It may be different in Tennessee, but how would they know the person had a malady unless they had seen a doctor within a certain amount of time?
"Generally in the U.S. autopsies are performed when there is suspicion of foul play, when there is some public health concern, like a mysterious disease, if someone dies unattended by a physician, or if the attending physician is uncomfortable signing the death certificate."
"Even if none of these conditions apply, the next-of-kin can request an autopsy. If an experimental treatment was being used, if a patient dies unexpectedly during a procedure that is rarely life-threatening, or if there are concerns about genetic implications, the state or the next-of-kin may decide to request this. An autopsy may also be performed when there are implications affecting insurance payouts." "Individual jurisdictions may have additional circumstances in which an autopsy is required. Some religious groups are opposed to autopsies and some require that a person in authority from that religion is present during the proceedings to ensure that their religious tenets are not compromised."
The above was taken from here: Under what circumstances is an autopsy carried out?
From Hawaii coroner codes see below. Okay, so in Hawaii it depends on the coroner as to whether they need a autopsy. The coroner made the determination within two hours? So we should be able to get the death certificate with coroners determination of death. Only if they had some power in Hawaii would this have happened this quickly. That power was obama’s visit a few days previous or Madelyn had some power herself.
§841-14 Autopsies and further investigations. If, in the opinion of the coroner, or of the coroner’s physician, or of the prosecuting attorney, or of the chief of police (in the city and county of Honolulu), an autopsy of the remains of any human body appearing to have come to death under any of the circumstances set forth in section 841-3 is necessary in the interest of the public safety or welfare, that person shall cause to have performed, such an autopsy. If, in the opinion of the coroner’s physician, a further or additional investigation as to the cause of death is necessary, the coroner’s physician may conduct the same or have the same made, and the expenses thereof shall be paid by the county concerned, and for this purpose, the coroner’s physician shall have the duties and powers conferred upon the coroner or deputy coroner by sections 841-4 to 841-8.
Any law to the contrary notwithstanding, the coroner’s physician or medical examiner of any county (including the city and county of Honolulu) may cause to have performed an autopsy to determine cause of death upon the remains of any human body which is brought into or found within the State and which appears to have come to death under any of the circumstances set forth in section 841-3, even though such circumstances may have occurred without the State. The coroner’s physician or medical examiner of any county (including the city and county of Honolulu) shall have the right to retain tissues, including fetal material, of the body removed at the time of autopsy to be used for necessary or advisable scientific investigation, including research, teaching, and therapeutic purposes. [L 1941, c 288, pt of §1; am L 1943, c 209, §1; RL 1945, §10913; am L 1949, c 355, §4; RL 1955, §260-14; am L 1963, c 84, §1; am L 1967, c 188, §2; HRS §715-14; ren L 1972, c 9, pt of §1; am L 1987, c 23, §2]