michigan association of medical examiners … · michigan association of medical examiners 2005...

MICHIGAN ASSOCIATION OF MEDICAL EXAMINERS

2005 EXECUTIVE COMMITTEEJohn C. Maino, MD, Chair1715 Lansing Ave. Suite 648Jackson, MI 49203-2135Phone: (517) 788-4482Alternate Phone: (517) 780-7264Fax: (517) 768-5823Email: [email protected] Expiration: 2005Assistant: Jill Glair @ (517) 788-4482

Stephen Cohle, MDKent County Chief Medical Examiner700 Fuller NEGrand Rapids, MI 49503Phone: (616) 336-3021Fax: (616) 336-3943Email: [email protected] Expiration: 2005

Joyce deJong, DO1215 E. Michigan Ave.Lansing, MI 48912Phone: (517) 364-2561Fax: (517) 372-0581Email: [email protected] Expiration: 2006

Carl Hawkins, MDMackinac County Chief Medical Examiner220 Burdette St.St. Ignace, MI 49781Phone: (906) 643-0466Fax: (906) 643-0464Email: [email protected] Expiration: 2007

Brian Hunter, MD1215 E. Michigan Ave.Lansing, MI 48912Phone: (517) 364-2561Fax: (517) 372-0581Email: [email protected] Expiration: 2006

Rubin Ortiz – Reyes, MD1200 N. Telegraph Rd.Pontiac, MI 48341Phone: (248) 858-5097Fax: (248) 452-9173Term Expiration: 2005

Daniel Remick, MDM2211 MSI, Box 06021301 Catherine Rd.Ann Arbor, MI 48109-0602Phone: (734) 763-6454Fax: (734) 763-6476Email: [email protected] Expiration: 2006

Dennis Smallwood, DOSanilac County Chief Medical Examiner171 North Dawson StreetSandusky, MI 48471Phone: (810) 648-4098Fax: (810) 648-2646Email: [email protected] Expiration: 2007

Richard Tooker, MDKalamazoo County Chief Medical Examiner3299 Gull RoadKalamazoo, MI 49048-1295Phone: (269) 373-5190Fax: (269) 373-5191Email: [email protected] Expiration: 2007

COUNTY NAME TELEPHONE2000 Population

ALCONA Greg Hanert, DO (989) 724-652611,719 311 Lake St. Fax (989) 724-9975

PO Box 218Harrisville, MI 48740

ALGER Christine Krueger, MD (906) 387-43389,862 1514 Sand Point Road Fax (906) 387-2825

Munising, MI 49862

ALLEGAN Joyce deJong, DO (517) 364-2561105,665 1215 E. Michigan Ave. Fax (517) 372-0581

Lansing, MI 48912 [email protected]

ALPENA Robert Coombs, MD (989) 358-682431,314 1063 US 23 North Fax (989) 356-6180

Alpena, MI 49707

ANTRIM Dewey Benson, DO (231) 377-778423,110 PO Box 1043 Fax (231) 377-7786

Bellaire, MI 49615

ARENAC Cesar Casten, MD (989) 846-953317,269 529 East Cedar Fax (989) 846-1015

Standish, MI 48658

BARAGA Cary Gottlieb, MD (906) 524-33388,748 Baraga County Memorial Hospital Fax (906) 524-7147

770 North MainL’Anse, MI 49946

BARRY Jeffrey P. Chapman, MD (269) 945-360656,755 1005 West Green Street Fax (269) 945-0405

Hastings, MI 49058

BAY Howard F. Hurt, DO (989) 895-4009110,157 Bay County Health Department Fax (989) 895-4014

1200 Washington AvenueBay City, MI 48708

STATE OF MICHIGANCHIEF MEDICAL EXAMINERS 2005

October 2005 1


BENZIE Matthew A. Houghton, Jr, DO (231) 334-818415,998 PO. Box 116 Fax (231) 334-8185

Glen Arbor, MI 49636

BERRIEN Robert Clark, MD (269) 983-8313162,453 1234 Napier Ave. (269) 983-8495

St. Joseph, MI 49085 Fax (269) 983-8258

BRANCH Troy Davis, DO (517) 542-321745,787 413 N. Chicago St. Fax (517) 542-3409

Litchfield, MI 49252

CALHOUN Mehmet B. Ismailoglu, MD (269) 969-8891137,985 391 South Shore Drive, Suite 214 Fax (269) 969-6193

Battle Creek, MI 49015

CASS Robert M. Knox, DO (269) 663-828851,104 27082 West Main Fax (269) 663-2426

PO Box 628Edwardsburg, MI 49112

CHARLEVOIX Reed Freidinger, MD (231) 547-448826,090 14730 Park Avenue Fax (231) 547-4488

Charlevoix, MI 49720 [email protected]

CHEBOYGAN Donald Ramsey, DO (231) 627-560126,448 748 South Main Street

Cheboygan, MI 49721

CHIPPEWA James C. Terrian, MD (906) 635-156838,543 508 Ashmun, Suite 120 Fax (906) 635-1701

Sault Ste. Marie, MI 49783

CLARE Elmer Shurlow, DO (989) 386-965931,252 4927 East Herrick Road Fax (989) 386-7686

Clare, MI 48619

CLINTON Donald L. Porter, MD (989) 224-233864,763 901 South Oakland Street Fax (989) 224-5608

St. Johns, MI 48879

October 2005 2


CRAWFORD William H. McNamara, MD (989) 348-767114,273 1010 North Down River Road, West Fax (989) 348-8414

Grayling, MI 49738

DELTA Steven A. Dosh, MD (906) 789-442738,520 3409 Ludington, Suite 203 Fax (906) 789-4406

Escanaba, MI 49829

DICKINSON Robert Anderson, MD (906) 774-131327,472 Dickinson County Health Care System Fax (906) 776-5572

1721 South Stephenson AvenueIron Mountain, MI 49801

EATON Robert L. Leeser, MD (517) 543-0600103,655 123 Lansing Street, Suite 3 Fax (517) 543-9533

Charlotte, MI 48813

EMMETT Carl W. Hawkins, MD (906) 643-046631,437 220 Burdette St. Fax (906) 643-0464

St. Ignace, MI 49781

GENESEE Gary Johnson, MD, MPH (810) 257-3155436,141 Genesee County Health Department Fax (810) 257-3147

630 South Saginaw Street [email protected], MI 48502-1540

GLADWIN James Sullivan, DO (989) 426-452126,023 105 East Fifth Street Fax (989) 426-1475

Gladwin, MI 48624

GOGEBIC Charles N. Iknayan, MD (906) 932-620717,370 N10561 Grand View Lane (906) 932-2525

Ironwood, MI 49938 Fax (906) 932-9766

GRAND TRAVERSE Matthew A. Houghton, JR., DO (231) 334-818477,654 PO Box 116 Fax (231) 334-8185


GRATIOT Lewis Sandel, MD (989) 463-242242,285 245 East Warwick Drive Fax (989) 463-2640

Alma, MI 48801

October 2005 3


HILLSDALE Lawrence E Dasch, MD (517) 254-475446,527 8591 Blount Rd. Fax (517) 254-4842

Hillsdale, MI 49242

HOUGHTON Dong Feng Liu, MD, PhD (906) 483-142736,016 Department of Pathology Portage Hospital Fax (906)483-1433

500 Campus Dr., [email protected], MI 49930

HURON Richard Lockard, MD (989) 375-227336,079 40 North Main Street Fax (989) 375-4552

Elkton, MI 48731

INGHAM Dean Sienko, MD (517) 887-4318279,320 5303 South Cedar Street, PO Box 30161 Fax (517) 887-4310

Lansing, MI 48909 [email protected]

IONIA James D. Banner, DO (989) 584-3971 Ext. 21961,518 406 East Elm Street Fax (989) 584-2331

Carson City, MI 48811-0879

IOSCO Richard Payea, MD (989) 362-214127,339 PO Box 392 Fax (989) 362-7740

1195 Tawas Beach RoadEast Tawas, MI 48730

IRON Nasseem F. Rizkalla, MD (906) 265-900113,138 1500 West Ice Lake Road Fax (906) 265-2634

Iron River, MI 49935

ISABELLA Elmer Shurlow, DO (989) 386-965963,351 4927 East Herrick Road Fax (989) 386-7686

Clare, MI 48619

JACKSON John Maino, II, MD, FACEP (517) 788-4482158,422 1715 Lansing Avenue Suite 648 Fax (517) 768-5823

Jackson, MI 49202

KALAMAZOO Richard Tooker, MD (269) 373-5190238,603 3299 Gull Road Fax (269) 373-5191

Kalamazoo, MI 49048-1295

October 2005 4


KALKASKA Richard Hodgman, MD (231) 258-777716,571 419 South Coral Fax (231) 258-7611

Kalkaska, MI 49646

KENT Stephen Cohle, MD (616) 336-3021574,335 Office of Chief Medical Examiner Fax (616) 336-3943

700 Fuller, NEGrand Rapids, MI 49503

KEWEENAW David Gilbert, MD (906) 289-45172,301 11314 Middle Point Rd. Fax (906) 289-1040

Eagle Harbor, MI 49950

LAKE Paul Wagner, DO (231) 873-567511,333 611 East Main Street Fax (231) 873-4805

Hart, MI 49420

LAPEER Charles Franckowiak, DO (810) 667-350187,904 Lapeer County Health Department Fax (810) 667-1551

1800 Imlay City Rd.Lapeer, MI 48446

LEELANAU Matthew A. Houghton Jr., DO (231) 334-818421,119 PO Box 116 Fax (231) 334-8185


LENAWEE Patricia Lamb, MD (517) 264-476098,890 320 Springbrook Ave. Fax (517) 266-2547

Adrian, MI 49221

LIVINGSTON Joyce deJong, DO (517) 548-4170156,951 300 S. Highlander Way Fax (517) 552-2196

Howell, MI 48843

LUCE James C. Terrian, MD (906) 293-51077,024 14150 Hamilton Lake Rd. Fax (906) 293-5453

Newberry, MI 49868

MACKINAC Carl W. Hawkins, MD (906) 643-046611,943 220 Burdette St. Fax (906) 643-0464

St. Ignace, MI 49781

October 2005 5


MACOMB Daniel J. Spitz, MD (586) 469-5214788,149 Macomb County Medical Examiners Office Fax (586) 469-6636

43525 Elizabeth Rd. [email protected]. Clemens, MI 48043

MANISTEE Michael Barna, MD (231) 398-115324,527 Office of Chief Medical Examiner Fax (231) 398-1469

1465 East Parkdale AvenueManistee, MI 49660-0397

MARQUETTE Randolph Smith, MD (906) 225-305064,634 Marquette General Hospital Fax (906) 225-3849

420 West Magnetic StreetMarquette, MI 49855-0220

MASON Marc E. Keen, MD (231) 845-236228,274 Clinical Laboratory Fax (231) 845-3849

One Atkinson DriveLudington, MI 49431

MECOSTA Paul Wagner, DO (231) 873-567540,553 611 East Main Street Fax (616) 873-4805

Hart, MI 49420

MENOMINEE Paul A. Haupt, DO (906) 863-789725,326 1100 Tenth Street Fax (906) 863-5762

Menominee, MI 49858

MIDLAND J. Daniel Cline, MD (989) 631-619082,874 2706 Louanna Fax (989) 631-3499

Midland, MI 48640

MISSAUKEE Gregory P. Lambourne, MD (231) 839-728214,478 1866 South Morey Rd. Fax (231) 839-7222

Lake City, MI 49651

MONROE Carl J. Schmidt, MD (734) 240-7910145,945 2353 South Custer Rd. Pgr (800) 991-7017

Monroe, MI 48161-9769 Fax (734) 240-7816

MONTCALM James D. Banner, DO (989) 584-3971 Ext. 21961,266 406 East Elm Street Fax (989) 584-2331

Carson City, MI 48811-0879

October 2005 6


MONTMORENCY Michael McNamara, DO (989) 786-487710,315 3040 Bourn Street Fax (989) 786-2187

Lewiston, MI 49756

MUSKEGON Joyce deJong, DO (231) 724-6246170,200 209 E. Apple Ave. Fax (231) 724-6674

Muskegon, MI 49442

NEWAYGO Richard W. Peters, MD (231) 739-360147,874 Department of Pathology Fax (231) 733-6745

1500 East Sherman Blvd. [email protected], MI 49444

OAKLAND L.J. Dragovic, MD (248) 858-50971,194,156 1200 North Telegraph Road, Bldg. 28 Fax (248) 452-9173

Pontiac, MI 48341-0438

OCEANA Rudy Ochs, DO (231) 873-567526,873 611 East Main Street Fax (616) 873-4805

Hart, MI 49420

OGEMAW James Hall, MD (989) 345-138721,645 150 North Burgess Fax (989) 345-2591

West Branch, MI 48661

ONTONAGON Cary Gottlieb, MD (906) 524-33387,818 Baraga County Memorial Hospital Fax (906) 524-7147

770 North MainLanse, MI 49946

OSCEOLA Paul Wagner, DO (231) 873-567523,197 611 East Main Street Fax (616) 873-4805

Hart, MI 49420

OSCODA Wayne Wahl, MD (989) 848-22109,418 1910 East Miller Fax (989) 848-7139

PO Box 250Fairview, MI 48621

OTSEGO Michael McNamara, DO (989) 786-487723,301 3040 Bourn Street Fax (989) 786-2187

Lewiston, MI 49756

October 2005 7


OTTAWA David A. Start, MD (616) 846-8360238,314 16920 Ferris Street Fax (616) 844-1778

Grand Haven, MI 49417 [email protected]

PRESQUE ISLE Michael Fairbanks, MD (989) 734-205214,411 555 North Bradley Highway, Suite A Fax (989) 734-7390

Rogers City, MI 49779

ROSCOMMON Howard Gregg, JR., DO (231) 876-729325,469 400 Hobart (231) 876-7296

Cadillac, MI 49601 Fax (231) 876-7497

SAGINAW Kanu Virani, MD (989) 792-6052210,039 Saginaw County Medical Exam Office Fax (989) 792-6053

111 S. Michigan Avenue [email protected], MI 48602

SANILAC Dennis A. Smallwood, DO (810) 648-409844,547 Sanilac County Health Department Fax (810) 648-2646

171 North Dawson Street [email protected], MI 48471

SCHOOLCRAFT James C. Terrian, MD (906) 293-51078,903 14150 Hamilton Lake Rd Fax (906) 293-5453

Newberry, MI 49868

SHIAWASSEE Brian Hunter, MD (517) 364-256171,687 1215 E. Michigan Ave. Fax (517) 372-0581

Lansing, MI 48912

ST. CLAIR David Hislop, MD (810) 982-4111164,235 3415 28th Street Fax (810) 985-2150

Port Huron, MI 48060 [email protected]

ST. JOSEPH John Robertson, MD (269) 659-426662,422 916 Myrtle Street Fax (269) 659-6592

Strugis, MI 49091

TUSCOLA Larry Cole, DO (989) 673-811458,266 Tuscola County Health Department Fax (989) 673-7490

1309 Cleaver RoadCaro, MI 48723

October 2005 8


VAN BUREN Jason Tompkins, MD (269) 657-871976,263 205 South Kalamazoo Street Fax (269) 657-5161

Paw Paw, MI 49079

WASHTENAW Bader J. Cassin, MD (734) 477-6310322,895 Office of the Medical Examiner Fax (734) 477-6315

2215 Hogback RoadAnn Arbor, MI 48105

WAYNE Carl J. Schmidt, MD (313) 833-25042,061,162 Chief Medical Examiner Fax (313) 833-2534

1300 East WarrenDetroit, MI 48207

WEXFORD Howard Gregg, Jr., DO (231) 876-729330,484 400 Hobart Street (231) 876-7296

Cadillac, MI 49601 Fax (231) 876-7497

October 2005 9

Robert Anderson, MDDickinson County

(906) 774-1313

James D. Banner, DOIonia County

(989) 584-3971 Ext. 219

Montcalm County(989) 584-3971 Ext. 219

Michael Barna, MDManistee County(231) 398-1153

Dewey Benson, DOAntrium County(231) 377-7784

Warren E. Bontrager, MDOscoda County(989) 848-2260

Bader Cassin, MDWashtenaw County

(734) 477-6310

Cesar Casten, MDArenac County(989) 846-9533

Jeffrey P. Chapman, MDBarry County

(269) 945-3606

Robert Clark, MDBerrien County(616) 983-8313

J. Daniel Cline, MDMidland County(989) 631-6190

Stephen Cohle, MDKent County

(616) 336-3021

Larry Cole, DOTuscola County(989) 673-8114

Robert Coombs, MDAlpena County(989) 358-6824

Lawrence E Dasch, MDHillsdale County(517) 254-4754

Joyce deJong, DOAllegan County(517) 364-2561

Livingston County(517) 548-4170

Muskegon County(231) 724-6246

Steven A. Dosh, MDDelta County

(906) 789-4427

L.J. Dragovic, MDOakland County(248) 858-5097

Michael Fairbanks, MDPresque Isle County

(989) 734-2052

Charles Franckowiak, DOLapeer County(810) 667-3501

Reed K. Freidinger, MDCharlevoix County

(231) 547-4488

October 2005

CHIEF MEDICAL EXAMINERSQQuuiicckk RReeffeerreennccee LLiisstt

1

David Gilbert, MDKeweenaw County

(906) 289-4517

Cary Gottlieb, MDBaraga County(906) 524-3338

Ontonagon County(906) 524-3338

Howard Gregg, Jr., DORoscommon County

(231) 876-7293

Wexford County(231) 876-7293

James Hall, MDOgemaw County(989) 345-1387

Paul A. Haupt, DOMenominee County

(906) 863-7897

Carl W. Hawkins, MDEmmett County(906) 643-0466

Mackinac County(906) 643-0466

David Hislop, MDSt. Clair County(810) 982-4111

Jason Hodges, MDAlcona County(989) 724-6526

Richard Hodgman, MDKalkaska County(231) 258-7777

Matthew A. Houghton Jr., DOBenzie County(231) 334-8184

Grand Traverse County(231) 334-8184

Leelanau County(231) 334-8184

Brian Hunter, MDShiawassee County

(517) 364-2561

Howard F. Hurt, DOBay County

(989) 895-4009

Charles N. Iknayan, MDGogebic County(906) 932-2525

Mehmet B. Ismailogliu, MDCalhoun County(616) 969-8891

Gary K. Johnson, MD, MPHGenesee County(810) 257-3155

Marc E. Keen, MDMason County(231) 845-2362

Robert M. Knox, DO Cass County

(269) 663-8288

Patricia Lamb, MDLenawee County(517) 264-4760

Gregory P. Lambourne, MD Missaukee County

(231) 839-7282

October 2005 2

Robert L. Leeser, MDEaton County

(517) 543-0600

Dong Feng Liu, MD, PhDHoughton County(906) 483-1427

Richard Lockard, MD Huron County (989) 375-2273

John C. Maino, II, MD, FACEPJackson County(517) 788-4482

Michael McNamara, DOMontmorency County

(989) 786-4877

Otsego County(989) 786-4877

William H. McNamara, MDCrawford County(989) 348-7671

Troy Davis, DOBranch County(517) 639-3223

Rudy Ochs, DOOceana County(231) 873-5675

Christine Kruefer, MDAlger County

(906) 387-4220

Donald Ramsey, DOCheboygan County

(231) 627-5601

Richard Payea, MDIosco County

(989) 362-2141

Richard W. Peters, MDNewago County(231) 739-3601

Donald L. Porter, MDClinton County(989) 224-2338

Nasseem F. Rizkalla, MDIron County

(906) 265-9001

John Robertson, MDSt. Joseph County

(269) 651-4373

Lewis Sandel, MDGratiot County(989) 463-2422

Elmer Shurlow, DOClare County

(989) 386-9659

Isabella County(989) 386-9659

Dean Sienko, MDIngham County(517) 887-4318

Dennis A. Smallwood, DOSanilac County(810) 648-4098

Randolph Smith, MDMarquette County

(906) 225-3050

Daniel J. Spitz, MDMacomb County(586) 469-5214

October 2005 3

Carl J. Schmidt, MDMonroe County(734) 240-7910

Wayne County(313) 833-2504

David A. Start, MDOttawa County(616) 846-8360

James Sullivan, DOGladwin County(989) 426-4521

James C. Terrian, MDChippewa County(906) 635-1568

Luce County(906) 293-5107

Schoolcraft County(906) 293-5107

Richard Tooker, MDKalamazoo County

(269) 373-5190

Jason Tompkins, MDVan Buren County

(269) 657-8719

Kanu Virani, MDSaginaw County(989) 792-6052

Paul Wagner, DOLake County

(231) 873-5675

Mecosta County(231) 873-5675

Osceola County(231) 873-5675

October 2005 4

Robert L. Anderson, MDDickinson County Health Care System1721 S. Stephenson AvenueIron Mountain, MI 49801(906) 776-5580

Susan AtwoodSpectrum Health – Downtown Campus1840 Wealthy Street SEGrand Rapids, MI 49506(616) [email protected]

James D. Banner, DO406 East Elm StreetCarson City, MI 48811-0879(989) 584-3131

Joan M. BatesMusculoskeletal Transplant Foundation2203 Platt Rd.Ann Arbor, MI 48104(800) [email protected]

Bruce Beckman323 S. Fair St.Otsego, MI 49078(269) 694-4627

William A. Belding, MD W5460 Pine Dr.Norway, MI 49870(906) 563-7076

Dewey Benson, DOPO Box 1043Bellaire, MI 49615

Gary M. Berman, DDS9840 Haggerty RoadBelleville, MI 48111(734) [email protected]

Robert S. BladekOttawa County Medical Examiners Office602 MichiganHolland, MI [email protected]

Jerome Bond, MD1500 E Sherman Blvd.Muskegon, MI 49441(231) 739-3662

Kam Bradman2201 Boston Blvd.Lansing, MI 48910(517) 228-9533

Wayne Brigman3299 Gull Rd.Kalamazoo, MI 49048(269) 373-5190

John R. Bruni, MD551 First CourtNiles, MI 49120(269) 683-3056

Russell L. Bush, MD720 Fourth StreetLapeer, MI 48446-1447(810) [email protected]

Elaine Butts100 McMoran Blvd.Port Huron, MI 48060(810) 984-9710

Bader J. Cassin, MDPO Box 15249Detroit, MI 48215(313) [email protected]

October 2005

MAME MEMBERSHIP

1

Isabelle Chapello, DO10643 Valleywood Dr.Luna Pier, MI 48157(734) 848-5565

Jason Chatman700 Fuller Ave. NEGrand Rapids, MI 49503(616) 336-3021

Stephen D. Cohle, MDSpectrum Health – East Campus1840 Wealthy Street SEGrand Rapids, MI 49506(616) [email protected]

John Connolly7258 Kettle Lake SEAlto, MI 49302(616) 774-7774

Roberty Coombs, DO1063 US23 NorthAlpena, MI 49707(989) [email protected]

N. Joe Danna100 McMorran Blvd.Port Huron, MI 48060

Troy Davis, DO413 N. Chicago St.Litchfield, MI 49252(517) 542-3217

Paul R. Davison1840 Wealthy, SEGrand Rapids, MI 49506

Joyce DeJong, DO1215 E. Michigan Ave.Lansing, MI [email protected]

Mark Deming1301 Catherine Rd.Ann Arbor, MI 48109-0602(517) 423-4432

Robert Demski43 Christy Rd.Battle Creek, MI 49015(269) 965-2728

Mike DermyerLake County BuildingMedical Examiners OfficeBaldwin, MI 49304

Joe Doan1512 Clinton StreetAlconac, MI 48001(810) 794-9772

Steven A. Dosh, MD3409 Ludington Suite 203Escanaba, MI 49829(906) [email protected]

Ljubisa Dragovic, MD44 Beverly Rd.Grosse Pointe Farms, MI 48236(248) 858-4046

Ronald Dunfield1697 Lansing Ave.Jackson, MI 49201

Charles Franckowiak, DO1800 Imalay City RoadLapeer, MI 48446(810) [email protected]

Reed K. Freidinger, MD14730 Park AvenueCharlevoix, MI 49720(231) [email protected]

October 2005 2

Diana French2215 Hogback Rd.Ann Arbor, MI 48105

Timothy Freye PA-C4166 Jensen RoadFruitport, MI 49415

David Gilbert, MD11314 Middle Point Rd.Eagle Harbor, MI(906) [email protected]

Jill Glair1440 Munith Rd.Jackson, MI 49201(517) [email protected]

Ruth Grant1215 E. Michigan Ave.Lansing, MI 48912(517) 483-2562

Howard W. Gregg Jr., DO101 Birchwood LaneCadillac, MI 49601(231) 876-7293

K.P. Gunaga, PhDSt. Lawrence Hospital/Toxicology1210 West Saginaw StreetLansing, MI 48915

James R. Hall, MD150 North Burgess StreetWest Branch, MI 48861(989) 345-1387

Paul A. Haupt, DO1100 Tenth StreetMenominee, MI 49858(906) 863-7897

Carl W. Hawkins, MD220 Burdette St.St. Ignace, MI [email protected](906) 643-0466

Laurie HiltsLake County BuildingMedical Examiner’s OfficeBaldwin, MI 49304

David M.C. Hislop, MD5030 Lakeshore Rd.Alconac, MI 48001(810) [email protected]

Gary Holowitz1111 DelawareMarysville, MI 48043

Brian Hunter, MD1215 E. Michigan Ave.Sparrow Forensic ServicesLansing, MI 48909(517) 364-2452

Charles N. Iknayan, MDE6385 Gheller DriveBessemer, MI 49911(906) [email protected]

Janie JerniganP.O. Box 255St. Helen, MI [email protected](231) 876-7293

Marc E. Keen, MDMemorial Medical Center of West MichiganOne Atkinson DriveLudington, MI 49431(231) 845-2362

October 2005 3

Matthew Kempf7230 Holton Duck Lake Rd.Holton, MI 49425

Scott Krebill4900 Rogers Rd.Parma, MI 49269

George Krymowski, MD741 Lakewood LaneMarquette, MI 49855(906) [email protected]

Richard Lockard, MD6 N Main StreetElkton, MI 48731(989) 375-2273

Jean Lockard, RN40 N Main StreetElkton, MI 48731

John C. Maino, II, MD1715 Lansing Ave. Suite 648Jackson, MI 49203-2135(517) [email protected]

Michael Markey, MD1215 E. Michigan Ave.Lansing, MI 48909(517) 364-2549

Steve Miller1697 Lansing Ave.Jackson, MI 49203-2135(517) 788-4482

Peter Noble4095 Jeanola Dr. NWGrand Rapids, MI 49544

Ruben Ortiz-Reyes, MD1200 N. Telegraph Rd.Pontiac, MI 48341(248) 858-5097

Bernardino B. Pacris, MD1200 North Telegraph RoadPontiac, MI 48341(248) 858-5097

Mary M. Palmateer3415 28th StreetPort Huron, MI 48060(586) [email protected]

Waldemar A. Palutke, MD9425 Whispering Sands DriveWest Olive, MI 49460(810) 858-5097

Richard PerrinLake County BuildingMedical Examiners OfficeBaldwin, MI 49304

Richard W. Peters, MD1500 E. Sherman Blvd.Muskegon, MI 49444(231) 739-3601

Timothy RakerMarysville Police Department1111 DelewareMarysville, MI 48040

Daniel G. Remick, MDM2210 Medical Science I, Box 06021301 Catherine RoadAnn Arbor, MI 48109-0602(734) [email protected]

Richard Rich, RN3226 Nazareth Rd.Kalamazoo, MI 49048(269) 345-6658

Rob Schultz301 W. UptonRead City, MI 49677

October 2005 4

Peter K. Shireman, MD500 East Sherman BoulevardPO Box 358Muskegon, MI 49443-0358(231) [email protected]

Elmer Shurlow, DO4927 E. Herrick Rd.Clare, MI 48617(989) [email protected]

Dean G. Sienko, MD5303 South Cedar StreetLansing, MI 48911-3800(517) [email protected]

Lawrence R. Simson Jr., MDP.O. Box 490Haslett, MI 48840(517) [email protected]

Roger Simpson2215 Hogback Rd.Ann Arbor, MI 48105(734) 477-6363

Dennis A. Smallwood, DOSanilac County Health Department171 North Dawson StreetSandusky, MI 48471(810) [email protected]

Randolph E. Smith, MD420 West Magnetic StreetMarquette, MI 49855-0220(906) 225-3050

Ashod Sonnad, MD1380 E. Main St.PO Box 619Edmore, MI 48829-0619(989) 427-3511

Ellen Spaulding4914 ChurchillLeslie, MI 49251(517) 589-8388

Daniel Spitz, MD34051 Gratiot Ave.Suite 202Clinton Township, MI 48035(586) 791-6700

Werner U. Spitz, MD23001 Greater Mack AvenueSt. Clair Shores, MI 48080(810) [email protected]

David A. Start, MD1840 Wealthly SEGrand Rapids, MI 49506(616) 774-7499

Robert G. StudabakerConstantine Police Department115 White Pigeon StreetConstantine, MI 49042

James Sullivan, DO105 East Fifth StreetPO Box 427Gladwin, MI 48624(989) 426-4521

Patricia Tackitt1300 E. Warren Ave.Detroit, MI 48207(517) 324-7330

Paul K. Tam, MDDepartment of Pathology1234 Napier Ave.St. Joseph, MI 49085-2428(616) 982-4853

Bradley Tennant1000 Wall StreetAnn Arbor, MI 48105

October 2005 5

Richard Tooker, MD3299 Gull RoadKalamazoo, MI 49001-1295(269) 383-8818

William L. TroutMarysville Police Department1111 DelawareMarysville, MI 48040

Deborah M. TubbSaginaw County Governmental Center111 S. Michigan Ave.Saginaw, MI 48602(989) [email protected]

Scott VanSickle100 McMorranPort Huron, MI 48060(810) 984-9711

Allan Warnick, DDS31632 Schoolcraft RoadLivonia, MI 48150(313) 425-6920

Kanubhai Virani, MD6189 Beachwood CourtWest Bloomfield, MI 48324(989) 758-3819

Barry C. Weeks1115 ResortPleasant Lake, MI 49572

Mark Wilk121 S. Second St.St Ignace, MI 49781(906) 643-6516

Stephen Zonts1112 Backus St.Jackson, MI 49202

October 2005 6

October 2005

According to the “Michigan Required Request Law” the next of kin must be given the option of organand tissue donation if the descendent is medically suitable.

ORGAN DONORS 1. Present or pending declaration of deathAge: No Limit 2. Mechanical ventilation and intact cardiovascular system for heart

beating organ donors3. Non-heart beating organ donors require ME release prior to death4. No absolute age or medical rule outs

TISSUE DONORS AGE TIME LIMITS

EYES 5 to 75 years 12 hoursBONE 12 years / no upper age limit 24 hours if cooledHEART VALVES Full Term and 7lbs to 55 years 24 hours if cooledVEINS 15 to 55 years 12 hoursSKIN 15 to 75 years 24 hours if cooled

LEGAL CONSENT

Consent for organ and tissue donation will be obtained by Gift of Life Michigan from the legal next ofkin on all cases.

MEDICAL EXAMINER

A Medical Examiner’s case DOES NOT preclude donation. Post autopsy cases DO NOT preclude dona-tion. The transplant agency or hospital designee will obtain clearance from the County Medical Examinerprior to any surgical recovery of organ or tissue. When the Medical Examiner’s duties require an autopsyprior to tissue recovery special arrangements will be discussed with the Medical Examiner.

MEDICATIONS

One or more of the following medications may be used during the donation process and detected bypathological examination:

A broad spectrum of Antibiotics Dopamine NiprideAqueous Pitressin Heparin RegitineDecadron Insulin ThyroxinDesmopressin Lasix Papavarin in vein recoveryDexamethasone Levophed EpinephrineDobutamine Mannitol A wide range of cardiac medications

CRITERIA FOR ORGAN AND TISSUE DONATION

October 2005

Dear Medical Examiner:

Thank you for allowing the Gift of Life to recover anatomical gifts from the body of ______________________________ . Care has been taken to complete the donation withaccepted medical standards. As indicated below, we have provided fluid specimens andpertinent documentation associated with the decedent. If any questions or commentsshould arise from this donation, please call 1-800-482-4881 24 hours a day.

Thank you,

Gift of Life Michigan

Eyes/Corneas ______ Femur ______ Fascia Lata ______

Heart ______ Fibula ______ Saphenous Vein ______

Kidneys ______ Humerus ______ Skin ______

Liver ______ Pelvis ______ Radius ______

Lungs ______ Ribs ______ Ulna ______

Pancreas ______ Tibia ______ ____________ ______

Intestines ______ Achilles Tendon ______

The following specimens and documentation were collected by:

Name: Initials:

Signature: Date/Time:

______________ Consent Form ______________ Chart Copy

______________ Clotted Blood ______________ Bile Specimen

______________ Urine Specimen ______________ Other: _______

______________ Vitreous Specimen ______________ Other: _______

* * * * * *This form will be completed by the Gift of Life recovery team

and will be attached to the body after donation.* * * * * *

LIFE PROGRAM

The LIFE Program has been designed for Medical Examiners andMedical Examiner Investigators involved in death investigation when the decedent may be a candidate for donation. This innovativeprogram provides families the opportunity to consider eye and tissuedonation when death occurs outside a health-care facility. Families areable to make an informed decision regarding donation under the guid-ance of a trained donation coordinator.

For further information and assistance in implementing this program in your office, please contact the Gift of Life Michigan at 1-800-482-4881.

GIFT OF LIFEAND

GIFT OF SIGHT

October 2005

Tissue / Eye Donor Worksheet

1. County: _________________________ Case Number: ____________________________________

2. Name of Decedent: ________________________________________________________________

3. Sex: _______________ 4. Race: __________________ 5.DOB: __________________________

6. DOD:________________________________ 7. TOD:____________________________________

8. Refrigeration Time: ______________ 9. Funeral Home: __________________________________

10. Circumstances of death/history include location, time of accident/incident, as well as,

sustained injuries.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

11. Probable Cause of Death: __________________________________________________________

____________________________________________________________________________________

12. Decedent’s approximate Height: ________________ 13. Weight: __________________________

14. Next of kin: Name:________________________________________________________________

Phone:________________________________________________________________

15. Has Condolence Card been given to family? YES NO

16. Autopsy? YES NO

17. Any restrictions? __________________________________________________________________

18. First Responder Contact Info (EMS, paramedics, police, etc): ______________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

*Exclusions defined on reverse side of form

Please phone or fax information to Gift of LifePhone: 1-800-482-4881 Fax: 734-973-0124

October 2005

The Gift of Life * Gift of Sight

Rule Out Criteria

Age:

• Females – acceptable up to & including 75

Males – No Age Limit

CDC High Risk Behaviors:

• Knowledge or evidence of (circle all that apply):

• Known IV Drug Users

• Hepatitis

• HIV/AIDS

• Sex In Exchange for Money or Drugs

• Inmate of Correctional System if Greater than 72 hrs in Last 12 Months

• Non Therapeutic Needle Marks

• Males that have had sexual relations with other males within last 5 years

Medical Conditions:

• If unknown Time of Death, Last Seen Alive Time (no greater than 15 hours)

• Rabies

• Creutzfeldt-Jakob Disease (Bovine Spongiform Encephalopathy)

• Hemophilia

• Active Tuberculosis or Malaria

• Leukemia or Lymphoma

• Active Cancer (except for eye alone donors)

• Multiple Open Fractures

October 2005

LIFE PROGRAM

MEDICAL EXAMINER / INVESTIGATOR REFERRAL PROCESS

Step 1: Offer the CONDOLENCE CARD which suggests the option of tissueand eye donation.

Step 2: Request the family’s permission to be contacted by a Gift of Life orGift of Sight representative.

Step 3: Call the Gift of Life Michigan at 1-800-482-4881, 24 hours a day, andask to speak with a screening coordinator. In situations when offering

the Condolence Card is not feasible, a Gift of Life and Gift of Sightrepresentative can directly contact the family to offer the option of donation.

Step 4: Provide the information on the MEDICAL EXAMINER / INVESTIGATOR REFERRAL WORKSHEET along with any additional information that will assist our agencies in their efforts to determine donor suitability, as well as, offering the option of donation to the family.

October 2005

MEDICAL EXAMINERQUALITY IMPROVEMENT FORM

Dear _______________ Medical Examiner/Investigator:

Gift of Life Michigan had an organ/tissue/eye donation that also involved a medicalinvestigation by your office. Please assist us by checking off the most appropriateresponses below to let Gift of Life know your evaluation of our service to your office:

Decedent’s Name: ____________________ Date of Donation: ____________________________

PROCESS ELEMENT YES NO N/A COMMENTDid your office receive timelytelephone communication from Giftof Life regarding the release oforgans/tissue/eyes?

Were blood tubes and otherspecimens labeled and deliveredproperly to your office?

Were copies or original documentsprovided by Gift of Life as requestedby your office?

Did your office receive timelytelephone communication from Giftof Life regarding the availability ofthe body following organ/tissue/eyerecovery?

Are there any other proceduralmatters that Gift of Life needs toaddress with your office?

Please fax return this document to Gift of Life at 734-973-3133. If further discussionregarding this case is required, please call 1-800-482-4881, 24-hours a day.

Thank you,

Gift of Life MichiganManagement and Staff Gift of Life # ____________________

Revised: 9/9/04Reviewed: 10/05

Gift of Life Michigan2203 Platt Road • Ann Arbor, MI 48104 • (734)973-1577 • (800)482-4881 • Fax: (734)973-3133

michigan association of medical examiners … · michigan association of medical examiners 2005...

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