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					DEATH CERTIFICATES AND
   CORONER’S CASES
 Dr AD Cala & Professor TJ Lyons
     Forensic Medicine Unit,
      John Hunter Hospital
WHAT IS THE CAUSE OF
DEATH?
THE CAUSE OF DEATH:

• “THE UNDERLYING CONDITION/S WHICH
 SET IN TRAIN AN EVENT OR EVENTS
 WHICH LEADS TO THE DEATH OF A
 PERSON”
MECHANISM OF DEATH IS NOT
THE CAUSE OF DEATH:
•   eg “ACUTE PULMONARY OEDEMA”
•   “BLOOD LOSS”
•   “DYSPNOEA”
•   “EXHAUSTION”
•   “DEHYDRATION”
•   THESE ARE NOT CAUSES OF DEATH!
•   NEED TO KNOW THE UNDERLYING REASON
    FOR EACH OF THESE
Example 1:

• eg 1.a) CARDIOGENIC SHOCK due to:
• 1.b) ACUTE MYOCARDIAL INFARCTION
  due to:
• 1.c) THROMBOSED CORONARY ARTERY
• 2. (CONTRIBUTING FACTORS TO DEATH)
• eg DIABETES MELLITUS, HYPERTENSION,
  HYPERCHOLESTEROLAEMIA
OTHER EXAMPLES OF CAUSES OF
DEATH:
• 1.a) DISSEMINATED CARCINOMA OF
  BREAST or
• 1.a) ASPIRATION PNEUMONIA and
  INANITION (WASTING/DEHYDRATION)
  due to:
• b.) ALZHEIMER’S DISEASE
CAUSES OF DEATH:

• 1.a) UPPER GASTROINTESTINAL
  HAEMORRHAGE due to:
• b.) OESOPHAGEAL VARICES due to:
• c.) DECOMPENSATED CIRRHOSIS OF THE
  LIVER
CAUSE OF DEATH:

• 1.a) “COMBINED EFFECTS OF VALVULAR
  AND ISCHAEMIC HEART DISEASE” or
• 1.a) “COMPLICATIONS OF BLUNT FORCE
  HEAD INJURY” or
• 1.a) “ACUTE RENAL FAILURE
  COMPLICATING DIABETES IN A MAN
  WITH CARCINOMA OF LEFT LUNG”
DEATH CERTIFICATES:

• NO ABBREVIATIONS-AVOID “AMI” or
  “CAL”, or “UTI” or “CLL”
• WRITE LEGIBLY
• CAPITAL LETTERS (BLOCK) FORM
• IT IS A LEGAL DOCUMENT SO BE SURE
  YOU SIGN IT.
• CHECK DETAILS BEFORE SENDING OFF
DEATH CERTIFICATES:

• IDENTITY OF DECEASED KNOWN TO YOU
• YOU HAVE TREATED DECEASED DURING
  LAST ILLNESS
• IF YOU KNOW THE CAUSE OF DEATH,
  YOU SHOULD WRITE A DEATH
  CERTIFICATE UNLESS IT IS A
  CORONER’S CASE.
CORONER’S CASES:
• VIOLENT, TRAUMATIC OR UNNATURAL
  DEATH eg MVA, SHOOTING, ASSAULT
• SUSPICIOUS OR UNUSUAL
  CIRCUMSTANCES eg
• SUDDEN DEATH, CAUSE OF WHICH IS
  UNKNOWN
• HAS NOT SEEN A DOCTOR IN 6 MONTHS
  (USED TO BE 3 MONTHS)
CORONER’S CASES:
• DEATH WHICH WAS NOT THE
  REASONABLY EXPECTED OUTCOME OF A
  SURGICAL, MEDICAL, DENTAL OR LIKE
  PROCEDURE
• +/- ANAESTHETIC (MOST +)
• UNDEFINED PART OF ACT
• UP TO MEDICAL PRACTITIONER TO
  INTERPRET
CORONER’S CASES:

• DEATH IN CUSTODY
• POLICE DETENTION eg CAR CHASE
  AFTER BREATHALYSER
• PUBLIC INSTITUTION eg MENTAL
  HEALTH FACILITY
• CHILD CARE CENTRE
• “GAZETTED” NURSING HOME/HOSTEL
FALLS IN THE ELDERLY:

• CERTIFICATE CAN BE ISSUED:
• PERSON 72 YRS +
• DIED AFTER AN INJURY BEING AN
 ACCIDENT ATTRIBUTABLE TO THE AGE
 OF THE PERSON, AND NOT CAUSED BY
 ACT OR OMISSION BY ANY OTHER
 PERSON
CORONER’S CASES:

• eg J.H.H. DEATH
• MEDICAL RECORDS PERUSED BY
  PATHOLOGIST
• +/- X-RAYS, PATH RESULTS etc
• COPIES OF RECORDS MADE
• SO MAKE LEGIBLE NOTES!
MEDICAL NOTES:
• LEGIBLE ENTRIES DATED & TIME
• CHRONOLOGICAL RECORDS BEST
• IF RETROSPECTIVE ENTRY, STATE
  SPECIFICALLY
• “Retrospective notes”…….
• DON’T “FUDGE” NOTES
• DON’T ALTER NOTES UNLESS
  PERMISSION GIVEN TO DO SO.
SUMMARY:
• IF UNSURE-ASK.
• SENIOR COLLEAGUES ARE NOT LAWYERS AND THEIR
    ADVICE MAY BE WRONG
•   ONLY ISSUE A D.C. IS YOU ARE SURE OF THE CAUSE
    OF DEATH (ON BALANCE OF PROBABILITIES)
•   MUST NOT “GUESS” THE CAUSE OF DEATH
•   DON’T BE INTIMIDATED BY NURSES TO “SIGN
    OFF”
•   CRITICALLY READ “DEATHS REPORTABLE TO
    CORONER” FORM (NSW HEALTH INTRANET)
THANK YOU.

				
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posted:8/16/2012
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