A great many of the death certificates filed in this country aren’t worth the paper they’re printed on, and neither are the scientific studies based on them.
I’ve expressed this opinion in writing and at conferences, and I’m glad to see that the horrendous error rate in death certification is starting to get some attention.
A Scripps Howard News Service report says, “Experts generally agree that nearly a third of the nation’s deaths had the wrong cause reported on their death certificates, although some believe the error rate is more than 50 percent.”
A New York Times article cited a study suggesting that “the health system is far too cavalier about the accuracy of death certificates.”
The Times article points out death certificates are an important basis for life insurance claims and estate settlements. They provide descendants with information about diseases that might be inherited. Through statistical analysis, death certifications spotlight causes of accidents and improve knowledge of disease prevalence.
Perceptions of disease prevalence guide research efforts and direct research funding. A study published in May of last year reported that of 521 resident doctors in specialty training programs, 54 percent said they sometimes knowingly certified an inaccurate cause of death.
Some said they were too busy to figure it out. Some said they were required to fill out death certificates for patients they didn’t know and had never treated. Some said electronic systems rejected the cause of death they believed to be correct – sepsis or blood infection, for instance – and hospital administrators instructed them to pick some other cause to get around the balky system.
These young doctors were certifying deaths inaccurately, in part, because they didn’t know how to do it. Only forensic pathology thoroughly trains its practitioners in death certification.
Because of that training, I know that electronic systems don’t reject sepsis because it’s wrong. They reject the certification because it’s non-specific and incomplete.
Many things result in fatal sepsis – both natural diseases like pneumonia and unnatural events like a gunshot wound to the belly. An acceptable death certification has to state the underlying disease or event, not just “sepsis.”
The doctors interviewed didn’t understand that, and neither did their bosses.
Heart disease is believed to be the nation’s leading killer. Maybe it is – or maybe doctors are using heart disease as a default because they know it will be readily accepted as a cause of death. After doctors in eight New York hospitals undertook new training in death certification, the rate at which heart disease was certified as the cause of death dropped by 54 percent.
I believe the root causes of unreliable death certification are lack of physician training and the failure of doctors to recognize the importance of accuracy.
When my former husband’s father died years ago, I asked the doctor how he had certified the cause of death.
“I put kidney disease,” he said with a shrug. “What difference does it make?
chuser@durangoherald.com. Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland.
