In Wisconsin, each county has the opportunity to select its death investigation system: a coroner system or a medical examiner system. Both systems have the same authority under Wisconsin State Statute. The main difference is that a Coroner is an elected official that serves a four-year term, where a Medical Examiner is appointed by a County Administrator or Executive. Neither system requires a Medical Examiner or Coroner to be a physician in Wisconsin.

In Marathon County, we operate as a Medical Examiner system.

The Coroner or Medical Examiner is mandated by the State of Wisconsin to determine the cause and manner of death of deceased individuals by means of investigation, toxicology, and postmortem examination. These include cases of homicide, suicide, accidental, and all natural deaths that are sudden, unexpected, or medically unattended.

Cause of death:the natural disease or traumatic injury which initiates the sequence of events resulting in an individual’s death.

Proximate cause of death:the disease process or injury which represents the starting point in an unbroken chain of events, ending in death—for example, coronary artery disease, chronic obstructive pulmonary disease, hip fracture, etc.

Immediate cause of death:the complication or sequelae of the proximate cause of death, which is related to the proximate cause but does not represent an intervening cause of death —for example, myocardial infarct, respiratory failure, aspiration pneumonia, failure to thrive, etc.

Manner of death:a classification of how a cause of death arouse, which include natural, accident, suicide, homicide and undetermined.

The Medical Examiner’s Office determines whether a death falls within their legal jurisdiction, as outlined by Wisconsin State Statutes. There are many factors that help determine if a death falls within jurisdiction, including past medical history, circumstances surrounding the death, witness interviews, place the death occurred, etc. The Medical Examiner’s Office will consider each case individually and determine whether it falls within the legal jurisdiction of the office. If the Marathon County Medical Examiner’s Office assumes jurisdiction, the Medical Examiner will decide what level of investigation/examination is necessary to determine the cause and manner of death.

Pursuant to Wisconsin State Statute 979.01, the Medical Examiner's Office is required to investigate deaths that fall into the following categories:

• All deaths in which there are unexplained, unusual, or suspicious circumstances
• All homicides
• All suicides
• All accidental deaths
• All maternal deaths following an abortion
• All deaths due to poisoning, whether homicidal, suicidal, or accidental
• All deaths where an injury has possibly contributed to the cause of death, whether the injury is or is not the primary cause of death and regardless of the interval of the time between the injury and the date of death.
• Where no physician or accredited practitioner is willing to act as the medical certifier of the death.
• When the physician caring for the decedent refuses to sign the death certificate.
• When after reasonable efforts, a physician is not available to certify the death as required within 6 days following the pronouncement of death or sooner under circumstances which the Medical Examiner determines to be an emergency.
• All deaths occurring while the person is in the custody of a law enforcement agency, state/federal department of corrections, or any death involving actions of a law enforcement officer.
• All deaths in the emergency room or outpatient area of a health care facility that occur within 24 hours of admittance.
• All deaths associated with a diagnostic, anesthetic, or therapeutic procedure.
• All deaths of public health interest, including infectious disease, communicable conditions, and/or terrorism.
• If a death is a miscarriage and 20 weeks or more have lapsed between the mother's last menstrual period and delivery, or stillbirth weighs 350 grams and the delivery is unattended by a physician or practitioner.
• All deaths occurring in a place other than a hospital or nursing home that are not registered with a Hospice Program licensed by the State Department of Health and Social Services, HSS 131.
• All deaths of a child under the age of 17 years, unless a physician certifies the manner and cause of death as natural.
• All deaths attributable entirely or in part to workplace factors.
• All cases where human or unidentified remains are discovered outside of a cemetery or documented burial plot.

Although the above cases must be reported, the Medical Examiner’s Office has the authority to accept or decline jurisdiction on a case-by-case basis. If the jurisdiction is declined, the attending physician signs the death certificate, and the disposition of the body is the responsibility of the next of kin.

If the Medical Examiner’s Office has ordered an autopsy, the office is responsible for its cost.

If the Medical Examiner’s Office determines that an autopsy is not necessary, however the family would still like to have one performed, it would be the legal next of kin’s responsibility to arrange the autopsy, transportation, and assume financial responsibility.

There is no guarantee that a pathologist would be willing to conduct the autopsy. For your convenience, we've listed two options for a private pay autopsy below.

• University of Wisconsin Pathology Department - Call Jodi at 608-263-8899 Monday-Friday to schedule.
• Midwest Anatomic Pathology Services (MAPS) - Call 920-214-2014

In some cases, the cause of death is evident at the time of autopsy or during the initial investigation and the death certificate is completed immediately. In other cases, the cause of death may require additional studies and therefore, additional time.

Many studies require the processing and analysis of specimens by consulting laboratories and forensic autopsy providers, whose turn-around times are not controlled by the Medical Examiner’s Office. Forensic toxicology analysis generally takes 3-6 weeks for the results. Autopsy results are generally available in 2-3 months, depending on whether toxicology or additional testing was performed. At times, the autopsy results may take longer if genetic or specialized testing is conducted.

Finally, the death investigation may be prolonged if additional investigation is required by law enforcement, which happens in special circumstances, such as a homicide investigation or motor vehicle crash involving numerous vehicles.

We greatly appreciate the patience of families and friends as we work try to provide accurate and complete answers as soon as practical.

The Medical Examiner’s Office will consider the facts of each case individually and decide what level of investigation/examination is necessary to determine the cause and manner of death and to clarify the circumstances surrounding the death. In many cases, this requires the performance of an autopsy. Autopsies are routinely performed on non-natural deaths such as homicides, suicides, accidents, and undetermined deaths. They are also conducted on natural deaths where the cause is unclear.

However, not all death investigations require an autopsy. Many times, the circumstances surrounding a death, in addition to the decedent’s medical history, is enough to determine the cause and manner of death without an autopsy.

An autopsy is a complete physical examination, internal as well as external, conducted on the decedent in a professional and dignified manner by a pathologist. The pathologist looks for and documents the presence of injuries and pre-existing natural disease. During the autopsy, samples of various organs, tissue, and body fluids are retained for additional studies, if needed. Some of the additional testing may include the following:

• Toxicology: evaluation of body fluids to determine the presence of alcohol, drugs, medications, or other toxic substances

• Histology: the study of tissue, organs, and cells under a microscope to identify disease processes

• Microbiology: cultures of certain areas within the body to determine the presence of bacteria, fungus, or viruses

In certain cases, items of evidentiary value are collected, such as trace evidence, bullets, hair, fingernail clippings, sexual assault swabs, or other foreign objects. The findings of the examination, and any known medical history, are combined with scene investigation to determine cause and manner of death.

In Marathon County, all autopsies are conducted by a board-certified forensic pathologist at either the Fond du Lac County Medical Examiner’s Office or University of Wisconsin Madison Pathology Department.

A Death Certificate is a legal document that serves as proof of death and provides the state, date, location, manner, and cause of a person’s death. The certificate is necessary for life insurance claims, to settle estates, to obtain death benefits, etc. The issuance of a death certificate is a 2-step process:

1. The funeral home will collect information from the family for the certificate.

2. The Medical Examiner or Physician will complete the cause and manner of death, then sign the certificate. “Pending” will be listed as the cause of death for all cases that remain under investigation.

Following the post-mortem examination or autopsy, the investigator will contact the legal next of kin with the preliminary findings. If the cause of death cannot be determined immediately (requiring further investigation and/or studies), the death certificate may be signed as "pending." You may obtain a copy of a certified pending death certificate either through your funeral home, or the local Register of Deeds Office. This certificate documents that the death occurred which may be suitable for you in closing final matters. Once cause and manner of death have been determined, the legal next of kin will be notified. At this time, an amended certified death certificate listing the final cause and manner may be obtained either through your funeral home or the local Register of Deeds Office.

Yes, a "pending" death certificate can be used as proof of death. The pending status implies that additional studies are necessary, such as toxicology or final autopsy results, to determine the cause and manner of death. A death certificate, even a pending certificate, is a legal document which serves as proof of death. The only thing that a pending death certification cannot be used for is life insurance, as life insurance companies generally need the final cause and manner of death to process claims. If any problems arise in the acceptance of a pending death certificate as proof of death, please call the Medical Examiner's Office at 715-261-1199 for assistance.

Following the post-mortem examination or autopsy, the investigator will contact the legal next of kin with the preliminary findings. If the cause of death cannot be determined immediately (requiring further investigation and/or studies), the death certificate may be signed as "pending". Once cause and manner of death have been determined, the legal next of kin will be notified. At this time, an amended certified death certificate listing the final cause and manner may be obtained either through your funeral home or the local Register of Deeds Office.

To inquire about a death investigation, you may contact our office at 715-261-1199. Our normal business hours are Monday-Friday, 8 am to 4 pm. If you have questions outside of these hours, please call our dispatch line at 715-261-7792 and they will page an investigator for you. You must provide your name, the name of the deceased, the date of death (actual or approximate), and your relationship to the deceased.

Keep in mind that, while we do our best to keep families informed, we may not be able to answer all questions if the investigation is incomplete or if release of the information would compromise an active criminal investigation. We can also only release information to the legal next-of-kin.

The Medical Examiner’s Office does everything possible to complete examinations and release decedents within the shortest period possible. In the majority of cases, decedents are examined and released within 24 hours. Since autopsies are not routinely performed on weekends or holidays, releases involving such periods may be delayed slightly.

During special circumstances, such as homicide or suspicious deaths, or when positive identification needs to be confirmed, there will be a delay in releasing the decedent until all testing can be completed and/or positive identification is established.

The first thing you need to do is take care of yourself. A lot of information will be shared with you, and you will need to make several decisions. The following is a suggested list to help guide you and your family through this process.

• If you are family member or friend that needs to report a death, please call 911 immediately
• Select a funeral home to assist you in making funeral arrangements and complete the necessary paperwork to coordinate the final disposition of your loved one’s remains. The funeral home’s director will make arrangements to pick up and transport your loved one’s remains back to the funeral home.
• Once you have chosen a funeral home, please notify our office to provide us with that information. We understand that many families will contact and/or meet with several funeral homes before finalizing their decision. Therefore, to avoid any confusion and ensure your loved one is transported to the funeral home of your choosing, we need to confirm your selection with you directly.
• When notified of a loved one’s death, involve your family, friends, and clergy for support and comfort. They will be able to assist you in making sense of this tragic and sometimes sudden news.
• Consult your support system and decide if tissue donation is something you want to consider. Ask your Medical Examiner as soon as possible if you would like more information.
• Start a file to organize all business cards, paperwork, and information that will be shared with you as a result of your loved one’s death.
• Finally, remember to check in on yourself. Stress can come into your life quickly and unexpectedly. Do not be afraid to use resources available to you in your community.