If someone you love died in a hospital and you believe something went wrong, you have the right to investigate. The process involves securing medical records, understanding what the hospital is doing internally, and deciding whether to pursue outside review through regulators, independent experts, or legal channels. Time matters at every step, so it helps to know exactly what to do and in what order.
Get the Full Medical Records First
The single most important step is obtaining a complete copy of the patient’s medical records. This means everything: physician notes, nursing flowsheets, medication administration records, lab results, imaging reports, operative notes, and any code or rapid response documentation. These records are the foundation for every other step in an investigation, whether you hire an attorney, request an independent review, or file a regulatory complaint.
Under federal privacy law, the personal representative of a deceased person can access their health information for 50 years after death. A personal representative is typically the executor of the estate, an administrator, or whoever has legal authority under your state’s law to act on behalf of the deceased. If you’re the executor named in a will or have been appointed by a probate court, you qualify. You’ll need to provide the hospital with proof of your authority, usually a copy of the death certificate and letters testamentary or letters of administration.
Submit your records request in writing to the hospital’s health information or medical records department. Be explicit that you want the entire chart, not a summary. Hospitals are required to provide access, though they can charge reasonable copying fees. If a hospital delays or refuses, you can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights, which enforces patient privacy and access rights.
Understand the Hospital’s Internal Review
When an unexpected death occurs, hospitals typically conduct an internal investigation called a root cause analysis. This is a structured, step-by-step review where an interprofessional team reconstructs the sequence of events, identifies what went wrong, and proposes changes to prevent it from happening again. The team collects facts, maps the timeline, analyzes contributing factors, and produces a final report with recommended actions.
Here’s the frustrating part: in most U.S. states, the root cause analysis report is protected from legal discovery. Hospitals classify these reviews as peer review or quality improvement activities, which state laws typically shield from disclosure. That means you generally cannot obtain a copy of the report, even through a lawsuit. The protection exists to encourage hospitals to investigate candidly without fear of litigation, but it can feel like a wall of silence to grieving families.
What you can do is ask. Contact the hospital’s patient advocate or ombudsman (sometimes called a patient experience officer or patient representative). This person serves as a neutral intermediary who can listen to your concerns, investigate by contacting staff and reviewing records, and explain what the hospital found. They can also share whether the hospital identified areas for improvement. An ombudsman won’t hand you the root cause analysis, but they can communicate its general findings and what corrective steps the hospital is taking. They also document your concerns formally, which creates a record that reaches hospital leadership.
Determine Whether the Death Required a Coroner Review
Not every hospital death is investigated by the county coroner or medical examiner, but certain circumstances legally require it. While the exact criteria vary by state, the categories are broadly similar. Deaths that must be reported typically include those resulting from violence, suicide, or accident; deaths that occur suddenly in someone who appeared healthy; deaths where the person was not under a physician’s care; deaths in suspicious or unusual circumstances; and deaths where the patient was admitted unconscious and never regained consciousness within 24 hours.
If the death fits any of these categories and no coroner investigation took place, you can contact your county coroner or medical examiner’s office directly and ask why. You can also request that they review the case. If they decline jurisdiction, that decision itself becomes useful information, as it means the office determined the death fell outside the criteria for further investigation.
Consider an Independent Autopsy
If no autopsy was performed, or if you question the findings of one that was, you have the right to hire an independent pathologist. A private autopsy typically costs between $3,000 and $5,000, with possible additional charges for transporting the body to and from the facility. This is an out-of-pocket expense, though an attorney may later recover it as part of a legal claim.
To find a qualified pathologist, the National Association of Medical Examiners and the College of American Pathologists both maintain directories. You can also get referrals from local medical examiner offices, medical schools, funeral homes, or attorneys who handle medical malpractice cases. The key is hiring someone with no connection to the hospital in question. An independent pathologist can identify causes of death that may have been overlooked, document surgical errors, or detect medication-related problems that wouldn’t be visible without a tissue examination.
Time is critical here. Embalming and especially cremation can destroy evidence. If you have any suspicion that the death warrants investigation, make this decision before the body is released to a funeral home for final disposition.
File Complaints With Regulators
Two outside bodies can investigate a hospital based on your complaint: your state health department and The Joint Commission, which accredits most U.S. hospitals.
Every state has a department of health (or equivalent agency) that licenses and regulates hospitals. You can file a complaint alleging violations of care standards, and the agency will review it for possible investigation. Most states require complaints to be submitted in writing and signed. Include copies of medical records, any correspondence with the hospital, and a clear description of what you believe went wrong. If the agency finds a potential violation, it can investigate, conduct unannounced inspections, and take enforcement action against the facility.
The Joint Commission accepts patient safety complaints about hospitals it accredits. You can submit a report through their online form, by mail to their Office of Quality and Patient Safety in Oakbrook Terrace, Illinois, or by phone at 1-800-994-6610. They do not accept copies of medical records or personal documents (these will be shredded if sent), so your report should describe the events and your concerns in your own words. The Joint Commission uses complaints to inform its accreditation review process, which can lead to required corrective actions.
Filing with both is not redundant. The state health department has regulatory enforcement power, while The Joint Commission can affect the hospital’s accreditation status. These are separate forms of accountability.
Consult a Medical Malpractice Attorney
If you believe negligence contributed to the death, a consultation with a medical malpractice attorney is a practical next step. Most work on contingency, meaning you pay nothing upfront and they take a percentage only if you recover compensation. The attorney will typically have the medical records reviewed by an independent physician to determine whether the standard of care was breached.
Every state sets a statute of limitations for malpractice claims, often two to three years, but the timeline can be complicated by the discovery rule. This legal doctrine recognizes that the cause of a hospital death isn’t always obvious right away. The statute of limitations may not begin running until the date you knew, or reasonably should have known, that the death was potentially caused by negligence. For example, if an independent autopsy performed six months later reveals a missed diagnosis or surgical error, the clock may start from that discovery rather than the date of death.
The “reasonably should have known” standard does impose a responsibility to investigate when circumstances seem suspicious. If a reasonable person in your position would have looked into the death sooner, a court may treat that earlier point as the start of the limitations period. This is another reason not to delay: the sooner you begin gathering records and seeking expert opinions, the stronger your legal position.
A Practical Timeline
In the first few days, make the decision about autopsy before the body is released for cremation or burial. Request the complete medical records in writing. Contact the hospital ombudsman to formally register your concerns and ask about the hospital’s internal review process.
Within the first few weeks, follow up on your records request if the hospital hasn’t responded. File complaints with your state health department and The Joint Commission if you believe a safety violation occurred. Contact your county coroner or medical examiner if you think the death met criteria for their review but wasn’t reported.
Within the first few months, consult with a medical malpractice attorney. Have the records independently reviewed by a physician. If a private autopsy was performed, obtain the final report and share it with your attorney. Keep a written log of every conversation, request, and response throughout the process, including names, dates, and what was said. This documentation can be invaluable if the case moves forward legally or through regulatory channels.