Who determines the cause of death if it occurs from natural causes more than 36 hours after treatment?

The determination of the cause of death in cases where it occurs from natural causes more than 36 hours after treatment falls under the responsibility of the last physician in attendance. This is based on the understanding that the last physician involved with the patient has the best access to the medical history and the circumstances surrounding the treatment which may provide insights necessary for a thorough assessment of the cause of death.

In these situations, the attending physician can evaluate the patient's medical records, treatment received, and any symptoms present at the time of death. This enables them to render a professional opinion on the cause of death, which is essential for means such as death certificates, insurance claims, and potential legal investigations.

To clarify why the other options are less appropriate: the county medical examiner typically deals with cases that may require forensic investigation, particularly in unnatural deaths or where foul play is suspected. The family of the deceased, while emotionally and personally involved, does not possess the medical expertise or access to the patient's medical records needed to competently determine cause of death. Finally, local health departments may be involved in public health aspects but do not possess the direct knowledge of individual medical cases necessary to ascertain a cause of death in this context.