The opioid abuse epidemic in Tennessee is tragically leaving Tennessee medical examiners with a tough call in determining manner of death. Did the deceased choose to end his/her life or did the ravages of addiction or misjudgment of prescription or illicit drugs cause an accidental death?

Under Tennessee law, determination by a county medical examiner that a manner of death is suicide can only be changed by the medical examiner who performed the autopsy. Until June 13, 2017, there was no formal process in law by which a family left behind could dispute the medical examiner's determination that the manner of death of their loved one was by suicide.

Public Chapter 493, brought by two Williamson County Republican legislators, Rep. Glen Casada and Sen. Jack Johnson, changes that, creating a fair and expedient way for family members to have the manner of death of a loved one which was initially labeled as suicide reconsidered and perhaps even changed. The law is codified at TCA 68-3-502.

Step 1 - What to File to Start the Process.

The next of kin must submit an affidavit of written request for reconsideration to the county medical examiner who signed the death certificate, the chief medical examiner of the regional forensic center where the autopsy was performed, and the commissioner of health. The Department of Health created a form for this purpose called Request for Reconsideration of Suicide as Manner of Death. The form can be accessed at http://www.tn.gov/health/article/OSCME-resources. The form must be submitted within one year from the date the death certificate was filed with the State Office of Vital Records. The affidavit form must include the reasons why there is disagreement that a loved one's death was a suicide.

Step 2 - Meeting with Medical Examiner to Reconsider Suicide Determination.

The county medical examiner who signed the death certificate has thirty (30) days to hold an in-person or telephonic meeting with the next of kin seeking the reconsideration. The meeting is the opportunity for the next of kin to present all evidence to the medical examiner as to why the manner of death was not suicide.

Family should be prepared for the meeting and bring any supporting documentation or medical articles or treatises supporting its position. Reasons do not have to be medical reasons; documentation may include emails, social media communications, purchase receipts or other evidence that the deceased had future plans. Such evidence would negate that the deceased intended to take his/her own life because intent is required according to the legal definition of suicide.

If the deceased had a long history of addiction to drugs and/or alcohol, that is extremely useful information to negate intent to kill oneself. Addicts need more and more substances to sustain their addiction. They may take a lot of pills not knowing their strength or interactions with other medications. They may obtain pills with unknown ingredients off the street. Taking drugs in those manners does not necessarily mean that a long time addict meant to kill himself/herself. A presentation authored by the Deputy State Chief Medical Examiner, How to Best Certify Deaths Due to Substance Use, is a useful resource and located on the Department's website.

After the meeting with the next of kin, the medical examiner has 30 days in which to make a decision to leave suicide as manner of death or to change it to something else such as "accidental" or "undetermined" - conclusions that make more sense in the absence of clear evidence of suicide, such as a suicide note or forensic evidence excluding other possibilities.

If the decision is to change it, the medical examiner has up to 30 additional days to file the change with the Tennessee Office of Vital Records. If the decision is to leave suicide as manner of death, the next of kin can accept the decision or proceed to the Step 3.

Step 3 - Appeal to the Chief Medical Examiner of the Regional Forensic Center

If the decision is to proceed to Step 3, further reconsideration may be obtained from the chief medical examiner of the applicable regional forensic center. Requests should include copies of all of the information that the chief medical examiner should consider to reverse the determination that the manner of death of your loved one was suicide.

The chief medical examiner has thirty (30) days to respond to the next of kin in writing with a decision that includes detailed reasons supporting the decision. If the decision is to leave suicide as manner of death, the next of kin can accept the decision or proceed to the Step 4.

Step 4 - Mediation.

Step 4 is mediation between the next of kin and the chief medical examiner of the regional forensic center. The next of kin is responsible for hiring the mediator. The mediator must be certified under Rule 31 of the Tennessee Supreme Court.

If mediation leads to an agreement that the manner of death was suicide, no further action is necessary.

If mediation leads to an agreement that the manner of death was other than suicide, then the chief medical examiner of the regional forensic center shall file an affidavit within thirty (30) days directing the Office of Vital Records to amend the death certificate to reflect the new manner of death.

To help navigate the public through the process created by the new suicide reconsideration law, the family which initiated the bills developed a step by step guide with resources, found at Notsuicidetn.com.

Yarnell Beatty has nearly 30 years' experience practicing health care law in Tennessee. He and his wife, Liz, lost their 24-year old son, Alex, to an overdose in 2016, prompting them to seek passage of the suicide reconsideration law in 2017.