Accurate death certificates challenged by poor training

Completing the document that marks the end of every American's life can take extraordinary amounts of time and persistence for both funeral providers and medical professionals.

"Funeral directors often struggle to obtain a physician's signature on a death certificate,'' said Dr. Kenneth Iserson, an emergency physician and professor emeritus at the University of Arizona, who has written several books on practices and rituals surrounding death.

"In an age of managed care, HMOs and multispecialty clinics, they must not only locate the busy practitioner for a signature, but also identify the correct physician."

In most states, under most circumstances, survivors cannot bury or cremate a body until a licensed physician has signed a death certificate, or a medical examiner has signed a temporary death certificate pending autopsy results.

"It is a major problem for the families of the deceased getting death certificates. Without them, they may not have access to financial records, bank accounts, insurance payments,'' said Dr. Robert Kirkpatrick, a family-medicine specialist in Memphis, Tenn., and former president of the Tennessee Medical Association. "Consistent efforts to ensure that data coming from the death certificates is accurate are also important.

"Most of the time, there's a delay because physicians are so inundated and aggravated with paperwork. That why we've been working with our vital-records office to make an effort to explain to physicians why death certificates are so important, rather than beating on them about it."

Sharon Leinbach, Tennessee's registrar of vital statistics, said, "You hear a lot of things said about whether it's the funeral directors or the doctors contributing to delays, but getting the certification done promptly and correctly is a combined effort."

She noted that the state's medical-licensure board two years ago adopted rules that call for any physician who is legally required to certify a death and refuses, or is consistently late, to be charged with unprofessional conduct, and that one doctor has been disciplined under the rule.

Such collaboration is hardly universal, though.

"I find that many doctors -- and/or their office staff -- are not particularly cooperative regarding the timely and proper completion of death certificates,'' said Robert Smith, a funeral director and mortuary-science educator in southern New Jersey.

"The state's vital-records office seems to expect funeral directors to educate doctors regarding the death-certificate process rather than tackling the process themselves."

Smith and other funeral-service educators say all formal mortuary training around the country deals, to some extent, with death-certificate completion.

But survey results in a 2002 report from researchers with the federal Centers for Disease Control and Prevention found that 52 percent of funeral directors had no formal training in death certification, and that nearly 4 in 5 had trouble determining a dead person's race, education or even occupation.

Michael Landon, a funeral director and educator in Fayetteville, N.C., said death-certificate information is covered twice in the program he oversees at a local community college.

"Completion of the biographical information is not difficult as long as you can get it during the arrangements meeting with the family,'' he said. "Only on rare occasions do funeral homes, that I am aware of, have difficulties in obtaining the signature of the physician for the death certificate."

E-mail Lee Bowman at bowmanl(at)shns.com

(Distributed by Scripps Howard News Service, http://www.scrippsnews.com)