1. DEATH CERTIFICATES AND CORONER’S CASES Dr AD Cala & Professor TJ Lyons Forensic Medicine Unit, John Hunter Hospital

2. WHAT IS THE CAUSE OF DEATH?

7. THE CAUSE OF DEATH: “THE UNDERLYING CONDITION/S WHICH SET IN TRAIN AN EVENT OR EVENTS WHICH LEADS TO THE DEATH OF A PERSON” “THE UNDERLYING CONDITION/S WHICH SET IN TRAIN AN EVENT OR EVENTS WHICH LEADS TO THE DEATH OF A PERSON”

8. MECHANISM OF DEATH IS NOT THE CAUSE OF DEATH: eg “ACUTE PULMONARY OEDEMA” eg “ACUTE PULMONARY OEDEMA” “BLOOD LOSS” “BLOOD LOSS” “DYSPNOEA” “DYSPNOEA” “EXHAUSTION” “EXHAUSTION” “DEHYDRATION” “DEHYDRATION” THESE ARE NOT CAUSES OF DEATH! THESE ARE NOT CAUSES OF DEATH! NEED TO KNOW THE UNDERLYING REASON FOR EACH OF THESE NEED TO KNOW THE UNDERLYING REASON FOR EACH OF THESE

9. Example 1: eg 1.a) CARDIOGENIC SHOCK due to: eg 1.a) CARDIOGENIC SHOCK due to: 1.b) ACUTE MYOCARDIAL INFARCTION due to: 1.b) ACUTE MYOCARDIAL INFARCTION due to: 1.c) THROMBOSED CORONARY ARTERY 1.c) THROMBOSED CORONARY ARTERY 2. (CONTRIBUTING FACTORS TO DEATH) 2. (CONTRIBUTING FACTORS TO DEATH) eg DIABETES MELLITUS, HYPERTENSION, HYPERCHOLESTEROLAEMIA eg DIABETES MELLITUS, HYPERTENSION, HYPERCHOLESTEROLAEMIA

10. OTHER EXAMPLES OF CAUSES OF DEATH: 1.a) DISSEMINATED CARCINOMA OF BREAST or 1.a) DISSEMINATED CARCINOMA OF BREAST or 1.a) ASPIRATION PNEUMONIA and INANITION (WASTING/DEHYDRATION) due to: 1.a) ASPIRATION PNEUMONIA and INANITION (WASTING/DEHYDRATION) due to: b.) ALZHEIMER’S DISEASE b.) ALZHEIMER’S DISEASE

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

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

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

14. DEATH CERTIFICATES: IDENTITY OF DECEASED KNOWN TO YOU IDENTITY OF DECEASED KNOWN TO YOU YOU HAVE TREATED DECEASED DURING LAST ILLNESS 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. IF YOU KNOW THE CAUSE OF DEATH, YOU SHOULD WRITE A DEATH CERTIFICATE UNLESS IT IS A CORONER’S CASE.

15. CORONER’S CASES: VIOLENT, TRAUMATIC OR UNNATURAL DEATH eg MVA, SHOOTING, ASSAULT VIOLENT, TRAUMATIC OR UNNATURAL DEATH eg MVA, SHOOTING, ASSAULT SUSPICIOUS OR UNUSUAL CIRCUMSTANCES eg SUSPICIOUS OR UNUSUAL CIRCUMSTANCES eg SUDDEN DEATH, CAUSE OF WHICH IS UNKNOWN SUDDEN DEATH, CAUSE OF WHICH IS UNKNOWN HAS NOT SEEN A DOCTOR IN 6 MONTHS (USED TO BE 3 MONTHS) HAS NOT SEEN A DOCTOR IN 6 MONTHS (USED TO BE 3 MONTHS)

16. CORONER’S CASES: DEATH WHICH WAS NOT THE REASONABLY EXPECTED OUTCOME OF A SURGICAL, MEDICAL, DENTAL OR LIKE PROCEDURE DEATH WHICH WAS NOT THE REASONABLY EXPECTED OUTCOME OF A SURGICAL, MEDICAL, DENTAL OR LIKE PROCEDURE +/- ANAESTHETIC (MOST +) +/- ANAESTHETIC (MOST +) UNDEFINED PART OF ACT UNDEFINED PART OF ACT UP TO MEDICAL PRACTITIONER TO INTERPRET UP TO MEDICAL PRACTITIONER TO INTERPRET

17. CORONER’S CASES: DEATH IN CUSTODY DEATH IN CUSTODY POLICE DETENTION eg CAR CHASE AFTER BREATHALYSER POLICE DETENTION eg CAR CHASE AFTER BREATHALYSER PUBLIC INSTITUTION eg MENTAL HEALTH FACILITY PUBLIC INSTITUTION eg MENTAL HEALTH FACILITY CHILD CARE CENTRE CHILD CARE CENTRE “GAZETTED” NURSING HOME/HOSTEL “GAZETTED” NURSING HOME/HOSTEL

18. FALLS IN THE ELDERLY: CERTIFICATE CAN BE ISSUED: CERTIFICATE CAN BE ISSUED: PERSON 72 YRS + 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 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

19. CORONER’S CASES: eg J.H.H. DEATH eg J.H.H. DEATH MEDICAL RECORDS PERUSED BY PATHOLOGIST MEDICAL RECORDS PERUSED BY PATHOLOGIST +/- X-RAYS, PATH RESULTS etc +/- X-RAYS, PATH RESULTS etc COPIES OF RECORDS MADE COPIES OF RECORDS MADE SO MAKE LEGIBLE NOTES! SO MAKE LEGIBLE NOTES!

20. MEDICAL NOTES: LEGIBLE ENTRIES DATED & TIME LEGIBLE ENTRIES DATED & TIME CHRONOLOGICAL RECORDS BEST CHRONOLOGICAL RECORDS BEST IF RETROSPECTIVE ENTRY, STATE SPECIFICALLY IF RETROSPECTIVE ENTRY, STATE SPECIFICALLY “Retrospective notes”……. “Retrospective notes”……. DON’T “FUDGE” NOTES DON’T “FUDGE” NOTES DON’T ALTER NOTES UNLESS PERMISSION GIVEN TO DO SO. DON’T ALTER NOTES UNLESS PERMISSION GIVEN TO DO SO.

21. SUMMARY: IF UNSURE-ASK. IF UNSURE-ASK. SENIOR COLLEAGUES ARE NOT LAWYERS AND THEIR ADVICE MAY BE WRONG 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) 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 MUST NOT “GUESS” THE CAUSE OF DEATH DON’T BE INTIMIDATED BY NURSES TO “SIGN OFF” DON’T BE INTIMIDATED BY NURSES TO “SIGN OFF” CRITICALLY READ “DEATHS REPORTABLE TO CORONER” FORM (NSW HEALTH INTRANET) CRITICALLY READ “DEATHS REPORTABLE TO CORONER” FORM (NSW HEALTH INTRANET)

22. THANK YOU.