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Trending Topic: Physician obligation to complete death certificates

The continuing issue of timely completion of death certificates was again before the Board in July, when a dispute between two licensees who both declined to certify a mutual patient’s death reached NCMB’s Disciplinary Committee. Committee members were dismayed to hear that the physicians’ unwillingness to certify the death led to the deceased being held by the funeral home, making it impossible for the family to proceed with funeral rites. After voting to send a confidential letter urging the primary care physician to certify the death, the Board directed staff to clarify NCMB’s position on physician responsibility to complete death certificates.

Some history: NCMB has repeatedly addressed the issue of certifying deaths in the Forum and has developed an online information sheet that states NCMB’s belief that physicians should complete death certificates when asked. However, in instances where a physician may not have recently examined the decedent, some clinicians continue to decline to certify deaths.

The crux of the problem: Based on NCMB’s experience with this issue, the most common reason for a clinician to refuse to certify a death is the clinician’s belief that he or she simply has no idea what caused the patient’s death. Believe it or not, it is OK to certify a death with your best educated guess. Such a “guess” should be based on a review of the decedent’s available medical records and your knowledge of that patient’s history.

What did the Board decide? The Board voted to develop a position statement that states NCMB’s expectation that clinicians complete death certificates, to the best of their ability and in good faith, when asked – even in situations where the patient has not been seen recently. It is the Board’s hope that elevating this expectation to the level of position statement will encourage more licensees to perform this final service for patients and families.

What else can be done? The Board also directed staff to explore the option of seeking an amendment to state law to explicitly state that a physician or other clinician authorized to certify deaths (such as a PA or a NP) is immune from prosecution for certifying a cause of death based on the best available evidence, provided the death certificate was completed in good faith.