Can a Maryland family get a hearing to challenge a medical examiner's ruling on how a relative died?

Plain-English summary

A state delegate asked whether a family member who disagreed with the Chief Medical Examiner's determination of how a relative died, as recorded on the death certificate, could demand a formal hearing under the Administrative Procedure Act. The opinion concluded no such hearing right existed.

The opinion explained that the APA itself does not create hearing rights; it only supplies procedures for hearings required by some other source of law, and nothing in the statutes governing medical examiners or death certificates required a hearing on a cause-of-death dispute. The opinion also considered, and rejected, the idea that the Public Information Act's general procedure for correcting "inaccurate or incomplete information in a public record" could be used instead, reasoning that the more specific vital-records statute, which lets the Secretary of Health and Mental Hygiene set rules for amending death certificates and which the Secretary had not done for cause-of-death disputes, controlled over the more general correction procedure. The opinion further noted the medical examiner's cause-of-death finding was inherently the only official opinion meant to appear on the certificate, so entering a different physician's contrary view would itself violate the statute, and that a death certificate could not practically carry the kind of formal "statement of disagreement" the general correction procedure otherwise allowed. The opinion concluded that a dissatisfied family member's only real recourse was to informally present additional evidence to the Chief Medical Examiner and ask for reconsideration.

Currency note

This opinion was issued in 1991. Its own editor's note records that the following year, Chapter 547 of the Laws of Maryland 1992 amended the Administrative Procedure Act to extend contested case procedures to a person in interest seeking correction of a death certificate, directly changing the answer this opinion gave. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis further since then. Treat this page as historical context, not current legal advice. Verify the current Administrative Procedure Act and vital records statutes before relying on any specific rule described here.

Common questions

Could a family demand a hearing to dispute how the medical examiner said a relative died? According to this 1991 opinion, no. The Attorney General concluded the Administrative Procedure Act did not entitle a family member to a contested case hearing over a medical examiner's cause or manner of death determination, because no other Maryland statute created that hearing right.

Was there any way to challenge a cause-of-death finding on a death certificate? The opinion found the Public Information Act's general procedure for correcting inaccurate public records did not apply to death certificates, since the more specific vital records law controlled and the Secretary of Health and Mental Hygiene had not adopted any regulation allowing amendment of a cause-of-death determination. The opinion said a family member's only real option was to informally ask the Chief Medical Examiner to reconsider in light of additional evidence.

Did this rule ever change?
Yes, according to the opinion's own editor's note. The year after this opinion issued, Chapter 547 of the Laws of Maryland 1992 amended the Administrative Procedure Act specifically to extend contested case hearing procedures to a person in interest seeking correction of a death certificate.

Background and statutory framework

Maryland law required a medical examiner to investigate certain deaths, including violent deaths, suicides, deaths by casualty, sudden deaths of a person in apparent good health or unattended by a physician, and deaths occurring in any suspicious or unusual manner, under §5-309(a)(1) of the Health-General Article. In a medical examiner's case, the medical examiner filled out and signed the death certificate, entering the cause of death and medical certification, under HG §4-212(b)(1)(i) and (b)(2)(ii). None of the statutes governing this process, the opinion found, set out any procedure to review or contest the medical examiner's determination once made.

The opinion then considered whether the Public Information Act's general correction procedure, allowing correction of "inaccurate or incomplete information in a public record" under SG §10-625(a), could fill that gap, and concluded it could not. It relied on the standard rule of statutory construction that a specific statute controls over a conflicting general one, citing Farmers & Merchants Bank v. Schlossberg, 306 Md. 48, 63, 507 A.2d 172 (1986), reasoning that the vital records statute's own amendment provision, HG §4-214(a) (letting the Secretary set rules to "protect the integrity and accuracy" of vital records), was the specific mechanism the legislature intended for correcting a document like a death certificate, and the Secretary had deliberately not extended that mechanism to cause-of-death disputes. The opinion also pointed out a death certificate has only one authoritative statement of cause of death under HG §4-212(b), so substituting a different physician's opinion, or attaching the kind of formal disagreement statement the general correction procedure allowed under SG §10-625(d), was not workable for this type of record. Finally, the opinion noted the correction procedure was available only to a "person in interest" as defined in SG §10-611(e), and questioned whether a family member challenging a deceased relative's death certificate would even qualify, since a death certificate concerns only the deceased and death is not commonly treated as the kind of "legal disability" that lets a parent or legal representative stand in for the record's subject.

Citations and references

Statutes:

• §5-309(a)(1) of the Health-General Article, requiring a medical examiner to investigate certain categories of death
• HG §4-212(c), listing circumstances requiring notification of the medical examiner
• HG §5-309(b), further detailing medical examiner investigation duties
• COMAR 10.35.01, the medical examiner regulations referenced generally
• HG §5-305(a)(2), establishing the State Postmortem Examiners Commission's medical examiner staff
• HG §5-305(b), requiring medical examiners to be physicians with pathology training
• HG §5-306(b), authorizing appointment of deputy medical examiners for each county
• HG §§5-309 and 5-310, the medical examiner's general investigation and reporting authority
• HG §5-309(c), requiring the medical examiner to reduce essential facts to writing at the scene
• HG §5-310(a), requiring a report on cause of death within 30 days of case notification
• HG §5-310(e)(1), governing when an autopsy is performed
• HG §4-212(b)(1)(i), requiring the medical examiner to fill out and sign the death certificate in a medical examiner's case
• HG §4-212(b)(2)(ii), requiring the certificate to include the cause of death and medical certification
• HG §4-212(d)(2), requiring a later report of cause of death to the Secretary if not determined immediately
• HG §4-214(a), governing amendment of vital records including death certificates
• COMAR 10.03.01.01C and D, the regulation governing amendment of birth certificates, cited by comparison
• SG §10-625(a), the Public Information Act's general procedure to correct inaccurate or incomplete public records
• §10-625(e), applying APA contested case hearing procedures to an agency's refusal to correct a record
• HG §4-212(b), establishing the medical examiner's cause-of-death entry as the certificate's operative statement
• SG §10-625(d), the statement-of-disagreement procedure under the general correction statute
• SG §10-611(e), defining "person in interest" for purposes of the Public Information Act's correction procedure
• Chapter 547 of the Laws of Maryland 1992, the following year's amendment extending APA contested case procedures to death certificate correction requests

Cases:

• Sugarloaf Citizens Ass'n v. Northeast Md. Waste Disposal Auth., 323 Md. 641, 652, 594 A.2d 1115 (1991), Maryland Court of Appeals decision on the sources from which a hearing requirement may arise
• Snyder v. Holy Cross Hosp., 30 Md. App. 317, 330, 352 A.2d 334 (1976), Maryland appellate decision describing the medical examiner's role in serving the state's interest in learning the cause of death
• Farmers & Merchants Bank v. Schlossberg, 306 Md. 48, 63, 507 A.2d 172 (1986), Maryland Court of Appeals decision on specific statutes controlling over general ones
• Benjamin v. Woodring, 268 Md. 593, 609, 303 A.2d 779 (1973), Maryland Court of Appeals decision on the inadmissibility of a medical examiner's manner-of-death opinion as litigation evidence

Source

• Landing page: https://oag.maryland.gov/resources-info/Pages/attorney-general%E2%80%99s-opinions.aspx
• Original PDF: https://oag.maryland.gov/resources-info/Documents/pdfs/Opinions/1991/Volume76_1991.pdf (this opinion appears at printed pages 276-280 of the bound annual volume; Maryland's site does not publish a standalone PDF of this opinion)

Original opinion text

Best-effort transcription from a scanned PDF. Minor errors may remain, the linked PDF is authoritative.

Health - Vital Records - Medical Examiner - Administrative Law - Contested Cases - Public Information Act - Medical Examiner's Determination or Cause of Death Not Subject to APA Hearing

December 10, 1991

The Honorable Ronald A. Guns
Maryland House of Delegates

You have requested our opinion whether the hearing requirement and other contested case procedures of the Administrative Procedure Act apply to an individual's challenge to the Chief Medical Examiner's determination of the cause or manner of death of a member of the individual's family, as set out on a death certificate.

For the reasons stated below, we conclude that a challenge to a medical examiner's determination about the cause or manner of death does not give rise to an entitlement to a hearing under the APA's contested case procedures.1

I

Contested Case Procedures

The hearing and related adjudicatory procedures in the APA apply to any "contested case," defined as "a proceeding before an agency to determine ... a right, duty, statutory entitlement, or privilege of a person that is required by law to be determined only after an opportunity for an agency hearing." §10-201(c) of the State Government Article ("SG" Article).

"It is well established ... that the APA itself does not grant a right to a hearing. That right must come from another source such as a

1
Sometimes the "cause" of death, strictly speaking, will be obvious, a gunshot wound to the head, for instance. In such cases, the medical examiner would also state on the death certificate an opinion about the "manner" of death, whether the wound was the result of an accident, or homicide, or suicide. See 41 Opinions of the Attorney General 242, 243 (1956). In this opinion, we shall use the term "cause" to include manner of death. See also note 4 below and accompanying text.

statute, a regulation, or due process principles." Sugarloaf Citizens Ass'n v. Northeast Md. Waste Disposal Auth., 323 Md. 641, 652, 594 A.2d 1115 (1991). We turn, then, to a consideration of possible sources for a hearing requirement regarding determinations by a medical examiner.

II

Determination of Cause of
Death By Medical Examiner

The General Assembly has required that certain deaths be investigated by a medical examiner:

A medical examiner shall investigate the death of a human being if the death occurs:

(i) By violence;

(ii) By suicide;

(iii) By casualty;

(iv) Suddenly, if the deceased was in apparent good health or unattended by a physician; or

(v) In any suspicious or unusual manner.

§5-309(a)(1) of the Health-General Article ("HG" Article).2 The medical examiner is to be notified if the deceased was not under treatment by physician during a terminal illness, if the cause of death is unknown, or if the death was apparently caused by an accident, homicide, suicide, "other external manner of death," alcoholism, or criminal abortion. HG
§4-212(c). See also HG §5-309(b). See generally COMAR 10.35.01.

2
Medical examiners are employed by the State Postmortem Examiners Commission. The staff comprises a chief medical examiner, a deputy chief medical examiner, and assistant medical examiners. HG §5-305(a)(2). Each medical examiner on the Commission's staff must be a physician with specialized training in pathology. HG §5-305(b). In addition, the Commission is authorized to appoint deputy medical examiners for each county. HG §5-306(b).

The role of the medical examiner is to serve the State's compelling interest in learning whether a death resulted from a criminal act or a cause that might threaten the public health. Snyder v. Holy Cross Hosp., 30 Md. App. 317, 330, 352 A.2d 334 (1976). To that end, the medical examiner offers his or her expert opinion about the cause of death, after investigation and if need be with the aid of evidence adduced by an autopsy. See HG §§5-309 and 5-310.3

In a medical examiner's case, the medical examiner is to fill out and sign the certificate of death. HG §4-212(b)(1)(i). Among other items, the medical examiner is to provide "[t]he cause of death and medical certification." HG §4-212(b)(2)(ii). If the medical examiner has not determined the cause of death immediately but does so later, the medical examiner is to send to the Secretary of Health and Mental Hygiene "a report of the cause of death, for entry on the certificate." HG §4-212(d)(2).

None of these provisions sets out any procedure for review of the medical examiner's determination of the cause of death. With respect to all vital records, including death certificates, HG §4-214(a) provides that a record "may be amended only in accordance with this subtitle and any rules and regulations that the Secretary [of Health and Mental Hygiene] adopts to protect the integrity and accuracy of vital records." The Secretary has not adopted any regulation regarding the amendment of a death certificate. Cf. COMAR 10.03.01.01C and D (procedures for amendment of birth certificate).

III

Correction of Public Records

The Public Information Act contains procedures under which "inaccurate or incomplete information in a public record" may be corrected. SG §10-625(a). An agency's decision to decline to correct

3
In medical examiners' cases, the medical examiner or an investigator "shall investigate fully the essential facts concerning the medical cause of death and, before leaving the premises [where the body was found], reduce these facts and the names and addresses of witnesses to writing, which shall be filed in the medical examiner's office." HG §5-309(c). "If the cause of death ... is established beyond a reasonable doubt, the medical examiner who investigates the case shall file in the medical examiner's office a report on the cause of death within 30 days after notification of the case." HG §5-310(a). An autopsy is performed "[i]f the medical examiner who investigates ... [the] case considers an autopsy necessary ...." HG §5-310(e)(1).

the record is subject to the contested case hearing procedures of the APA. §10-625(e). However, we conclude that this procedure is not a means by which a family member may challenge a medical examiner's opinion about the cause of death.

As noted in Part II above, the General Assembly has specifically addressed the issue of amending vital records, including amendments seeking to correct an alleged inaccuracy. Under HG §4-214(a), a death certificate "may be amended only in accordance with" departmental regulations, and none pertinent to death certificates have been adopted. Presumably, this administrative decision not to provide an amendment procedure reflects a concern that such a process would be incompatible with "protect[ing] the integrity and accuracy" of death certificates. HG §4-214(a).

Applying customary principles of statutory construction, we conclude that the more general procedures in SG §10-625 are not available to correct a death certificate. "It is well settled that when two statutes, one general and one specific, are found to conflict, the specific statute will be regarded as an exception to the general statute." Farmers & Merchants Bank v. Schlossberg, 306 Md. 48, 63, 507 A.2d 172 (1986).

Indeed, the correction procedures in SG §10-625 appear especially ill-suited to the issue of a death certificate's statement about the cause of death. The General Assembly has vested in the Chief Medical Examiner and other medical examiners the authority to investigate certain cases and, from the evidence, deduce a cause of death. Though others might disagree with it, the medical examiner's opinion in these cases is the only one that is to be entered on the death certificate. HG §4-212(b). As this office put it in a prior opinion, "this is clearly an opinion expressed for whatever value it may have for vital statistics and other non-judicial purposes ...." 41 Opinions of the Attorney General 242, 243 (1956).4 Hence, a death certificate cannot be "corrected", that is, a different physician's opinion about the cause of death cannot be entered on the death certificate, without violating HG §4-212(b). And a death certificate cannot feasibly carry with it the statement of disagreement authorized by SG §10-625(d).

4
We note that the medical examiner's opinion about the manner of death, for example, that death resulted from suicide, would not be admissible evidence if the issue were litigated. See Benjamin v. Woodring, 268 Md. 593, 609, 303 A.2d 779 (1973).

Finally, the correction procedure is available only to a "person in interest," and only as to a record that "the person in interest is authorized to inspect." SG §10-625(a). Because a death certificate concerns only the deceased, it is hard to see that any "person in interest" exists to invoke the procedure.5

IV

Conclusion

In summary, it is our opinion that an individual seeking to challenge a medical examiner's determination about the cause of death of a family member has no legal entitlement to a contested case hearing under the Administrative Procedure Act. The individual's recourse under current law is to attempt to persuade the Chief Medical Examiner that the original determination was incorrect, and, we understand, the Chief Medical Examiner's practice is to give open-minded and careful consideration to whatever additional evidence might be presented.

J. Joseph Curran, Jr.
Attorney General

Jack Schwartz
Chief Counsel
Opinions & Advice

Editor's Note:

In Chapter 547 of the Laws of Maryland 1992, the General Assembly amended the Administrative Procedure Act to extend contested case procedures to requests by a person in interest for correction of a death certificate.

5
The definition of "person in interest" is set out in SG §10-611(e):
"Person in interest" means:
(1) A person or governmental unit that is the subject of a public record or a designee of the person or governmental unit; or
(2) If the person has a legal disability, the parent or legal representative of the person.
Although the estate of a deceased person would have a personal representative who could be said to be the "legal representative of the person," death is not commonly described as "a legal disability."