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The Disposition Authorization program was established in 2008 as a Cremation Review program by the King County Council (formerly KCC 2.24.135; now KCC 2.35A.100*). It was expanded to include both cremations and burials in 2011 and it became known as the Disposition Review. Presently known as the Disposition Authorization, the King County Medical Examiner (KCME) staff review each death certificate to ensure that the cause of death is accurate before burial or cremation occurs.

Deaths that fall within the jurisdiction of the KCME include accidental deaths, homicides and suicides. If an unnatural death is discovered before the body is buried or cremated, then law enforcement and KCME can conduct an investigation.

We owe it to families to be able to tell them what happened to their loved one. We do not want suspicious or accidental deaths to go uninvestigated or accounted for.

2.35A.100  Burial, cremation or other disposition - report to and authorization by medical examiner - fee - waiver for certain cremations - expenditure.

  1. A person shall not bury, cremate or otherwise dispose of the body of a decedent who died in the county without first reporting the death to the medical examiner's office and receiving an authorization from the medical examiner releasing the body for disposition.

    1. A person reporting a death to the medical examiner's office of a person whose remains are to be buried, cremated or otherwise disposed shall be charged the fee in K.C.C. 4A.650.150.

    2. The medical examiner may waive the fee for a cremation only if the cost of the cremation to be performed was paid before January 1, 2008. The fee shall not be charged if the cost of the cremation is borne by the county.

    3. Revenues generated by the body disposition permit fee shall be expended to support the duties and functions of medical examiner performed by the prevention division of the department of health.  (Ord. 17733 § 15, 2014:  Ord. 17692 § 2, 2013:  Ord. 16973 § 2, 2010:  Ord. 15952 § 2, 2007.  Formerly K.C.C. 2.24.135).

Source: King County Clerk of the Council, Title 2 - Administration Codes

About the fee of the DA program

The fee is $70 per death and will cover the full cost of administering the DA program, which is staffed by four full-time people and one part-time person (total: 4.25 FTE). Funeral homes pay the fee and may pass it on to families of decedents. Public Health pays for reviews of the deaths of people who are indigent.

By comparison with Medical Examiners around the country with similar programs, fees can range from $15 to $350 per death.

How the program works

The KCME reviews all deaths that occur in King County. Before a death is certified, DA program staff review each death certificate to verify that the cause (what the person died from) and manner (natural, homicide, suicide, or accident) of death do not indicate the need to assume jurisdiction.

Comparing the Washington State Electronic Death Record System (ERDS) and the King County Disposition Authorization program

EDRS uses an algorithm to flag records that should be investigated by the KCME. While EDRS provides an added layer of assurance that KCME takes jurisdiction over all appropriate cases, it does not replace the need for expert human review of all deaths that occur in King County each year. Communities that don't have a DA program and rely on ERDS may not be finding all jurisdictional deaths that occur in their community.

Success rates of the DA program

The State predicted the Cremation Review program would catch 25 KCME cases per year; in the first year, KCME caught 94 cases. In 2015, the DA review process caught 86 KCME jurisdictional cases that would have otherwise gone unexamined. Since this law was enacted in 2008, over 100,000 deaths have been reviewed, resulting in over 1,000 new cases that were identified through the review.

Examples of the kinds of cases that the DA program finds:

Homicides have been found. For example, a community doctor recently felt that a traumatic brain injury from a gunshot wound to the head was a natural death.

Occasionally deaths are reported as traumatic in nature, but has been reported as a natural death on the certificate. For example, seizure disorders are cases that are reviewed to ensure that the seizures are not from traumatic causes.

Malnutrition is another cause that can be missed—the KCME investigates to determine the cause of malnutrition and to ensure that neglect isn't a factor.

The KCME also investigates certain types of ulcers to ensure that wound care has been appropriately managed.

Accidental deaths are the most common "catch" on DA review, e.g. drug overdoses, broken bones due to car accidents, injuries from falls, brain bleeds, and choking.

There are also deaths from unique circumstances, including a recent death reported as exposure to pesticides: Investigation revealed that the exposure occurred in childhood and was not of local community concern.

Number of deaths caught after the EDRS program went into effect

64 deaths were found between January 1 and December 1, 2016, so the number is about the same as in past years.