Monday, January 19, 2009

HOW TO ISSUE PROPER CAUSE OF DEATH CERTIFICATE AND THE RULES THEREOF TO BE FOLLOWED

Rules as per Registration of Birth and Deaths Act, 1969 [Amended in 2004]:

Certain sections of the act are relevant to every medical practitioner. As per Section 8(1-b), a medical practitioner in charge of a hospital, maternity home, health centre, nursing home or other like institutions has to notify births as well as deaths within 21 days of occurrence. As per Section 10(2), every State Government has made a provision to obtain cause of death certificate from a medical practitioner. As per Section 10 (3), with regards to section 10 (2), in case of death of a person, a certificate of cause of death has to be issued by a medical practitioner who attended the deceased in his last illness without charging any fee in the prescribed form stating to the best of his knowledge and belief, the cause of death and the same has to be delivered to Registrar of Births and Deaths at the time of notifying death. As per Section 17 (1-b), any person on payment of required fees and postal charges subject to any rules made by respective State Governments, can obtain an extract from the register relating to any birth or death, without disclosing confidentiality of the cause of death. If a medical practitioner neglects or refuses to issue a cause of death certificate as per Section 10 (3), he is liable to be punished with fine up to Rs. 50/- as per Section 23 (3) of this act.

Responsibilities of medical practitioner:

All hospital deaths including medico-legal case deaths are to be covered under the scheme called MCCD [Medical Certification of Cause of Death]. This scheme has been put forward by WHO and has been incorporated in RBD Act, 1969 of India. As per the MCCD scheme, any medical practitioner attending the deceased in his/ her last illness, after death of the person shall fill in Form No. 4 [for institutional deaths] and Form No. 4A [for non-institutional deaths] [The forms are given at the end]. Medical practitioners are instructed not to fill and submit form 4/ 4A for still births. For still births, separate Form 3 is made available. He has to send the completed form to the respective District Registrar of Birth and Deaths by 5th of every month that in turn has to send it to the Chief Registrar of the State who shall send it to the Registrar General, India.

Instructions on how to fill the certificate:

Name of the deceased should be in full – not in initials. In case of infants not yet named at the time of death, write S/o or D/o followed by names of father and mother. If the deceased is above the age of 1 year, give the age in completed years, if below 1 year, give age in months, if below 1 month, give age in completed number of days and if below 1 day, give it in completed hours. Sex of the deceased should be noted.

The column for cause of death is divided into two parts: Part I and Part II. Part I has three parts (a), (b) and (c). The cause of death includes any disease or injury responsible to initiate a chain of events incompatible with life resulting in death of a person3. In single morbid condition, it should be written on line (a) of Part I.  Nothing else needs to be written. Immediate cause is reported in line (a). It is the disease/injury/complication that preceded death. It may be the sole entry. But there must be an entry. Mode of dying (heart failure/respiratory failure/ cardiorespiratory arrest) should never be entered. Mode or mechanism of death is the physiological disturbance or derangement resulting from cause of death being incompatible with life3. It serves no purpose. If condition on line (a) is due to another condition, record that in line (b). It is antecedent to the immediate cause of death. If condition on line (b) is due to another underlying condition, mention it in line (c). It is the condition antecedent to condition on line (b). If condition on line (b) is underlying condition then nothing more should be entered. When many conditions are involved, write full sequence. There should only be one condition per line with most recent condition at the top; example: [a] Perforation – [b] intestinal obstruction – [c] inguinal hernia; Septicemia - [b] gangrene foot - [c] diabetes.

          In part II, other conditions/diseases that unfavorably influenced the course/ modified/ contributed to the fatal outcome should be written. It may even not relate to the disease causing death.

          Next column is for interval between onset of diseased condition & death. Write exact period, when it is known. When unknown, approximate period should be written. It provides useful check on the sequence of events. Last column is for ICD code. That is not to be filled by the certifying medical practitioner. It shall be filled at the Registrar’s office after consulting the International Statistical Classification of Diseases 10 and National List prepared from ICD 10. The list is available at the District Registrar. The list being exhaustive is not given here.

          Below the cause of death column, there is provision for indicating the manner of death; being natural, accidental, suicidal, homicidal or if pending investigation. Manner of death is the fashion in which the death occurred. The certifying practitioner is expected to clearly write how the injuries occurred, as the case may be. Then for female deaths, one has to mention whether the death was associated with pregnancy. If yes, whether there was delivery or not?

          Below the certificate, every medical practitioner is expected to sign and write his full name and designation along with date [preferably use seal].

          Last part is detachable portion of the certificate which has to be duly filled and given to the next of kin of the deceased along with the body. In this part, confidentiality regarding the cause of death is to be maintained. The purpose of giving the last portion is to enable the relative register the death of the deceased.

          Form 4, Form 4A and Form 3 can be procured from the Registrar of Births and Deaths present in each city. 

1 comment:

Roopam said...

Dear Dr Lavlesh Kumar and Dr Swapnil Agrawal and Team,
Congratulations! You have done a wonderful job by creating this Blog. Having known you personally I can vouch for your Dedication and Professionalism in this Field of Legal Medicine.
I feel that Hospital Administrators and Private Doctors need to update thier Medico Legal knowledge very frequently and this blog shall help them in doing so very effectively.
Keep up the good work!
Regards,

Dr. Roopam Gupta
CMO-cum-Administrator
Alipore Hospital & Research Centre,
Alipore, NH- No.8, Taluka- Chikhli,
District- Navsari; State- Gujarat.
INDIA. PIN-396409

Mobile-+91 909 992 2480
(+91 2634) 233146, 231742, 329310, 651586
www.aliporehospital.com