A University Place woman died at home. Why did a signed death certificate take so long?

A dead bird lying in Sue Olinger’s University Place yard for “quite some time” had concerned a neighbor.

Olinger, an avid gardener occupied with keeping her yard in immaculate condition, would surely already have disposed of the animal. The neighbor also found it strange, they told police, that the 77-year-old woman’s street-side trash cans hadn’t been put away.

Olinger, who lived alone, was discovered deceased inside her home on July 2 by three officers called to conduct a welfare check — the details of which were documented in a police report obtained by The News Tribune. She died of natural causes.

Her death was difficult enough for her family, including three siblings based in Washington and a daughter and son-in-law in Georgia. A prolonged struggle that followed made things worse.

In a state where death certificates are required by law to be filed within five calendar days after a death or from when a body is found, Olinger’s certificate wasn’t signed for nearly a month, according to her son-in-law, Mark Mulvaney.

For 27 days, the family was stuck. Basic necessities that follow a loved one’s passing were at a standstill without the signed document. No cremation. No estate account to manage her finances. No closing accounts she had opened. All the while, Olinger’s body remained inside a funeral home while the essential paperwork sat unresolved.

“There is a glitch in the process that you’re putting families, that are already distraught, through so much more stress,” Mulvaney said.

The family’s experience was highly unusual. Over the past four years in Washington, the average time between a death and certification has been four days, according to the state Department of Health. That timeline only reached 28 days or longer in roughly 1% of deaths since 2020.

“(W)e recognize that registration delays happen for a variety of reasons,” DOH spokesperson Mark Johnson said in a statement.

In Olinger’s case, her endocrinologist accepted responsibility for the delay, attributing it to a technological oversight. But an interview with Mulvaney also revealed a family’s confusion over a fundamental question: Who was supposed to sign the death certificate?

Declining jurisdiction

In Washington, a death certificate must be signed by a medical certifier, which includes coroners, medical examiners, physicians and other medical occupations, according to the Department of Health. By law, certifiers have two calendar days to sign the certificate or, in terms that reflect the current use of an electronic system, to certify the report of death. Who exactly the certifier should be can vary based on the circumstances surrounding the death.

Mulvaney, 53, who first spoke with The News Tribune on Aug. 9, said the family’s exasperated efforts to get the document signed were hampered by a debate over who was going to do it.

He said the medical examiner’s office told him it wouldn’t sign because it never took possession of Olinger’s body. Dr. Ronald Graf, an endocrinologist, was one of two specialty doctors — including a dermatologist — who had been treating Olinger. It was Mulvaney’s understanding that Graf never signed death certificates and also wouldn’t sign hers.

When contacted by the medical examiner’s office to sign the document, however, Graf had “happily agreed to do so,” according to Scott Thompson, a spokesperson for Graf’s employer, Tacoma-based MultiCare. But as an endocrinologist, it wasn’t something that Graf had regularly done and he hadn’t done it in many years, Thompson said in a statement.

“Unfamiliar with a new online system utilized by the medical examiner’s office, a step was missed resulting in a delay,” Thompson said. “Our condolences go out to the family, and we apologize for the delay.”

The missed step went unnoticed for some time, according to Thompson, who summarized the delay as a result of “a series of unfortunate events.” Luke Vogelsberg, the medical examiner office’s director of operations, said the system in question was instituted more than six months ago by the state Department of Health and noted that it was not a medical examiner system.

The medical examiner’s office, and not Graf, ultimately signed the document after weeks had passed. Mulvaney expressed frustration toward the medical examiner for not resolving the matter sooner and claimed that office staff had been generally unhelpful throughout the ordeal.

“It’s appalling that (they) would put a family through that,” he said.

The medical examiner’s office, in response, explained why it hadn’t acted earlier: The office had declined jurisdiction over Olinger’s case and it therefore had been Graf’s responsibility to sign the document, according to Vogelsberg.

“It wasn’t like we were, in a sense, refusing to sign,” Vogelsberg said, adding that the office eventually signed to “end the hardship” that the family had been going through.

The medical examiner focuses on investigating unnatural deaths. Normally when someone is found deceased outside of a medical setting, the office is informed by emergency responders called to the scene. The office is often able to obtain enough information about a decedent, such as medical history, to feel comfortable that a person died from natural causes without needing to bring the body in for further examination, Vogelsberg said.

With the death determined to be natural, in conjunction with a decedent having a doctor who had been regularly treating them, the office will decline to take on a case. When that happens, the individual’s doctor is supposed to sign the death certificate and funeral homes facilitate that process, according to Vogelsberg.

It’s not unusual for the office to release a body from the scene to a funeral home and relinquish any further involvement. The office had declined jurisdiction in more than 700 cases this year as of mid-August that were similar to Olinger’s in that they were natural deaths that occurred outside of a hospital, Vogelsberg said.

“The vast majority of deaths in Pierce County are from entirely natural causes,” reads the office’s general guidelines for death investigation. “For most deaths occurring in Pierce County, a physician who has medically attended the patient, should, and usually will certify the cause of death.”

Vogelsberg said that it’s the doctor’s responsibility even if they aren’t a traditional primary care provider but did, by definition, primarily treat the decedent. He said he wasn’t aware why Graf hadn’t signed the document and noted that, while not necessarily rare, it wasn’t often that the medical examiner’s office had to intervene in cases it didn’t oversee.

He said the medical examiner’s office had gone above and beyond in this case despite terminating its jurisdiction and having no authority to enforce any laws or rules. Multiple staff tried to contact the doctor’s office to resolve the issue. Vogelsberg said he even had multiple conversations with the doctor’s office, although he’s typically not involved in a specific case. At one point, it seemed imminent that Graf would sign but the delay continued to drag on, he said.

He also said that the medical examiner’s office, which had been in contact with the family numerous times, had explained that they were working to end the lengthy holdup. He apologized if that communication had been unclear. For Mulvaney, it was.

‘It was horrible’

After his mother-in-law’s death, Mulvaney traveled to Washington with his wife but was forced to return to his job as a security supervisor in a Georgia hospital while his wife stayed behind, trying to sort everything out.

“My wife is stuck in Washington, by the way, staying in the house my mother-in-law passed away in,” he said.

Mulvaney said that Olinger, who was cremated just last week, had been deceased for a week or so before she was discovered. The police report showed that two dogs were found in her home and a third dog had died. As the family made arrangements, the funeral home had recommended they not view Olinger’s body, he said.

Mulvaney said the situation had been worsened by unpleasant interactions that he described having with the medical examiner office’s staff. He claimed that staff members were rude, lacked empathy and offered conflicting or insufficient information.

“It was horrible,” he said in a follow-up interview later this month. “When somebody from the medical examiner’s office tells you that they absolutely will not sign the death certificate, that’s not explaining anything, that’s a refusal.”

Before there had been a resolution, the office had suggested the funeral home file a complaint against Graf for not signing the certificate, according to Mulvaney, who said he ultimately filed two complaints. Both were against the medical examiner, however. One was filed with the state Attorney General’s Office and the other with a state ethics board, he said.

Soon after those complaints were filed, Mulvaney said his wife received a call informing her that the medical examiner’s office had signed the death certificate.

“I don’t believe in coincidence,” he said. “So the timeline to me is not coincidental at all.”

But Vogelsberg said he wasn’t aware of those complaints and insisted they had nothing to do with the office’s decision to sign. He encouraged Mulvaney and other family members to contact him with their concerns about staff attitudes so he could follow up accordingly.

The vast majority of cases progress without significant issues or delay in getting death certificates signed, according to Vogelsberg. Issues that do arise aren’t unique to the county or even the state, he said, adding that medical examiners and coroners across the country have regular conversations with physicians, families and funeral homes on the subject.

“I really regret how this all went down for the family,” he said, “because basically they’re the only ones really feeling the impact of this, and it’s unfortunate that this happens.”

For Mulvaney, the experience taught him a tough lesson that he offered to share with anyone who might encounter a similar problem. He suggested that families attempt to obtain the best information they can from the medical examiner’s office. He also said he has recently learned that it was helpful to plan ahead in the event of one’s own death in order to make things as easy as possible for survivors.

“My whole goal here is, no other family should have to go through this,” he said.

Anyone who has a complaint that a death certificate is taking too long to be signed can contact the state Department of Health. A spokesman said the public should utilize a feedback form at doh.wa.gov/form/feedback-form.