New system from 2015.  Medical Certificate of Cause of Death (MCCD) provides a permanent legal record of the fact of death and enables the family to register the death, make arrangements for the disposal of the body, and settle the deceased’s estate. In addition, a MCCD provides a record of causes of death for public health reasons.

Electronic system available but paper copy remains legal, and family  needs it to register death.

Ideally consultant responsible for patient completes or is at least involved in completion.  This should be recorded in notes.

New system of reviews:

• In the shorter level 1 review cause of death checked, reviewer will speak to the certifying doctor about anything unusual. If the certifying doctor is unavailable or incapacitated, the Medical Reviewer will discuss the MCCD with the consultant in charge of the case or another member of the team who knew the deceased and / or has access to the clinical records.
• A level 2 review is similar to a level 1 in that the Medical Reviewer will check the MCCD and speak to the certifying doctor. However, in addition, the Medical Reviewer will also consider relevant documents associated with the death, including health records and results of investigations. They may also wish to view the body.

These review types will be conducted through a random selection process, will be available on request in certain circumstances from interested persons, or may be targeted by Medical Reviewers in response to any emerging pattern that requires further checks.

The last type of review is the “Interested Person” review – provides further reassurance. Includes relatives, any person present at death, healthcare professional involved with deceased etc.  Must be within 3yrs of death, and can only take place if not already reviewed randomly.  Request to medical review service.

Tips for Certifying Doctors

Contact the Death Certification Review Service (DCRS) by phone or email for help, open Monday to Friday 08:30-17:30. There is an on-call medical reviewer available out of hours.

Consider whether there is any reason to report to or discuss the case with the Procurator Fiscal (guidance here) e.g. trauma has been identified as a cause or contributor to death, there is a complaint about the care provided prior to death etc.

If you have discussed a case and agreed with the Procurator Fiscal that the case does not need to be formally reported, then do not tick the “PF” box.

Your writing should be in CAPITALS using BLACK ink throughout when completed by hand.

The time of death is the time that to the best of your knowledge and belief you think the patient died and NOT the time that death was verified.

Use business telephone numbers; do not include personal mobile numbers.

You must not include any abbreviations except HIV or Aids which are both permissible.

The causes must make sense both medically and chronologically. If you use more than one line in section 1 then what is entered in 1a MUST be caused by what is in 1b which MUST be caused by what is in 1c etc. Durations likewise should be sequential.

Sites and organisms in infections, including resistance and routes of infection are important and should be entered if known.

If you wish to enter a cause of death that you believe is the case but you have no confirmatory evidence, you can qualify it with “Probable” or “Presumed”.

If obesity has significantly contributed to the death it should be included.

None of the form is optional and all parts and questions on both sides should be considered and answered as appropriate.

It is the statutory duty of the doctor, who has “attended” the deceased during the last illness, to issue the MCCD. There is no clear legal definition of “attended”, but it is generally accepted to mean a doctor who has cared for the patient during the illness or condition that led to death and so is familiar with the patient’s medical history, investigations and treatment. It is not unlawful to complete a certificate if you have not personally attended the patient but you have to be in a position to certify to the best of your knowledge and belief and willing to be personally accountable having had access to the appropriate records.

If you cannot issue an MCCD you should contact a colleague who can, or discuss/report to the Procurator Fiscal.

[HIS tips – Support around Death (SAD) website]