A certificate to prove that you are dead is easy but to prove you are alive is difficult. The death certificate filled up by majority of registered medical practitioners in hospitals and nursing homes are either incomplete or improperly scribbled. The problem is not with the young doctors but method of teaching in different medical colleges about how to complete a certificate of death properly. Jurisprudence is a neglected subject during the career of a MBBS student in most of the medical institutes.
If one look at the cause of death its invariably written “cardio-respiratory arrest”. This is totally wrong, because this is a terminal event in all patients, be it due to infection or cancer or heart attack or poisoning. It’s clearly mentioned in the death certificate ‘not the mode of dying’ but disease, injury or complication which caused death not the mode of dying like heart failure or respiratory failure.
If a snake bite victim is mentioned as cardiac arrest then the statistics at the end of the year will be wrong, similarly many accident cases are reported as cardio respiratory arrest as the cause of death or septicemia then we get a totally wrong statistics. The actual number of deaths figures due to road or train accidents in our country is totally understated because of the improper death certificates.
Why a Proper Certificate with the Correct Entries and Cause of Death is Important?
First the mortality statistics is a very Vital statistics for any country. That would reflect the population growth, health trends, mortality rates, how effective are the public health programmes and implementation of future policies. If many young people are dying due to road traffic accidents (RTA) then the problem can’t be solved by employing more neurosurgeons but by prevention through proper planning, issuing of driving license, vehicular check up, road condition and traffic control.
The other important aspect for the planners would be the proper implementation of different policies for better health planning and management. Say if there are more deaths in summer months due to heat strokes and gastroenteritis then prevention and educating the public would help the society and bring down the death rate in that locality rather than having more ice or air conditioned rooms or mineral water for the victims.
It’s unfortunate that every year the same scenario is repeated in different parts of Odisha as a result of contaminated drinking water due to faulty system of having drinking water pipe lines and sewerage system lines very close to each other, which results in epidemic of hepatitis and gastroenteritis .The government can go for future health policy and remedial measures after analyzing the morbidity and mortality statistics. Unfortunately we do not have good record keeping culture/habit hence developed countries and medical faculties do not believe our statistics.
Here are few suggestions for the Doctors and the Administrators
• Complete the medical certificate regarding all diseases, morbid conditions or injuries which resulted in or contributed to death.
• If untimely deaths are to be prevented the chain of events has to be cut, or cure instituted at some intermediate point. The most effective public health objective is to prevent the precipitating cause from operating hence the relevance of the underlying cause.
• Doctor must be taught properly about completion of death certificate within stipulated time.
• Public should be told that the hospital certificate is not legally valid.
• The municipality/ health department death certificate is final and legally valid.
• Medico legal cases death certificates are to be issued by police after post mortem report of the doctor.
• Without proper death certificate burning or burial of a dead body without proper intimation or registration in health department is dangerous practice.
• All female deaths associated with delivery of a child or aborting or associated with pregnancy are to be reported to the concerned authority.
• All unnatural deaths, accidental deaths, death on table during surgery if not reported to the proper authority then SP have the power to go for an inquest.
• No doctor should certify a death without proper knowledge about certifying death and signs of deaths.
• A doctor should not issue a death certificate without being present with the patient at the time of death.
• A dentist cannot issue a death certificate.
• A dead body of a RTA victim cannot be handed over to the relatives by the hospital authority or the treating doctor; it’s the job of the police.
• The doctor or hospital authority must inform police in case, the cause of death could not be ascertained by the treating doctor. Or it’s a death due to suicide or poisoning or RTA.
• In case of doubt a doctor must consult a senior doctor before declaring the person as dead.
• A doctor should not charge fees for issuing a death certificate for the burning ghat.
• All said and done the doctor must be sympathetic to the relatives and friends of the dead.
• If he or she was not the treating doctor then there should not be any adverse comments about the treating doctor at the time of death.
• Dead patients file is very important record hence to be kept under lock and key.
• Medico legal case files may be taken by the police authority for court purpose hence a Xerox copy must be kept with the hospital authority.
• Proper identification of the dead person with his or her ID cards is a must before handing over the body to the relatives from the hospital morgue.
• If autopsy facilities are there in a hospital and the party is willing then death certificate may be issued after the autopsy.
• CME on this subject is a necessity amongst the present generation of doctors so that the death statistics and cause of death are analyzed by the health department for future planning.
• Here I have tried to touch upon some important and pertinent points which may be of help to the doctors as well as the public and administrators.
By: Dr. Sanjoy Kumar Satpathy
Ex-Joint Director, Steel Authority of India. (SAIL)