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Cause of Death Certificate: Things to Know

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As a doctor, you hold a vital responsibility in certifying the cause of death for your patients. However, did you know that hasty or inaccurate completion of a Medical Certification of Cause of Death (MCCD) could land you in legal hot water?

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 On January 25, 1988, a patient was brought to a hospital with a history of chest pain, difficulty breathing, giddiness and profuse sweating, as relayed by their concerned relatives. The attending doctor conducted a thorough examination of the patient and discovered that the pupils were dilated and unresponsive to light with no discernible heartbeat or pulse. The ECG also showed a straight line. All of these made the doctor suspect that the patient might have passed away on the way to the hospital. In light of this, the doctor recorded that the probable cause of death was ‘Acute Myocardial Infarction’ based on history’ and allowed the relatives to take the body for the final rites.

Around three months later, a complaint was filed claiming that the patient died of unnatural causes. Hence, the police initiated an investigation and ordered the exhumation of the body for a post-mortem examination. The findings of the examination revealed that the actual cause of the patient’s death was poisoning. A case was filed against the doctor for issuing a false certificate.

This tragic incident highlights the importance of conducting a thorough investigation before issuing an MCCD. Erroneous recoding of the cause of death can lead to severe legal repercussions and all doctors must exercise the utmost care and attention to detail while fulfilling this responsibility.

In the present case, the doctor declared the cause of death based solely on a superficial examination of the deceased’s body and the history provided by their relatives, without any supporting medical evidence or clinical examination. Here are some of the things that the doctor could have done differently to avoid legal complications.

  • First and foremost, the doctor should not have made a definitive declaration about the cause of death if there is a lack of medical evidence to support the diagnosis.
  • Secondly, since the doctor had no supporting medical evidence, it would have been prudent to involve the police and inform them of the circumstances leading up to the patient’s death. This could help ensure that the case was thoroughly investigated and all relevant information was taken into account.

As a healthcare professional, it is essential to gather medical evidence to substantiate the cause of death. It is critical to avoid relying solely on a patient’s history while issuing MCCDs.

Medical research suggested that a staggering 80% of the MCCDs issued by medical practitioners showed errors. It was revealed that 99% of them were incorrectly written, and 21% were incomplete. These findings further underscore the need to address this issue with urgency and seriousness.

Let’s get into the basics and understand this better.

Are MCCDs and Death Certificates the same?

MCCD and Death Certificates are not the same. It is wrong practice to present MCCDs as death certificates. MCCSs are issued by registered medical practitioners and they state the cause of death (form 4 in the case of hospital deaths, form 4A in cases of non-hospital deaths). Death Certificate, on the other hand, is issued by the Office of Registrar (form 10) and it is an official record of the death.

Who is legally obliged to issue MCCDs?

According to Section 10(3) of the RBD Act of 1969 , the medical practitioner who attended to the deceased in his or her last illness is responsible for issuing the certificate of the cause of death immediately. Later, the same doctor should also forward a “Death Report” to the Death Registry Authority along with the MCCD.

What happens if a doctor refuses to issue an MCCD or issues a false certificate?

According to RBD Act Section 23(3) any medical practitioner who neglects or refuses to issue a certificate under Section 10(3) shall be punishable with a fine, which may extend to fifty rupees. Whereas, the issuance of a false certificate may result in medical practitioners being imprisoned for 3 to 4 years (Section 197 of the IPC).

Can a doctor deny issuing MCCD in medico-legal cases?

No, a doctor cannot deny issuing MCCD in medico-legal cases as per the RBD Act (Section 10(3)). In any case, if no medical evidence is available to certify the cause of death, then only a doctor can deny issuing an MCCD. In medicolegal deaths, the doctor must inform the police about the case. However, the doctors must refrain from using statements such as ‘final cause of death to be decided after post-mortem’ while issuing the MCCD. According to Section 174(3) CrPC only the police can decide whether or not to conduct a postmortem.

Can a doctor hold MCCD for non-payment of hospital bills?

The issuance of an MCCD does not require any fees. Therefore, medical practitioners cannot refuse or delay providing MCCD due to outstanding bills from the patient. If such situations arise, they should be resolved through independent means, such as legal action against the deceased’s legal heir for failure to clear payments. Few hospitals still withhold MCCD; however, it is illegal to do so.
Dr. Indrajit Khandekar
WRITTEN BY

Dr. Indrajit Khandekar

MD (Forensic Medicine & Toxicology), LLB

A forensic expert and a lawyer. Talks about Medical Negligence, Medical Records, Patient Consent, Patient’s Rights

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