstances. Other Fire-Related Deaths. If a death occurs in a fire or is related to a fire, the medical examiner shall thoroughly investigate the circumstances of the death and report the death to the Center for the Study of the Health Effects of Fire in the Office of the Chief Medical Examiner for Maryland. When the medical examiner has made a determination of the cause and manner of death, the medical examiner shall complete the death certificate. On the death certificate the medical examiner shall enter the: Name of the deceased; Cause of death and medical certification; Date and hour of death; Place where death occurred; and Place where the body was found. The Medical Examiner shall record the manner of death under the section of the certificate designated as the medical certification. If the cause of death has not been established with reasonable medical certainty and further investigation is being conducted, the cause of death is left pending. If the cause of death has not been established with reasonable medical certainty, and the investigation has been completed, the certificate shall be completed to reflect that the cause of death was “undetermined”, and the manner of death was “undetermined”. The hospital physician shall be guided by the history and other circumstances in judging whether or not a death is under the jurisdiction of the medical examiner. Cases that do not fall under medical examiner jurisdiction may not be made such and will not be accepted simply because hospital autopsy permission has been refused or is not available. Cases that fall under medical examiner jurisdiction may not be autopsied by the hospital pathologist because consent for autopsy has been obtained in accordance with Health-General Article, §5-501, Annotated Code of Maryland. The following types of medical examiner cases may be autopsied by the hospital pathologists with the authorization of the Chief Medical Examiner: Death from acute or chronic alcoholism without manifestation of trauma; Death from accidental burns occurring in the home; Death, or sudden death, associated with a therapeutic procedure; Death following a fracture in an elderly person and resulting from a simple fall in the home. In the cases listed in Sec. A of this regulation, permission from next of kin is not required since these are under the medical examiner's jurisdiction and the hospital pathologist is acting pursuant to this jurisdiction. The hospital agent shall complete the death certificate, and each death certificate shall be countersigned by the medical examiner. In non-medical-examiner cases, a hospital shall require proper autopsy permission in accordance with Maryland Autopsy Law, Health-General Article, § 5-501, Annotated Code of Maryland. Appointment. Each hospital shall appoint a responsible agent, office, or individual with whom the medical examiner can communicate at any hour regarding medical examiner cases in the hospital, after receiving notification of them from the police authority. Each hospital shall notify the medical examiner of the agent so appointed. Responsibilities. Notification of Police. In accordance with Regulation .02 of this chapter, whenever a hospital in Maryland has a medical examiner case, the hospital agent shall report the case to the local law enforcement agency with jurisdiction in that subdivision of the State. The local law enforcement agency so notified shall transmit the information to the medical examiner’s investigator on duty. A health care facility may not refuse the medical examiner access to a body which is the subject of a medical examiner’s case at any time. In order to prevent destruction or alteration of evidence, once death is determined, the hospital shall follow medical examiner guidance as to management of the body of the deceased. The medical examiner shall respond to the location of the body, investigate the case, and arrange for transportation of the body. Preliminary Hospital Reports. The hospital agent designated in accordance with Regulation .08 of this chapter shall submit promptly to the medical examiner, for each medical examiner case, the following information: The name and age, if known, of each decedent; The date and time of admission; Time of death; Diagnosis, if made; Place, date, time, and manner of accident, or violence, if any, and other information that the Medical Examiner may request; Next-of-Kin, if known, as an attempt of a reasonable search effort; and If any evidence is recovered during therapeutic intervention, the Office of the Chief Medical Examiner shall be notified. Medical Examiner Requests. The hospital agent shall promptly respond to a medical examiner request for records and specimens. Failure to provide requested information within 24 hours will result in a report to the Office of Health Care Quality. If, during a routine autopsy by a hospital pathologist, evidence is encountered which indicates that the death should be under the jurisdiction of the medical examiner: The death then shall become a medical examiner case; The hospital agent immediately shall notify the police or sheriff, who will in turn notify the medical examiner; and The hospital pathologist shall discontinue the autopsy pending the arrival of the medical examiner. Clinical and Autopsy Reports from Hospitals. Whenever a medical examiner case is autopsied in a hospital, the hospital agent shall submit to the medical examiner, without delay, a clinical summary report, preferably filled out by the physician most familiar with the case, and a provisional anatomical diagnosis, and later a copy of the final autopsy report. In the case of any anesthetic death occurring in Maryland, the hospital in which the death occurred shall notify immediately, by telephone, the Chief Medical Examiner or a Deputy Chief Medical Examiner, an assistant medical examiner, or the deputy medical examiner of the county in which the death occurred. An individual, other than a member of the staff of the Chief Medical Examiner, may not enter the storage room or the autopsy room while work is being carried on there, except with the permission of the Chief Medical Examiner or the medical examiner performing the work. Whenever an authorized organ and tissue procurement organization has informed the Chief Medical Examiner or the Chief Medical Examiner's deputy or assistant medical examiner that there is a need for tissue for research or transplantation, the Chief Medical Examiner shall allow the authorized organ and tissue procurement organization to make a recovery if: Proper authorization has been provided to the medical examiner; The body has been tested to determine its suitability for transplantation; An autopsy is going to be performed and the removal does not interfere with the subsequent investigation or examination; and The medical examiner does not know of an objection to the autopsy or donation of tissue by the next of kin. Whenever there is an immediate need for an internal organ as a transplant, that is, heart, lung, kidney, liver, pancreas, spleen, lymph nodes, or adrenal gland, a medical examiner may provide the organ, if requested by a transplant surgeon, under the following conditions: The medical examiner has jurisdiction over the body of a decedent; The body has been tested to determine its suitability; The hospital representative and treating physician have obtained proper authorization for this decedent; A reasonable, unsuccessful search has been made by the procurement organization as required by Estates and Trusts Article, §4–512(f), Annotated Code of Maryland; No objection by the next of kin is known or reasonably foreseen by the medical examiner; and The removal of the organ requested for transplant does not interfere with an investigation or autopsy. Whenever a medical examiner on duty determines that an organ cannot be removed for one of the reasons stated in Sec. A of this regulation, the transplant surgeon may request that this decision be reviewed by the Chief Medical Examiner, a Deputy Chief Medical Examiner, or their designee. Whenever a decedent is determined to have died by some violent means, the medical examiner may not authorize removal of the requested organs without observation by the medical examiner or the medical examiner's agent. Except in a case of a finding of homicide, a person in interest as defined in General Provisions Article, §4-101, Annotated Code of Maryland, may request the Office of the Chief Medical Examiner to correct findings and conclusions on the cause and manner of death recorded on a certificate of death under General Provisions Article, §4-502, Annotated Code of Maryland within 180 days after a medical examiner files those findings and conclusions in accordance with Health-General Article, §5-309(d), Annotated Code of Maryland. A person in interest, has the meaning stated in General Provisions Article, §4-101, Annotated Code of Maryland. The request to correct the findings and conclusions on a death certificate shall: Be in writing to the Chief Medical Examiner; Describe the requested change precisely; and State the reasons for the change. Within 60 days after receiving the request in §C of this regulation, the Chief Medical Examiner shall provide the person in interest written notice of the action taken. If the Chief Medical Examiner denies the request to correct findings and conclusions on the cause of death, the person in interest may appeal the denial in writing within 15 days to the Secretary. The Secretary shall refer the matter within 15 days of receipt to the Office of Administrative Hearings. An administrative law judge shall conduct a hearing both on the denial and on the establishment of the findings and conclusions on the cause of death. Upon reviewing the findings of fact submitted by an administrative law judge, the Secretary or the Secretary's designee shall issue an order within 60 days to: Adopt the findings of the administrative law judge; or Reject the findings of the administrative law judge and affirm the findings of the medical examiner. If the Secretary or Secretary's designee rejects the findings of an administrative law judge, the person in interest may appeal that rejection to a circuit court of competent jurisdiction under Maryland law. If the final decision of the Secretary or the Secretary's designee, or of a court of competent jurisdiction on appeal establishes a different finding or conclusion on the cause or manner of death of a deceased than that recorded on the certificate of death, the medical examiner shall amend the certificate to reflect the different finding or conclusion. The medical examiner shall send a change letter to the Division of Vital Records to amend the certificate of death, to reflect the final decision of the Secretary or Secretary's designee, or a court of competent jurisdiction. The final decision of the Secretary or the Secretary's designee, or of a court in an appeal under this regulation, may not give rise to any presumption concerning the application of any provision of or the resolution of any claim concerning a policy of insurance relating to the deceased. If the findings of the medical examiner are upheld by the Secretary, the appellant is responsible for the costs of the contested case hearing, based on the billing rate established by the Office of Administrative Hearings. Otherwise, the Department is responsible for the costs. Individual files of the Chief Medical Examiner are confidential medical records protected from disclosure under the provisions of Health-General Article, §4-301, Annotated Code of Maryland, and General Provisions Article, §§4-329 et. seq., Annotated Code of Maryland. An exception to these confidential medical records is the official medical examiner's autopsy report. This report is a public record and is generally subject to disclosure under General Provisions Article, §4-329, Annotated Code of Maryland, unless the case is subject to an ongoing investigation, or other appropriate reason for denial of disclosure exists. Records request by court order or subpoena shall be subject to the fee schedule set forth herein. Fee Schedule. Autopsy reports may be sent electronically to the requestor. The fees schedule is the same for paper or electronic reports and is as follows: No fee for a first-degree relative, as defined by COMAR 10.35.01.01B; and A fee of $50 for all others may be charged for providing a requested autopsy report. Requests for other information or material shall be accompanied by a court order or subpoena unless the Custodian of Records determines compelling circumstances exist warranting the release of materials. If releasable, the contents of the file will be copied at a cost of $1 per page with a minimum charge of $25 excluding any item independently listed in §D of this regulation. Photographs are copied electronically. There is a $50 processing fee for each digital record, plus $5 per each image copied. X-rays and CT scans are copied electronically. There is a $50 processing fee for each digital record, plus $25 per X-ray. Slides are copied electronically. There is a $50 processing fee for each digital record, plus $20 for each image copied. Slides may be viewed in the Office of the Chief Medical Examiner facility at a rate of $200 for the first hour and $50 for every 15 minute increment thereafter, partial or whole. The reviewer will have access to the medical examiner during the review. A proof of death document may be obtained for $20. If any or all of the items listed in §D of this regulation are requested in digital format, an additional fee of $60 shall apply. These fees do not apply if the releasable documents are viewed only, by appointment, at the OCME, at the discretion of the custodian of records. An individual, other than the custodian of the records of the Office of the Chief Medical Examiner or a designee, may not copy or distribute a copy of the official report of the Office of the Chief Medical Examiner. If, during the investigation of a death under the jurisdiction of the Office of the Chief Medical Examiner, a communicable disease is identified, it shall be reported by the medical examiner in writing within 24 hours to the health officer in the appropriate jurisdiction and to the deputy State health official, on the forms supplied by the Maryland Department of Health, in accordance with COMAR 10.06.01.04. A death that is investigated by the Office of the Chief Medical Examiner that is found to be caused by or related to child abuse or neglect shall be reported by a medical examiner orally and in writing to local departments of social services and the local law enforcement agency of the jurisdiction in which the child last resided, in accordance with Family Law Article, §5-704, Annotated Code of Maryland. Whenever it is required that the Office of the Chief Medical Examiner notify a firefighter, emergency medical technician, rescue squad member, law enforcement officer, correctional officer, etc., of exposure to contagious disease or virus, and pursuant to Health-General Article, §18-213, Annotated Code of Maryland, the following procedures shall be followed: A medical examiner shall review information gathered in the course of the postmortem examination, including testing for contagious disease or viruses; If evidence of contagious disease or virus, as defined in Health-General Article, §18-213, Annotated Code of Maryland, is identified in the test carried out in the postmortem examination, this information shall be provided by the Office of the Chief Medical Examiner to the officially designated agency representative of the appropriate firefighter, emergency medical technician, rescue squad member, law enforcement officer, correctional officer, etc., with a copy to each of these. The Office of the Chief Medical Examiner shall verbally notify the agency-designated representative within 48 hours after confirmation of the diagnosis, and subsequently confirm that notice, in writing, and in a manner that protects the confidentiality of the patient; and The agency representative shall notify the individual believed to have been exposed to the contagious disease or virus. A death in a State-funded or State-operated facility which constitutes a medical examiner's case, as defined in Health-General Article, §5-308, Annotated Code of Maryland, shall be investigated by the Office of the Chief Medical Examiner. Notification and Investigation. The sheriff, police, or chief law enforcement officer, in the jurisdiction where a death occurs, shall notify the medical examiner whenever a death that constitutes a medical examiner's case occurs in a State-funded or State-operated facility. If the death may have occurred by violence, by suicide, by casualty, suddenly when the person was in apparently good health, not attended by a physician, or in any suspicious or unusual manner, the medical examiner or investigator shall: Respond directly to the administrative head of the facility; Conduct an investigation; Complete the investigation report; and Arrange to have the body sent to the Office of the Chief Medical Examiner for an autopsy, if necessary. Completion of Investigation Report. A medical examiner or investigator shall document in an investigation report all of the information regarding the death that was: Gathered in the course of the investigation; and Provided by the administrative head of the facility to the sheriff, police, chief law enforcement official, or health officer in the jurisdiction where the death occurred. A medical examiner or investigator shall append to an investigation report the written report of the death that the administrative head of the facility provided to the sheriff, police, chief law enforcement official, or health officer in the jurisdiction where the death occurred. Required Contents of Report. The report of the administrative head of a facility where the death occurred shall contain all the information set out in Health-General Article, §10-713, Annotated Code of Maryland. The report: May be oral, if followed by a written report within 5 working days from the date of the death, or written; and Shall contain the following relevant information: The name, age, and sex of the deceased; The time of discovery of the death; The deceased's place of residence at the time of death; If the death occurred in a place other than the residence of the deceased, the location of the body at the time of discovery; The place where the body was found; The name of the person who took custody of the body; The name of the person evaluating the death, if known; Whether an autopsy is being performed, if known; The name, address, and telephone number of the next of kin or legal guardian, if known; and Other information the administrative head of the facility determines should be provided to the medical examiner. The report of the investigation by the Office of the Chief Medical Examiner constitutes an individual file of the Chief Medical Examiner not subject to disclosure under General Provisions Article, §4-101 et seq, Annotated Code of Maryland. The Chief Medical Examiner shall appoint one or more deputy medical examiners and forensic investigators for each county. The Chief Medical Examiner may appoint a deputy medical examiner from a list of qualified individuals submitted by the county medical society. However, the Chief Medical Examiner may appoint a deputy medical examiner for the county without a list if there is no county medical society or if the medical society does not submit a list of names. Each deputy medical examiner appointed shall be a physician. The Chief Medical Examiner shall select a forensic investigator from a list provided by the Deputy Chief Medical Examiner for Statewide services. Entitled Fees. As provided in the State budget, for each medical examiner’s case investigated, the deputy medical examiner or forensic investigator is entitled to a fee of $150. If the case does not meet the requirements of Health-General Article, §5-308, Annotated Code of Maryland, and is declined, the deputy medical examiner or forensic investigator is entitled to a decline fee of $12.50. The deputy medical examiner is entitled to $25 for certifying the death and completing the death certificate. The deputy medical examiner or forensic investigator shall arrange for body transportation services of human remains from a scene of death in Maryland to a specified location within Maryland. The deputy medical examiner or forensic investigator shall contact local county funeral directors or appropriate body transportation service providers within their jurisdiction, on a rotational basis, to arrange for body transportation services. Funeral directors and body transportation service providers are eligible to transport human remains for the Office of the Chief Medical Examiner. However, it is the responsibility of each local funeral director or body transportation service to notify the deputy medical examiner or forensic investigator if they are interested in providing this service for the State. Providers of body transportation services shall be available 24 hours a day, 7 days per week, 365 days per year to provide body transportation services, as needed, and shall provide their own equipment to transport human remains. Human remains shall be accorded the proper dignity expected under accepted mortuary standards and practices, and shall be handled in accordance with standard precautions as defined by COMAR 10.06.01.02B and the Office of the Chief Medical Examiner guidelines to protect remains and evidence. Payment. Providers of body transportation services shall be paid as provided in the State budget, $3.50 per mile, one way, plus any tolls, and a scene response fee of $100, with a minimum total payment of $200 from the scene of death to a designated location. The mileage shall be verified by the OCME. This is the sole compensation the provider is entitled to, and the provider or any other person may not submit a charge to any other party, including the family of the deceased, for this service. In the case of a victim of a homicide, the transport service shall be paid the rate stated in §F(1) of this regulation to transport the body from the site of autopsy or examination to a location within Maryland specified by the victim's family. The Office of the Chief Medical Examiner is responsible for completing the Transportation of Bodies Report for payment. The Office of the Chief Medical Examiner is responsible for providing a replacement body pouch when the body is transported to that office. When a deputy medical examiner, or forensic investigator as the examiner’s designee, is called as a witness before a grand jury or in a criminal case, the examiner or investigator is entitled to: The fee that the court sets; and Any additional compensation that a county or court provides. When any deputy medical examiner or forensic investigator is called as a witness in a civil case they are entitled to: $20 per hour; and Any additional compensation that a county or court provides. Health-General Article, §§5-301 et seq., Estates and Trusts Article, §4-509; Annotated Code of Maryland Effective date: July 13, 1939 Amended December 22, 1950; February 27, 1951; May 15, 1951; June 26, 1951; January 15, 1963; October 22, 1963 Chapter revised effective August 2, 1993 (20:15 Md. R. 1220) Regulation .01B amended effective May 5, 2008 (35:9 Md. R. 898); November 24, 2014 (41:23 Md. R. 1373); May 11, 2026 (53:9 Md. R. 414) Regulation .02 amended effective November 24, 2014 (41:23 Md. R. 1373); May 11, 2026 (53:9 Md. R. 414) Regulation .03 amended effective May 5, 2008 (35:9 Md. R. 898); May 11, 2026 (53:9 Md. R. 414) Regulation .06B, C amended effective May 11, 2026 (53:9 Md. R. 414) Regulation .08B amended effective May 5, 2008 (35:9 Md. R. 898); November 24, 2014 (41:23 Md. R. 1373); May 11, 2026 (53:9 Md. R. 414) Regulation .11 amended effective May 11, 2026 (53:9 Md. R. 414) Regulation .12A, C amended effective May 11, 2026 (53:9 Md. R. 414) Regulation 13A, B amended effective May 11, 2026 (53:9 Md. R. 414) Regulation .14 amended effective November 24, 2014 (41:23 Md. R. 1373); May 11, 2026 (53:9 Md. R. 414) Regulation .14C amended effective May 5, 2008 (35:9 Md. R. 898) Regulation .14D amended effective August 29, 2016 (43:17 Md. R. 955) Regulation .16 amended effective May 11, 2026 (53:9 Md. R. 414) Regulation .18A, C amended effective May 11, 2026 (53:9 Md. R. 414) Regulation .19A, B amended effective May 11, 2026 (53:9 Md. R. 414) Regulation .19C, E amended effective November 24, 2014 (41:23 Md. R. 1373) Regulation .19E amended as an emergency provision effective July 1, 2006 (33:15 Md. R. 1275); amended permanently effective November 6, 2006 (33:22 Md. R. 1733) Regulation .19E amended effective December 31, 2018 (45:26 Md. R. 1246); May 11, 2026 (53:9 Md. R. 414) Regulation .20E amended effective May 11, 2026 (53:9 Md. R. 414) Regulation .20F amended effective May 5, 1997 (24:9 Md. R. 657); November 24, 2014 (41:23 Md. R. 1373) Regulation .20F amended as an emergency provision effective July 1, 2006 (33:15 Md. R. 1275); amended permanently effective November 6, 2006 (33:22 Md. R. 1733) Regulation .20F amended effective May 5, 2008 (35:9 Md. R. 898); August 19, 2024 (51:16 Md. R. 742) Regulation .21 adopted effective November 24, 2014 (41:23 Md. R. 1373) Courts and Judicial Proceedings Article, §§10-304 and 10-306; Health-General Article, §§5-307 and 5-311; Annotated Code of Maryland Effective date: October 4, 2010 (37:20 Md. R. 1394) Regulations .01 — .09 repealed effective May 11, 2026 (53:9 Md. R. 414)