Medical Therapy-Related Deaths and the Medical Examiner

Medical therapy-related deaths are incidents with great significance to public health and the medical community. However, there is controversy regarding the prevalence and the appropriate manner certification of these deaths given the paucity of guidelines regarding these cases. Our study aimed to identify potential medical therapy-related deaths in a large medical examiner jurisdiction and to determine the consensus rate regarding 1) identification of a case as being attributable to medical therapy, 2) manner of death, and 3) hypothetical utility of the “therapeutic complication” (TC) manner. Retrospective review over a 12-year period (2002–2013) revealed 113 appropriate cases, which were summarized and provided to forensic pathologists in our jurisdiction. Results were analyzed for consensus rate between pathologists and cases were categorized by complication type. The largest majority of these cases fell into the medication category (n=44; 39.0%) followed by operative (n=38; 33.6%), cases not medical therapy-related (n=31; 27.4%), and nonoperative (n=19; 16.8%). The interobserver agreement rate for original manner classification ranged from fair to moderate. The addition of TC as an available manner improved the consensus rate in four cases and decreased the consensus rate in 37 cases. There were 73 cases that at least one pathologist attributed to medical therapy, 19 of which were attributed to medical therapy by all pathologists. Our study indicates that there is disagreement about which cases are attributable to medical therapy and poor consensus in manner classification of medical therapy-related deaths. As such, guidelines are proposed for the classification of deaths thought attributable to medical therapy.