Somebody sign the death certificate, already!

I'm still pissed off about something.

Consequently, I still feel the need to get this off my chest, even though I've said from the very beginning that this blog was never meant to be primarily about me or my life, but rather about science, medicine, and skepticism. Despite that intent, sometimes things happen that I have a hard time not venting about, and it's not always possible not to inject a bit of my own personal life into my writing. Also, after all the bad things that happened during my recent trip home, I'm having a hard time getting back to my usual topics. Yes, I'm aware that there's a blogger out there who took the time over the holiday week to write a two-part attack on something I wrote. Yes, I had briefly considered answering his attack. Unfortunately (or perhaps fortunately, depending upon your point of view), my heart just isn't into getting into a blog pissing match at the moment. (And, yes, I know I haven't always been above enthusiastically engaging in such activities occasionally in the past.) Unfortunately, this is festering, and, now that I think about it, it is relevant to the usual topics of this blog, given that it has to do with medicine. So I'm going to write about it.

Please indulge me for one more day. I promise to get back to my usual topics soon, and I haven't forgotten about the plans I had made for this blog's second year.

Here's what pissed me off last week. As I mentioned a few days ago, my uncle died last week after having suffered a massive heart attack the Thursday night before Christmas. It happened at around 2 AM last Wednesday. The doctor on duty declared him dead--and then left for India without signing the death certificate. I don't necessarily blame her for that. Most likely she was covering that night and was scheduled to leave the next morning. It's not at all uncommon for it to take several hours to type up a death certificate to be signed, although many times as a resident I filled out the death certificate myself when I happened to have to declare a patient dead. No, what happened next is what irritated the hell out of me. Perhaps it is the fact that the funeral is tomorrow and I won't be able to attend that brought this to a head today.

They couldn't find any other doctor to sign the death certificate. And without the death certificate the funeral home director couldn't legally take the body from the hospital morgue. The body couldn't legally be cremated according to my uncle's stated wish. The body had to stay in a refrigerated cubicle in the morgue. To add to the indignity, my uncle's family was charged $75 a day for storage and refrigeration of the body! It still makes my blood do a slow boil to picture my uncle's body left there for any longer than was absolutely necessary. All I can envision is his body on a slab in a cold, dark refrigerator, collecting frost.

And if I, as just his nephew, thought about such things, imagine what his wife and daughter were thinking about.

This went on for almost three days. Any hope of having the funeral before the end of the year (while most of the family from out of state--including me--was still around) dissipated. During this difficult time after my uncle's death, his wife and daughter had to deal with this additional problem and try to find out who could sign the death certificate in the absence of the doctor who declared the patient dead. I understand that it's a legal document. In fact, I've even balked at signing a death certificate for one of my partner's patients once before, but that was only because I knew he was in town and not on vacation. If he had been on vacation or out of town, I would have simply asked for the chart to verify the cause of death and then signed the certificate. That's all it should have taken: For one of the doctor's partners (or the attending physician if, as I suspect but don't know, the doctor in question was a resident or a house doctor) to do that. There is no excuse for this doctor's absence to have delayed the signing of the death certificate for more than a few hours at most, holidays or no holidays.

No excuse at all.

Yet, for over two days, my cousin was given what seemed to all of us to be the runaround. She made multiple phone calls, and finally appealed to my mother to get a couple of relatives on her side of the family involved, one of whom happens to be an attending at the very same hospital where my uncle died (but was unfortunately in Florida at the time) and the other of whom is a surgical assistant there. She was given the number of hospital administration, and I hope she gave them hell. The sad thing is, it should never have been necessary for anyone to give anyone hell just to get the death certificate signed!

The lesson of this incident is that little things we doctors do, without even thinking about it, can, without our knowing it or necessarily appreciating it, cause enormous distress in patients or their families. Should I ever be faced with the prospect of having to sign a death certificate for one of my partners when he is unavailable, I won't balk. I'll ask for the chart to verify the cause of death (a death certificate is a legal document, after all, and it's foolish to sign it without some minimal verification), but I won't balk the way I did a couple of years ago.

I'll remember this incident when it comes to other things I do that affect patients. I also hope that my fellow physicians who may read this will consider what I've said and think about how even the seemingly smallest things they do can impact the lives of their patients and/or their families.


  1. That's a good lesson for life in general: try to be more aware of how even your smallest actions affect those around you.

  2. No excuse, indeed. I'm afraid, based on my experience at the time of my father's death, that some hospital administrators' main concerns is CYA (Someone on the hospital staff stole -- excuse me -- "lost" my father's wedding ring). If your family's experience had happened to me, I would have told them that if they had not resolved the matter by the next time I called, my next call would be to a lawyer because I was feeling really, really emotionally damaged. And I would beg them to sue me for the $75 a day.

  3. This is more than inconsiderate.
    It is the same as abandoning a patient while they are alive.They abandond your family.
    My own response would be to request a sincere personal apology to the family.If this is not done,then I would file a complaint with the State Medical Practice Board,and the hsopital.I would certainly have any postdeath charges sent to the doctor.
    The opposite situation happened to me,when a nephew desired a private cremation and burial for his aunt.When I gave him the death certificate,he was irrate that I hadn't arranged cremation,transfer,and other permits.He clearly was expecting me to be his free funeral director.I politely told him,these arrangements were his responsibility.

    William Barrett MD

  4. Although the original problem was with the doctor who left before signing the death certificate, the continuing problem was with the hospital administration. It's not reasonable to expect a patient's family to chase down administrative details; that's the administrators' job. So, I would contact the hospital administrator, but I would be surprised if he offers an apology. When we talked to the hospital administrator about the disappearance of my father's wedding ring, he was more concerned about not admitting liability than in apologizing.

  5. Orac-
    Call your friendly local coroner. We have signed death certificates many times, even when patients were under a doctor's care, to let the arrangements happen. It's better for the family.

    It enrages me when someone who is taking care of a patient for years, or one of his partners will not sign the death certificate. Why have you been taking the patient's money all those years?

    Step up to the plate and do your job. Sheesh!

  6. i have great sympathy for you. the medical/legal details are an unwanted pain in the butt when trying to deal with the death of a loved one. i recently went 'round and 'round with all manner of crap in ireland. my paternal uncle at the end of a long, painful, battle with cancer took his own life. the local church refused to bury a suicide. we tried reason, we tried money, we tried. . .we finally buried him ourselves among his beloved apple trees and had a "renegade" priest officiate. all of the extra work is the last thing you want to deal with when you are dealing with the loss of a loved one. take all the time you need to work through this. you are what's important here. my best wishes go with you.

  7. I think that a little more understanding for the position of your patients is a good thing. My little sister was visiting for the holidays (really to see her neice). She is a pediatric dentist and is always furious when people give their infants bottles before they sleep as that leads to tooth rot (my daughter doesn't have to woory about that as she doesn't have teeth yet). However, when she woke up at 11 pm and wouldn't be soothed back to sleep, seeing that she stopped crying as soon as the bottle was put in her mouth allowed her to understand why a parent would ignore her advise and use a bottle. She told me that she would be more understanding to her patients in the future.

  8. wow, that is absolutely unacceptable! in your shoes, i'd be (justifiably) outraged.


  9. It seems the Hippocratic Oath should extend to the patient after death as well to his/her family.

  10. Odd how this Intarweb thing works. I've read this blog for about 8 months or so. I'm a total stranger, yet I'm genuinely moved by what gets written here. I wish you strength in hard times, Orac.

    And, if events somehow conspire to make you a better doctor in the future: take that wisdom and run.

    That, by the way, is the real secret of life.


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