641—127.3 (331,691) Autopsies.
	 127.3(1) Autopsy required. A county medical examiner shall perform an autopsy or order that an autopsy be performed in the following cases:
	  a.   	 All cases of homicide or suspected homicide, irrespective of the period of survival following injury.
	  b.   	 All cases in which the manner of death is undetermined.
	  c.   	 All cases involving unidentified bodies.
	  d.   	 All deaths of children under the age of two when there is not a clear cause of death, including suspected cases of sudden infant death syndrome. A summary of the findings of the autopsy shall be transmitted by the physician who performed the autopsy to the county medical examiner within two days of completion of the report. Autopsies performed on children under the age of two when the circumstances surrounding the death indicate that sudden infant death syndrome may be the cause of death or the cause of death is not clearly explained by known medical history shall conform to Form ME-4.
	  e.   	 All work- and farm-related deaths unless there is an obvious natural cause of death.
	  f.   	 All drowning deaths.
	  g.   	 All deaths of commercial vehicle drivers that occur during the performance of their job duties.
	  h.   	 Deaths due to poisoning.
	  i.   	 Deaths of airplane pilots who die as a result of an airplane crash. The National Transportation Safety Board and the Federal Aviation Administration should be contacted prior to the autopsy to request specimen kit(s).
	  j.   	 Deaths due to a natural disaster, including tornadoes and floods.
	  k.   	 Deaths in a prison, jail or correctional institution or under police custody, where there is not a natural disease process that accounts for the death.
	 127.3(2) Autopsy recommended. It is recommended that a county medical examiner should perform an autopsy or order that an autopsy be performed in the following cases:
	  a.   	 Deaths of adolescents less than 18 years of age when there is not a natural cause of death.
	  b.   	 All cases which involve a motor vehicle crash, unless it is a single motor vehicle accident with no potential for litigation and there is an obvious cause of death or the injuries have been clearly documented by hospitalization.
	  c.   	 Rescinded IAB 3/29/06, effective 5/3/06.
	  d.   	 Deaths from suicide.
	  e.   	 All pedestrian, bicycle, motorcycle, snowmobile, boating, watercraft, three- or four-wheeler or all-terrain vehicle fatalities.
	  f.   	 Deaths due to failure of a consumer product.
	  g.   	 Deaths due to a possible public health hazard.
	  h.   	 Deaths due to drug or alcohol abuse or overdose.
	  i.   	 Electrical- and lightning-related deaths.
	  j.   	 Deaths from burns or smoke or soot inhalation.
	  k.   	 All deaths related to exposure, such as hypothermia and hyperthermia.
	  l.   	 All sport-related deaths, including but not limited to deaths from auto racing and deaths resulting from injuries sustained in football, basketball, baseball, softball, soccer, or other games or sports.
	 127.3(3) Other deaths. For those deaths not listed in subrule 127.3(1) or 127.3(2), a county medical examiner shall determine whether the public interest requires an autopsy and may perform an autopsy or order that an autopsy be performed. A county medical examiner may consult with the state medical examiner to assist in determining the need for an autopsy.
	 127.3(4) Performance of autopsy.
	  a.   	 Who may authorize. Autopsies may be authorized by the state medical examiner, the county medical examiner for the county in which the death occurred or the county where any injury contributing to or causing the death was sustained, or the county attorney who would have jurisdiction in any criminal proceeding related to the death.
	  b.   	 Who may perform. An autopsy shall be performed by a pathologist trained or with experience in forensic pathology, licensed to practice medicine and surgery or osteopathic medicine and surgery in the state of Iowa and board-certified by the American Board of Pathology, or under the direct supervision of a physician with these qualifications. If an autopsy is performed by a physician who does not satisfy these criteria and who is not performing under the direct supervision of a physician who satisfies these criteria, the physician shall submit a supplemental report with the Permit by Medical Examiner for Autopsy, Form ME-3, which details the specific training, education, and experience which qualify the physician to perform an autopsy. The following cases/types of deaths shall be transported to the office of the state medical examiner for autopsy unless otherwise approved by the state medical examiner:
	 (1) 	 Deaths of adolescents through 18 years of age when there is not a known or preexisting natural cause of death.
	 (2) 	 All cases of homicide or suspected homicide, irrespective of the period of survival following injury.
	 (3) 	 Deaths of children under the age of 2 years if death results from an unknown cause or if the circumstances surrounding the death indicate that Sudden Infant Death Syndrome may be the cause of death.
	 (4) 	 All suspicious suicides.
	 (5) 	 All high-profile deaths including, but not limited to, deaths of elected officials in municipal, state or federal government.
	 (6) 	 All deaths of inmates occurring in any institutions under the department of corrections as outlined in Iowa Code section 904.102, excluding those deaths that result from a pre-existing medical condition.
	  c.   	 Permit required—Form ME-3. A medical examiner shall complete the Permit by Medical Examiner for Autopsy, Form ME-3. All reasonable efforts shall be made to complete the Form ME-3 prior to the performance of an autopsy and to submit the form with the body of the decedent or to submit the form via facsimile to the state medical examiner.
	 127.3(5) Autopsy report. A complete record of the findings of the autopsy shall be submitted to the state medical examiner’s office, the county attorney of the county where the death occurred and the county attorney of the county where the injury contributing to or causing the death was sustained within 90 days following the date of death, unless unusual circumstances requiring further investigation or testing exist. The report filed shall include all diagrams, transcriptions of the autopsy observations and opinions, and toxicology reports.
	 127.3(6) Out-of-state autopsy. The body of a decedent may be sent out of state for an autopsy or postmortem examination only if the county medical examiner certifies in writing that the out-of-state autopsy or examination is necessary for any of the following reasons:
	  a.   	 A forensic pathologist practicing in the state of Iowa is unavailable;
	  b.   	 Requiring an in-state autopsy would cause financial hardship; or
	  c.   	 Requiring an in-state autopsy would delay the funeral or burial more than three days.
	 127.3(7) Retention and disposal of tissues, organs, and bodily fluids. The office of the state medical examiner shall retain tissues, organs, and bodily fluids as necessary to determine the cause and manner of death or as deemed advisable by the state medical examiner for medical or public health investigation, teaching, or research. Tissues, organs, and bodily fluids shall be retained at a minimum for the time periods established by the National Association of Medical Examiners and may be retained for a longer time period at the discretion of the state medical examiner. Tissues, organs, and bodily fluids retained under this subrule shall be disposed of without the specific consent or notification of the legal next of kin and in accordance with applicable federal and state regulations including but not limited to OSHA-recommended biohazard and blood-borne pathogen standards. The anatomical material shall be removed from the laboratory premises through use of a contracted, licensed, and bonded medical waste removal service to a medical waste processing center for final disposition.