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As a 30-year veteran of the Eastern Regional Medical Examiners Office, now the Eastern Regional Autopsy Center, I urge clinicians to obtain the circumstances of death—usually they are benign. If the medical examiner has declined jurisdiction, that means the circumstances are benign—not suspicious for an unnatural death. Sometimes the medical examiner has the information about circumstances and can provide it to you to help you be more confident in providing this closure for families.  MGF Gilliland MD

By MGF Gilliland MD on Apr 30, 2019 at 2:33pm

This position that the NCMB has taken or is about to take is ludicrous. To presume that I would or should know what a patient died of whose last office encounter may have been 2 - 3 years ago is just a manner of dumping this problem in the laps of the primary care physicians. The “death certificate being a legal document and not a scientific document” doesn’t seem to make any sense. Therefore, it doesn’t need to be accurate?  And if we need to contact the medical examiner for the circumstances surrounding the death, the ME already has more information in these situations than we do. If accuracy is not paramount, then why doesn’t he/she sign off on the death certificate as “probable cause of death”. After all, the accuracy of it all apparently doesn’t really seem to be of importance. The arguments made by this author are nonsensical. If I have had reasonably recent contact with the patient and it is a long time patient with established medical problems, I, as I am sure many others, would have no issues with filling out the death certificate.  But in the case where I may have had a short exposure to an patient from an unassigned ER admission and he/she fails follow-up in the office and now I am to certify a cause of death a year later? It makes the document worthless ..... period! I have called the Board in the recent past because I was threated by the Ambulance service to be reported to the NCMB if I didn’t agree to sign the certificate. So I called the NCMB myself to report this incidence and was assured that I had no obligation to sign such a document and would not have to fear any retaliatory action by the Board if such a report were to be made at some point in time in the future. Please someone, use some common sense. Don’t use this as a solution to the ME’s services being overwhelmed. Let them sign off on it as they see fit. Best case scenario, they solve their own problems.

By Gerald Ahigian, M.D. on Apr 30, 2019 at 6:10pm

This is welcomed news….my practice site is part of a large hospital system with patients tending to migrate from one clinic to the other being cared for by residents often who frequently rotate from one clinic to the other.  It is often difficult to determine who the latest provider is/was at the demise of patient. Providers frequently have conversations over who is “responsible” for the signing of a death certificate….....this makes it more clear…...we all are.

By Earl Cummings, PA on Apr 30, 2019 at 8:38pm

I personally feel more comfortable speaking to the police officer who investigated the circumstances, especially if the patient was on pain medications or if there was something worrisome in their background.  Maybe it would be better to have law enforcement certify the death and have the physician just fill out a medical addendum on history and significant known illnesses that might have contributed to the death. If I haven’t seen the patient in a while, and there is no obvious reason for him/her to die, there is always “natural causes” and then list possible “contributing illnesses” such as smoking, obesity, sleep apnea, hypertension, CAD, etc. Natural causes probably drives the epidemiologists crazy, but it is actually more accurate than making up something when we really do not know what happened.

By Lillian Burke MD on Apr 30, 2019 at 10:25pm

Prosecution and persecution of signers of death certificates remains a problem.I have never shirked the responsibility. Yet if the Board obligates a physician to do the necessary at the time of death then immunity from all legal entanglements should also be obligatory.If the case needs to be reviewed by a Medical Examiner afterward and the death certificate revised the original signer should also be held blameless. Death certificate assignation is a community service, not a patient nor family matter, and as such must be a blameless act immune from malpractice considerations.

By Keith Raymond, MD on May 01, 2019 at 12:18am

The problem arises when a family member gets the document, then wants to know why we have determined the reason as the cause of their loved ones death. This will surely arouse distrust if we cannot provide evidence. As a “legal document”, practitioners should not be guessing as to a cause of death and this is especially true when a patient has not been recently seen by the practitioner. I’m afraid that “fudging a legal document puts us all at risk!

By C Benson MD on May 01, 2019 at 12:27pm