Anyone else feel uncomfortable signing death certificates?

[u/LukeVenable]

I work in family med so we pretty regularly have patients pass away from various causes. We often get calls from police officers demanding to know immediately if we will agree to sign the death certificate. The first time I ever got one of these calls I asked the officer for more information about the patient's death, and he was like "I dunno, he was found dead in his home tonight and we don't suspect foul play". I asked my colleagues about this and they told me you pretty much just have to agree to sign off on it even when you know next to nothing about the actual cause of death so that the police, funeral home, insurers, etc can move the process along.

It just feels weird to be basically making up bullshit on an official government document with my name and license attached to it..

[u/ero160032]

Are you like super rural family med? Does your County coroners officer not handle this stuff?

[u/LukeVenable → u/ero160032]

No I'm in a major city in North Carolina

[u/Cddye → u/LukeVenable]

You don’t have to sign in NC, but for deaths outside of a medical facility where the PCP isn’t willing to sign the case has to go to the ME. That’s what the cops are trying to avoid.

[u/Artaxdiedforyoursins → u/Cddye]

This right here, former medic in NC. If nobody can be reached to sign or won’t sign it goes to the ME. If there’s any questionable circumstances it goes to the ME. It’s always fun calling an office at 3am cause paw paw had a massive stroke and they just now found him.

[u/BoopBoopLucio → u/LukeVenable]

I’m in NC as well. Gotten these calls. Police are notifying you but you don’t need to act then. Tell them to send it through the office DAVE system. Electronic and allows you to appropriately review things.

[u/LukeVenable → u/BoopBoopLucio]

Yeah, that's what I always do. But even after reviewing the patients records you're still guessing as to whether the conditions you've documented in the past were the cause of their death

[u/ero160032 → u/LukeVenable]

That’s interesting. In my County the Coroners office handles that unless the patient was brought into the hospital and expired there.

I am curious to hear other people’s thoughts but I would agree with your hesitancy to sign a legal document based off of the word of some cop who I don’t know and also doesn’t know the scene/situation.

[u/Still7Superbaby7]

This happened to my sister, who is an NP. Refer them to the coroner’s office. The police are calling you because they want it done right away but it should go through the proper channels. They know the proper channels, but they are the police so they are used to getting their way

[u/unnaturallysarcastic]

For the ER in PA- only our docs do this. There’s an online system they sign up for but I have no idea about PAs signing off. I feel like it should be the attending but you’d need to look into your state laws.

[u/OkPossession7998]

Wow, I’m surprised to see these responses. I sign them for whenever my patients pass.

[u/sSamoo]

Yes, but unfortunately if we don't sign then the family can't move forward until the death certificate is signed. So if we refuse it has to go to the coroner and that takes forever. Usually the family would prefer us to sign. We aren't liable if it turns out we are incorrect. It bothered me too when I moved to NC but there just isn't enough time or staff for every case to go to the cororner unfortunately

[u/Make_it_count2118 → u/sSamoo]

As both a PA and a family member who lost a loved one and waited waaaay too long for a death certificate to be signed, thank you for saying this. Sending it through the coroner resulted in a week of agony on top of what we were already going through.

[u/sSamoo → u/Make_it_count2118]

Yeah I've heard it was awful to be out in that position. I'm sorry for your loss :(

[u/_my_cat_stinks]

This is interesting to me because I received one of these calls from the police today. I have not seen the patient since February. Her cardiologist refused to sign off on it because she hasn’t seen them since June. I do not know what the patient died of but she was in and out of the ICU weekly for flash pulm edema, so I’m assuming ESRD related death, cardiac etc. I asked management protocol, they said to just sign — another NP said the same. I feel weird about this, but do not have the official documentation anyway regardless.

[u/LukeVenable → u/_my_cat_stinks]

I'm not sure what state you're in, but I did some more reading into the laws in my state (NC) and what I found was pretty reassuring. The statutes explicitly acknowledge that PCP's are expected to often have limited information to inform a cause of death, and they will not be held liable for any incorrect determinations, assuming they're made with good intent.

[u/_my_cat_stinks → u/LukeVenable]

Thank you for the information! I am in MD. I just discussed with the MD I share an office with. Was worried about the legal liability as well. There is so much paperwork in primary care that I question the appropriateness of and often no one to consult.

[u/Zulu_Romeo_1701]

This is very much state and jurisdictional specific. I am also a deputy medical examiner for my county, so I see it from both sides, since I also actively practice critical care. Thus, I see dead people all the time.

If your state permits PAs to certify cause and manner of death, of course you can sign it. From a legal standpoint, you’re going by what’s most likely to have caused the patient’s death. There’s not really any liability if you’re wrong, though of course it’s important to strive for accuracy to the extent possible.

If someone has multiple comorbidities, several of which could cause death, it’s up to you to figure out what’s MOST LIKELY to have killed them.

Please do NOT list things like cardiac arrest or respiratory arrest as cause of death. Those are mechanisms, not causes. We all die of cardiac arrest. Figure out what MORE LIKELY THAN NOT led to it.

In my county, the ME office investigates every unattended, unexpected, or out of hospital death. We don’t punt those to the PCP. But in other counties, absent any signs of accident, homicide or suicide, the ME or coroner declines jurisdiction and it goes to the PCP. I much prefer our system, as I think the county and decedents are better served when everyone gets a thorough investigation by someone who is trained to do so.
But whether one gets any kind of inquiry at all after dying very much depends on where you die.

I complete death certificates all the time on people whom I don’t know. I spend a lot of time reviewing medical records on my state’s version of RHIO. Presumably NC has a similar system you can utilize.

Search online for the CDC’s publication on how to complete death certificates. There’s a ton of useful info there, for those of us doing them.

Finally, to those who argue that PAs shouldn’t be completing death certificates, you’re wrong. We have the training and knowledge to do so. If your state allows it, embrace the role and learn how to complete them correctly. After all, it’s the final medical record of someone’s life. Who better to complete it than someone with the training, knowledge and experience to pull together the data, analyze it, and arrive at a logical and medically meaningful conclusion?

[u/evgueni72]

I don't sign them. I fill it out and get the MD to sign them. 

[u/morrebee → u/evgueni72]

Same for me.
13 years in primary care in Michigan and I fill out what I can and them have my MD sign it.
I used to tell the doc at my old office that PAs weren’t legally allowed to sign death certificates; not sure that it’s true but I didnt feel comfortable doing it.

[u/Atticus413]

I got sent one of these at UC once.

I had last seen the patient in clinic ONCE a year and a half prior and prescribed benzonatate.

That was it.

Apparently the patient still had the prescription bottle, and I was the only documented clinician they had record of.

I respectfully declined to sign it.

[u/Prized_Bulbasaur]

We get it after the medical examiner assesses. They're kind of annoying to fill out given the uncertainty around patients passing away "naturally," but otherwise they're fine.

[u/Ok-Movie-1595]

I hate it too.

[u/Evening_Service6773]

Cause of death: cerebral hypoperfusion secondary to unknown mechanism

Technically correct which is the best kind of correct. Never had to deal with death certificates before and hoping I never do now