The study found that over this period, 1 percent of the DCs signed by OMI forensic pathologists were amended as to cause and/or manner of death; external examinations were amended slightly more often than autopsies. Arteriosclerotic cardiovascular disease and intoxicants were the most commonly amended and resulting causes of death, respectively. There was a significant link between manner of death and number of DCs amended. By percentage, DCs that attributed death to natural causes and suicide were the most frequently amended. Initial DCs that determined homicide to be the manner of death were the least likely to be amended, followed by DCs that indicated the manner of death as "undetermined." The way in which manner of death changed on the DC was significantly associated with an increasing length of time between the production of the original and the amended DCs. Most of the cases that were changed to "suicide" or "accidents" were done after toxicology was completed, a process that can take weeks or months. Changing a manner of death to "undetermined" takes more time, largely because of the nature of these cases and the impetus for change. Reluctance to change a manner of death to "undetermined" may also contribute to the longer time taken for such an amendment. 4 tables, 5 figures, and 18 references