What are the most common pitfalls in signing death certificates? Lack of training in death certification and infrequency in certifying death can cause uncertainty and anxiety about how and when to complete death certificates. The implications of this uncertainty can be multifaceted because death certificates are the primary source of information that is used for a variety of purposes. For example, death certificates provide information used by policy makers to set public health goals and determine priorities in funding health care and research.
More acutely, death certificates are used to help settle the estates of the deceased, and insurance companies use them to assist in determining issues related to beneficiaries. Delays in the certification of death can delay burial or cremation. Death certification, when handled properly, can help family members achieve peace of mind after the death of a loved one. The situation described in this scenario is a bit unusual because typically it is the attending physician, who has the most complete understanding of the likely cause of death, who should serve as the certifying physician.
When the attending physician is unavailable but a colleague who is familiar with the situation is available, the colleague may complete the death certificate. The cause-of-death section of the standard death certificate is designed specifically to elicit the opinion of the certifying physician, based on the preponderance of evidence, as to the most likely cause of death.
It is generally recognized that death certificate opinions are probability statements and that opinions may vary among physicians.
If the person in this scenario was the last physician to see the patient alive, and there were no concerns that the patient died of unnatural causes, it is reasonable for this physician to certify the cause of death, especially because of the longstanding physician-patient relationship. Circumstances that should be reported to the medical examiner include possible homicide or suicide, accident or trauma, sudden infant death syndrome SIDS , suspicious circumstances, and occupational causes. When coroners believe that additional investigation is necessary, they assign the cause and manner of death.
Because that did not happen in this circumstance, it might be reasonable to conclude that the coroner thought the attending physician was in the best position to identify the probable cause of death. The standard death certificate, which is used with modifications in all U. There is a difference between the cause of death and the mechanism of death Table 1. Part I also requires the certifier to list the time interval involved in the immediate and underlying causes of death.
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Declarations of time intervals are expected to be estimations. When injuries or accidents contribute to the sequence leading to death, even if temporally remote, they must be included in the cause of death section, with additional information reported e. All deaths resulting from injury must be reported to the medical examiner or coroner, who decides whether to assume jurisdiction and certify the cause of death, or allow the attending physician to certify. The rightsholder did not grant rights to reproduce this item in electronic media.
For the missing item, see the original print version of this publication. If the patient smoked, that fact should be listed in part II as a contributing condition. Because the death certificate has many potential uses, the certifying physician should be sure that he or she can explain the content and the rationale for what is written in the death certificate to the family.
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Shortage of staff has been cited as one cause of delay in the completion and release of death certificates by state governments. Illegibility creates difficulty and sometimes contributes to the inaccuracy of information. Efforts to improve the utility, accuracy, and timeliness of death certification have led a coalition of federal agencies and professional organizations representing funeral directors, physicians, medical examiners, hospitals, and vital records officials to develop an Electronic Death Registration EDR system, 9 which is currently being tested in several states.
The revision of the Standard Death Certificate in was a key step toward development of an EDR that will allow certifiers to access and complete the required documents electronically and from a variety of locations.
The EDR will provide physicians with real-time help in completing many items in the death certificate. Until EDR becomes commonplace, family physicians will continue to complete paper death certificates. Question the certification of any individual who does not appear to have the usual authority. In Canada, each province has a unique death certificate, and the death certificate itself does not state a cause of death.
Information contained within death certificates may vary markedly between and within nations. Increased mortality fueled by rising abuse of prescription drugs and legalized medical marijuana has only complicated the policy adjudication picture.
Many insurers have not adjusted accidental death and dismemberment language accordingly. For example, a recent RGA survey revealed that nine out of 16 U. He could have been a forensic claims examiner. With the sound application of science and a little deductive reasoning, we often find that the truth of a basic death certificate is stranger than fiction. For more insights into the fascinating world of forensic claims, contact U. Group Re. Are you interested in learning the latest fraud tactics and prevention methods?
Physician Liability from Signing Death Certificate:
Louis, Missouri. Same old claims? Not anymore. This article demystifies the fascinating world of forensic claims.
Skip to Main Content. Consider these actual examples of forensic analysis: A young man dies in his home and the cause of death is initially listed as a drug overdose.
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The Death Certificate will then be completed by the Coroner's Office with as much information as possible. In summary you are not liable while making a good faith effort to provide the present and future generations with the best educated and knowledgeable conclusions about the death of your patient. If you do not provide such documentation you are in breach of the law. Please work with the patients family and the Coroner's Office to c the most beneficial Death Certificate to file.
Death certificates in which mechanisms of death sepsis, shock, cardiac arrest, multiorgan failure, etc are listed as the underlying cause are often reported to our office by Vital Records. Listing a mechanism of death rather than an etiologically specific underlying cause will generate follow up from the Vital Records office or involvement by our office.