by Dennis Reeves Cooper…….

I WAS JUST WONDERING. I have been writing columns for The Blue Paper since 1994. And many, if not most of the concepts for those columns started with “just wondering” about how something works or the truth about a particular topic. Maybe because I’m getting older, I have recently been wondering about what happens– or what HAS to happen– when a person dies in Key West. As with many stories, this one turned out to be more complex (and maybe more interesting) than I thought it would be. As I researched this story, I couldn’t help but note the seemingly out-of-proportion importance of two little pieces of paper in the life of every person. Two certificates. One that officially documents the beginning of a person’s life in America and another that officially documents the end of a person’s life. Your birth certificate and your death certificate.

Your birth certificate simply documents that your birth has been registered with the government. It documents the name you have been given, your birthday and where you are born. Unlike a death certificate, a birth certificate is often a happy little document. Mine has a little baby footprint on it. But it is a very important legal document, which, in essence, certifies your very existence. And you will be required to show this document many times during your life. Although you don’t remember it, your mommy had to show your birth certificate to even get you into school for the first time. And I have to make a political observation here: If the initials “USA” appear on a baby’s birth certificate, he or she is a very lucky little baby, in terms of the many perks and advantages that he or she will receive throughout his or her life as a citizen of the United States of America.

And then there is the death certificate, which documents the end of your life. In essence, it certifies that you no longer exist. In Key West, and virtually everywhere else in America, this piece of paper– which must be signed by a licensed physician– is required before a funeral director can do anything to plan your cremation or burial– and before your family can make a life insurance claim and even before your will can go into effect. In essence, when you die, everything is put on hold until a physician signs your death certificate. But it is becoming increasingly common for even family physicians to refuse to sign death certificates if they have not recently seen or examined the deceased. And in Key West, that means that, without a death certificate, the deceased must be transported to the County Medical Examiner’s (ME) facility in Marathon. In essence, the morgue. Here, the ME has the responsibility to determine cause of death and sign the death certificate.

Some doctors say that, if they have not recently seen the deceased, they would only be guessing about cause of death– and they fear litigation or involvement in an investigation if their “guess” turns out to be wrong in the future. The recent death of comedian Garry Shandling generated a number of national news stories after his doctor refused to sign his death certificate. The doctor said that he had not recently seen or examined Shandling– but that the last time he had seen the comedian, he appeared to be in good health. So the local medical examiner had to launch an investigation. It has since been reported that Shandling died as the result of a heart attack. Ironically, Shandling had talked about his own death during a recent television appearance: “What I want at my funeral is a boxing referee who counts to five and says, ‘He’s not getting up.'”

It is somewhat sobering to think that, if I die tonight, my personal physician might not be willing to sign my death certificate. Although he has been my doctor for years, I typically do not see him more than every year or two for routine physical examinations. And without a death certificate, the law requires that I would be transported to the morgue in Marathon to join the line of other bodies in those horizontal refrigerators waiting for the ME to determine cause of death and sign a death certificate.

In writing this story, I talked to funeral directors, hospital officials, Hospice and others, including the cops. Based on those interviews, here are several examples of what typically happens– and what HAS to happen when someone dies in Key West. First of all, all deaths fall into one of two categories– “attended” and “unattended.” Attended deaths are those that happen in hospitals, nursing homes and when Hospice is involved. Unattended deaths are all others– ranging from a grandfather dying suddenly at home, next to his sleeping wife, to a murder on the street. In virtually every instance of an unattended death, the police must be called in– just to make sure there are no suspicious circumstances. And in most instances, there are no suspicious circumstances, The big difference in “attended” and “unattended” is whether or not the deceased has been under the care of a physician– as is the case for those who die in hospitals, nursing homes and under the care of Hospice. In the cases of attended deaths, representatives of the hospital, nursing home or Hospice call in the attending physician to determine the probable cause of death and sign the death certificate. At that point, no police involvement is required and the funeral director may be called to pick up the deceased and start the funeral process.

It’s a different story when it comes to unattended deaths. A typical example of an “unattended” death is a wife who discovers that her elderly husband, who has been napping on the sofa, won’t wake up. According to those who deal with death every day, the wife should call 911. Not the husband’s doctor. Not a relative. Not a neighbor. But 911.Two things happen when she does that. (1) The cops show up and (2) one of the Fire Department’s Rescue units also show up. After all, the husband might not be dead. And if he’s not dead, Rescue will treat him and transport him to the hospital. If they find that he is not responsive and that further efforts to resuscitate him would likely be futile, they leave and the police officers continue with their investigation. Assuming no suspicious circumstances and assuming that the wife can advise the police officers who the husband’s doctor is, they will try to contact him to see if he will sign the death certificate. If the doctor cannot be located or if he cannot or will not sign the death certificate, the deceased is transported to the county morgue at the Medical Examiner’s Office.

What if the deceased has been living alone and is discovered by the landlord? The landlord should dial 911 and the cops will take it from there. Even then, assuming that there are no suspicious circumstances, the priority is to try to determine if the deceased had a personal physician who will sign the death certificate. Initially, the police officers might check for physicians’ names on medical bottles in the residence. If a physician cannot be located who is willing to sign the death certificate, the deceased is transported to the Medical Examiner’s facility. In obvious cases of murder or suicide, or people who are killed in automobile accidents or other types of accidents, the deceased are also transported to the county morgue. In Key West, Dean-Lopez Funeral Home has a contract with the Medical Examiner to handle transport in these instances– at $350 per body. Although the ME has the responsibility to provide probable cause of death information to law enforcement to supplement any ongoing investigations, a primary reason the ME is involved at all is to provide a death certificate when there is no other physician to do that.

In Key West and Monroe County, it should not be surprising that even topics that are not typically controversial– like the Medical Examiner’s Office– find a way to be controversial here. Perhaps even scandalous. You may have read news stories about the alleged scandal currently swirling around the office of Dr. Thomas Beaver, the Monroe County Medical Examiner, including the story recently published here in The Blue Paper. Among the critics of Dr. Beaver are local funeral directors who complain about delays in getting death certificates from the ME’s office. They also complain that the ME’s office is habitually slow-pay when it comes to paying them for transport of bodies. And then, there was that incident in which the ME’s office transported a body from an accident scene in the back of an open-bed pickup truck, rather than wait for pick up and transportation by one of the contracted funeral homes. Families of the deceased said that was disrespectful.

These and others complaints resulted in calls for the County Commission to fire Beaver. But there was one little problem. Dr. Beaver is a private contractor appointed by the governor. Although County officials are mandated by state law to finance the ME’s office, they do not have the authority to hire or fire the ME. This prompted County Administrator Roman Gastesi to last year call for an audit of how Dr. Beaver is spending county money. The results of that audit, released just last month, were not pretty. In addition to paying himself $180,000 per year, he also used county money to buy himself a $29,000 pickup truck. He spent another $26,000 to rent and furnish his personal residence. Auditors also questioned the use of county money to pay for video games, diving equipment, baseball equipment, firearm training and supplies, fitness equipment and a fitness club membership, “age management” drugs and two trips to Little Palm Island Resort & Spa.

But what the audit also revealed was that all of that may have been allowed by the loosely-written contract that County officials had negotiated with Dr. Beaver. Members of the County Commission hope to remedy that in a new County budget, now being developed for 2017. In the meantime, Dr. Beaver has submitted his own 2017 budget, which proposes an annual increase of more than $50,000, from $631,370 to $686,055. In part, the increase reflects Dr. Beaver’s prediction that his office will be dealing with more dead bodies in 2017 and in future years than in past years. And perhaps this reflects the trend that more family physicians are refusing to sign death certificates than in past years– and this increases the work load at the ME’s office. Keep in mind that the only deceased individuals who end up in Dr. Beaver’s morgue are those for which another doctor has not determined the cause of death and has not signed a death certificate.