Death Cer)ficaon Training - Southern Nevada Health District...Mechanisms of Death NAC 440.165, NRS...

DeathCer)fica)onTraining

Whatisadeathcer,ficate?

• Anofficialstatement,signedbyaphysician,ofthecause,date,andplaceofaperson’sdeath.• Permanentlegaldocumentsta)ngthefact(s)ofdeath

www.naphsis.org

www.naphsis.org

Whatisadeathcer)ficate?Sta)s)cally•  Providespersonalinforma)onaboutthedecedent•  Providesarecordofthedisposi)onofthedecedent•  SourceofStateandna)onalmortalitysta)s)cs–  Usedtounderstandtrendsofdiseaseandmortality–  Usedtopriori)zeandallocateresearchfunding–  Educa)onandawareness–  Preven)on

LegalandAdministra)vePurposesI.  Establishingthefactanddateofdeath:

§  Claiminglifeinsurancebenefits§  Claimingpensions§  SeMlingestates

II. Establishingcertainfactsaboutdecedent:§  Causeandcircumstancesofdeath§  Deathandplaceofinterment§  Evidenceofage,gender,andrace§  Parentage§  Ci)zenship

FuneralArrangements•  Adeathcer)ficateaMes)ngtothecauseofdeathmustbeacceptedandsignedbytheSouthernNevadaHealthDistrictVitalSta)s)csRegistrarbeforethefamilycanmoveforwardwithburial,crema)onorremovalofthebodyfromNevada.

Cer)fierofDeath Thecauseofdeathsec,onmustbecompletedbythea9endingorcer,fyingphysician,theMedicalExaminer,ortheCoroner.§  Legalandethicalobliga)onofthephysician§  Shouldbecompletedwithin48hoursaUerpresenta)onofthe

record.§  Causeofdeathpor)onshouldreflecthis/herbestmedical

opinion.Thismayvarybetweenphysicians.

TypesofDeathCer)ficates

§  FetalDeath-mustbecompletedforallfetaldeathsof20weeksgesta)onormore,inwhichthechildshowsnoevidenceoflifeaUercompletebirth.NRS440.070.

§  DeathCer)ficate

CauseandManner

•  CauseofDeath–  underlyingmedicalcondi)on(diseaseorinjury)whichini)atesthelethalchainofeventsculmina)ngindeath(remoteorrecent)

•  MannerofDeath–  Natural–  Accident–  Suicide–  Homicide–  Undetermined

MannerofDeath

•  Natural–  deathexclusivelybydisease

•  Accident–  deathduetonon-inten.onaltrauma

•  Suicide–  deathbyactofdecedentwithintenttokilloneself

•  Homicide–  deathduetointen)onal,voli)onalactmeanttocauseharm,fear,or

death•  Undetermined

–  whenreasonableclassifica)oncannotbedetermined

PreliminarySteps

DeterminewhetherthedeathisreportabletotheCoronerorMedicalExaminer.

§  Ifitisreportable,verifythatithasbeenreported.§ WhenindoubtcalltheCoroner’sofficeandreportthefactsasyouknowthem.

§  IftheCoroner/MEacceptsjurisdic)on,youwillnotsignthedeathcer)ficate.

WhentoContactCoroner•  Violentdeath,includinghomicidal,suicidaloraccidentaldeath•  Deathcausedbythermal,chemical,electricalorradia)oninjury•  Deathcausedbycriminalabor)on,includingself-inducedabor)on•  Deaththathasoccurredunexpectedlyorfromandunexplainedcause•  Deathofapersonconfinedinaprison,jailorcorrec)onalins)tu)on•  UnaMendeddeaths•  Deathofapersonwheretheiden)tyofhedeceasedisunknown•  Deathcausesbydrugoverdoseorwhichisbelievedtobecausedbydrugoverdose•  Whenas)llbornfetusisdeliveredandthecauseofhedemiseismedicallybelieved

tobefromtheusebythemotherofanycontrolledsubstance•  Deathsknownorsuspectedasresul)nginwholeorinpartfromorrelatedto

accidentorinjuryoccurringwithinoneyear•  Deathsundersuchcircumstancesastoaffordareasonablegroundtosuspectthat

thedeathwascausedbythecriminalactofanother,medicalmisadventureoranydeathreportedbyotherpersonshavingknowledgeofdeathforinquiry

CONTACTCORONERThislistisnotallinclusive

•  Asphyxia•  Bolus•  Burn•  Choking•  Drugoralcoholoverdose/drugor

alcoholabuse•  Epidural(hematoma)•  Exsanguina)ons•  Fall•  Fracture•  Hematoma•  Hemorrhage•  Hematuria•  MotorVehicleAccident

•  Hipfracture•  Hyperthermia•  Hypothermia•  Injury•  Openreduc)on/internalfixa)on

(ORIF)•  Pulmonaryembolism•  Seizures/seizuredisorder•  Subarachnoid(hemorrhage)•  Subdural(hematoma)•  Surgery•  Trauma/trauma)c•  Thermal/chemicalburns

StandardFormatforRepor)ngCauseofDeath

Effect→

UnderlyingCause→

(a)

Dueto(orasaconsequenceof)

(b)

Dueto(orasaconsequenceof)

(c)

Dueto(orasaconsequenceof)

(d)

Bluntforceheadtrauma

Motorvehicleaccident

Intervals

PartI.Diseases,injuries,orcomplica,onsthatcausedthedeath25.  ImmediateCause

DataQualityIssues

•  Onecauseperline•  NoAbbrevia)ons•  UseIntervals•  AcorrectlycompletedCODsec)onrepresentsadirectsequencesothateachcondi)onmayberegardedasbeingaconsequenceofthecondi)onenteredimmediatelybelowit

•  Medicallyimprobablesequenceofcondi)onsleadingtodeath

•  Failuretospecifyavalidunderlyingcauseofdeath

MedicallyImprobableSequence

DEATHCERTIFICATE§ Aproperlycompletedcauseofdeathsec)on,providesane)ologicexplana)onoftheorder,type,andassocia)onofeventsresul)ngindeath.

MechanismsofDeathNAC 440.165,NRS440.120,44.380,440.410

–  “Causes”listedthatarenotspecificallyrelatedtothediseaseprocessorterminaleventbutmerelyaMesttothefactofdeath

–  Shouldnotbelistedastheimmediatecauseofdeath–  Examples

•  Cardiacarrest•  Cardiopulmonaryarrest•  Pulmonaryarrest•  Respiratoryarrest•  RenalFailure•  Mul)organFailure

CAUSEOFDEATH

Themodeormechanismofdying(effect),shouldnotbereportedastheimmediatecauseofdeathwithoutshowingtheunderlyingcauseofdeath(cause).

CauseProduces Effect

UnderlyingCauseofDeath•  Thediseasethatini)atedthechainofmorbideventsleading

directlytodeath Or

•  Thecircumstancesoftheaccidentorviolencethatproducedthefatalinjury.

Standardformatforrepor)ngcauseofdeathExampleofincompleterecord

Effect

UnderlyingCause

(a)

Dueto(orasaconsequenceof)

(b)

Dueto(orasaconsequenceof)

(c)

Dueto(orasaconsequenceof)

(d)

Sep,cShock

Pneumonia

Intervals

PartI.Diseases,injuries,orcomplica,onsthatcausedthedeath25.ImmediateCause

Ven,latordependentrespiratoryfailure

Renalfailure

WhatCausesRenalFailure?

Natural •  Kidneydisease•  Malignanthypertension•  Diabetes•  Obesity•  Liverdisease

Possibletrauma•  Burns•  Dehydra)on•  Hemorrhage•  Injury•  Sep)cshock•  Surgery

MostQueriedQues,onableCauses

• Atrialfibrilla)on• Ventricularfibrilla)on• Pneumonia• Aspira)onpneumonia• MyocardialInfarc)on• Mul)organFailure• Intracranialhemorrhage• Liverfailure• RenalfailureorE/Srenalfailure• Sepsis/Bacteremia• AdultRespiratoryDistressSyndrome(ARDS)

Pneumonia•  Pneumoniaisacommoncomplica)onofsurgeryandisalsoacommoncomplica)onofinjuries.

•  Pneumoniacanbeacomplica)onofmanydiseasesorcondi)ons.Especiallycondi)onsthatdecreasemobility.

•  Pneumoniamayexistwithoutanunderlying.Inthiscaselist“primarypneumonia”.Thistermrulesoutothercontribu)ngcauses.

80YearOldInpa)ent

Whennotcompletedproperly,missinginforma,oninthecauseofdeathsec,onmayresultinthereadernotknowingwhythecondi,onenteredonthelowestlinedeveloped.

Exampleofcer,ficatewithonly“modes”listed

Probable/Presumed

•  Itispermissibleforacer)fiertoqualifyacuseofdeathas“probable”or“presumed”evenifthecausehasnotbeendefini)vleydiagnosed.

NAC440.1653(c)

StandardFormatforRepor)ngCauseofDeath

Effect→

UnderlyingCause→

(a) 12days

Dueto(orasaconsequenceof)

(b)12days

Dueto(orasaconsequenceof)

(c)

12days

Dueto(orasaconsequenceof)

(d)

2years

AnoxicBrainInjury

CardiogenicShock

Intervals

PartI.Diseases,injuries,orcomplica,onsthatcausedthedeath25.  ImmediateCause

CardiacArrest

CoronaryArteryDisease

SUSPECTED/PRESUMED

49YearOldInpa)ent

SecondAMempt

Ini)allypresentedtoVitalSta)s)cs

StandardFormatforRepor)ngCauseofDeath

Effect→

Produces

Cause→

(a)

Dueto(orasaconsequenceof)

(b)Metasta,cBreastCancer

Dueto(orasaconsequenceof)

(c)

Dueto(orasaconsequenceof)

(d)

RespiratoryFailuresecondarytopneumonia

Pneumonia

Intervals

PartI.Diseases,injuries,orcomplica,onsthatcausedthedeath

25.  ImmediateCause-onecauseperline

Metasta,cBreastCancer

3Days

Minutes

5Years

Standardformatforrepor)ngcauseofdeath

Effect

Cause

(a) Immediate

Dueto(orasaconsequenceof)

(b)2days

Dueto(orasaconsequenceof)

(c)1week

Dueto(orasaconsequenceof)

(d)2weeks

Cardiorespiratoryarrest

Sep,cshock

Intervals

PartI.Diseases,injuries,orcomplica,onsthatcausedthedeath

25.   ImmediateCause

Pneumonia

Acutemyocardialinfarc,on

OSC:Quadriplegia,renalfailurePartII-

OtherSignificantCause:Quadriplegia,renalfailure

Deathcer)ficatequeried:

Whatcausedthequadriplegia?

StandardFormatforRepor)ngCauseofDeath

EffectCause→

A. 2weeks

Dueto(orasaconsequenceof)

B.3years

Dueto(orasaconsequenceof)

C.

3years

Dueto(orasaconsequenceof)

PARTIIOSC:Dilatedcardiomyopathy

Bronchopneumonia

Quadriplegia

Intervals

PartI.Diseases,injuries,orcomplica,onsthatcausedthedeath25.  ImmediateCause

Gunshotwoundoftheneck

HOMICIDE

DEATHREGISTRATIONWORKFLOWDEATH

IS THIS A CORONER

CASE?

FD INITIATES DEATH

CERTIFICATE

FD SENDS CERTIFICATE TO CORONER

FD SENDS CERTIFICATE TO MD

MD CERTIFIES CAUSE AND MANNER WITHIN

48HRS OF PRESENTATION

SNHD REVIEWS CERTIFICATE

SUSPECT CAUSE?

SNHD ISSUES BURIAL PERMIT AND REGISTERS

DEATH CERTIFICATE

NO

CCOCME DETERMINES CAUSE AND MANNER OF

DEATH

INCOMPLETE OR ILLOGICAL?

DEATH IS REPORTED TO

NCHS

CCOCME CERTIFIES DEATH CERTIFICATE

YES

RETURN TO MD

UNNATURAL DEATH?

YES

YES

FD=Funeral Director CCOCME=Clark County Coroner/MEMD=PhysicianSNHD=Southern Nevada Health District

NO

PhysiciansResponsibility

•  DateofDeath•  TimeofDeath•  SocialSecurityNumber•  Deathduetocommunicabledisease?•  Causeofdeath?•  Didtobaccousecontributetodeath?

CauseofDeathTab

RecordQuery

SignatureTab

RejectTab