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