Investigation by the DuPage County Coroner
Natural Death Investigations
Most people are under the care of a physician and have no suspicious circumstances at the time of their death. In these situations the attending physician will certify the death certificate at the approval of the Coroner. The Physician attending the patient for the condition that caused patients' death is responsible, by law, to sign the death certificate.
When a person has an attending physician and dies in a hospital emergency room, or within 24-hours after being admitted to a hospital, or at home, or at any public place, or under any other kind of unknown circumstance, the Coroner's office is notified. The circumstances and details of the death are reviewed. If it appears to be a death of natural causes the attending physician will be contacted. The circumstances are reviewed with the attending physician. If the deceased has a medical history that supports a cause of death that is consistent with the circumstances surrounding the death and the physician agrees, the case is released to the doctor to sign the death certificate.
If the attending physician does not have enough medical history to support the cause of death the death is investigated and the death certificate is signed and filed by the Coroner.
The Coroner also reviews all deaths certified on a Medical Certificate of death when a cremation permit is requested to assure that the death should have been certified as a natural cause of death and there is no need for further investigation.
Do Not Resuscitate (DNR)
The purpose of cardiopulmonary resuscitation (CPR) is the prevention of sudden, unexpected death. This decision to Do Not Resuscitate (DNR) is made by a physician and patient or the physician and the patient's family. The physician must sign this order and therefore is responsible as the treating physician authorizing that no extraordinary means will be deployed. As the treating physician attending the patient for the condition that caused patients' death you are responsible, by law, to sign the death certificate.
Home Deaths When Enrolled with a Hospice Program
Patients diagnosed with a terminal illness and choose to enroll in a hospice program whether at the hospital or home require an attending physician. The hospice patient must have a valid DNR (Do Not Resuscitate) order on file. A police/fire/emergency agency is not called to respond to the scene in this type of situation and the Deputy Coroner on-call may not respond to the residence. Either the hospice nurse or the funeral director reports the death to the DuPage County Coroner's Office. The report is taken over the phone and the Deputy Coroner taking the call releases the body to the funeral director. The Physician attending the patient for the condition that caused patients' death is responsible, by law, to sign the death certificate.
Home Deaths Without Hospice
If your patient dies at home under these circumstances, 911 should be called and when death has been confirmed the Coroner’s Office will be contacted and requested to respond to the scene. The circumstances of the death will be reviewed and the body examined to confirm that there were no suspicious aspects. You, as the attending physician will be contacted. If all appears in order and you are willing to certify the death, you may sign the death certificate. If you do not feel comfortable making that decision the Coroner's office will certify the Death Certificate but will greatly value your input into the the probabilities as to the cause of death.
If a person dies at home and the death was not expected, the Coroner's Office will be notified and will investigate the death. When the investigation is completed, the body will be released to the funeral home chosen by the family.
Nursing Home Deaths
If a person is enrolled in a hospice program and dies in a nursing home the hospice nurse reports the death to the Coroner.
If the nursing home is considered a state facility they must report all deaths. Most deaths in private nursing homes in DuPage County report are reported. However, if a person is in a nursing facility because of injury or they have sustained a recent fall or injury, or any other trauma, the death must be reported.
The DuPage County Coroner's Office is mandated to monitor nursing home deaths in such a way as to monitor neglect and abuse. We take this responsibility very seriously while also understanding that most nursing homes are excellent facilities who take the care of these elderly patients very well. The investigation may include testing and autopsy dependent on the circumstances.
The Physician attending the patient for the condition that caused patients' death is responsible, by law, to sign the death certificate.
The last service and care that the attending physician can offer to the deceased patient, and especially, the remaining family and descendants is a proper and most accurate completion of the Death Certificate. The purpose of the Death Certificate is to create a permanent record of the cause and manner of death. If there is no suspicion or questionable death then our goal is to record the most valuation information available for the personal and public good.
You, as the treating Physician, are helping create a document for posterity to help future generations. This cause of death can best be determined by a thorough examination, autopsy toxicology etc.. The coroner's office is charged with doing this when there is suspicion and other mandated situations. However, when these situations do not exist the coroner is not mandated to do further examination. The hospital pathologists may perform and autopsy or the family may request private autopsy.
When an autopsy is not done the patient's personal physician has the best knowledge and is best able to document the vital information regarding the patient's final illness and death.
This information is considered so important to the Public Good (well being of society) that the Illinois Legislature has obligated the attending physician with the duty to certify the death certificate of patients under their care.
Treating Physician's Obligation
The following is the pertinent section of the Vital Records Act which mandates that the treating physician must sign the death certificate for patients under their care:
(410 ILCS 535/18) (from Ch. 111 1/2, par. 73-18)
(2) The medical certification shall be completed and signed within 48 hours after death by the physician in charge of the patient's care for the illness or condition which resulted in death, except when death is subject to the coroner's or medical examiner's investigation. In the absence of the physician or with his approval, the medical certificate may be completed and signed by his associate physician, the chief medical officer of the institution in which death occurred or by the physician who performed an autopsy upon the decedent.
This statutes states that the physician attending the patient for the condition which caused his or her death SHALL complete the Death Certificate within 48 hrs of the death. There is no time frame as to when the patient was last seen or cared for in this statute, only the question of whether the death is subject to a Coroner's investigation or not.
Please consider the value that you as the treating Physician can pass to the remaining family and generations to come by putting your most educated and thoughtful diagnosis on this important document. If you do not feel that you can provide this data then consult with the Coroner or Deputy Coroner and assist them. The Death Certificate will then be completed by the Coroner's Office with as much information as possible.
Physician Liability from Signing Death Certificate
Physicians are reasonably concerned about liability and repercussions for their actions.
Later, in this statute, it is stated that you are committing a Class A misdemeanor only if you knowingly make a false statement and at the same time are committing a Class A misdemeanor if you do not perform the duties of this act.
In summary you are not liable while making a good faith effort to provide the present and future generations with the best educated and knowledgeable conclusions about the death of your patient. If you do not provide such documentation you are in breach of the law. Please work with the patients family and the Coroner's Office to c the most beneficial Death Certificate to file.
(410 ILCS 535/27) (from Ch. 111 1/2, par. 73-27)
Sec. 27. (1) (a) Any person who willfully and knowingly makes any false statement in a report, record, or certificate required to be filed under this Act, or in an application for an amendment thereof, or who willfully and knowingly supplies false information intending that such information be used in the preparation of any such report, record, or certificate, or amendment thereof
(2)(b) Any person who refuses to provide information required by this Act; or
(c) Any person who willfully neglects or violates any of the provisions of this Act or refuses to perform any of the duties imposed upon him or her by this Act is guilty of a Class A misdemeanor.
Death Certificate Tutorial
The Department of Public Health has created a tutorial for Physicians to help them understand the proper and best way to fill out Death Certificates: http://www.netsmartu.com/ivrs/cod/player.html.
Death certificates in which mechanisms of death (sepsis, shock, cardiac arrest, multiorgan failure, etc.) are listed as the underlying cause are often reported to our office by Vital Records. Listing a mechanism of death rather than an etiologically specific underlying cause will generate follow up from the Vital Records office or involvement by our office. Please remember that mechanism is not a cause of death for official purposes on a death certificate.
In cases where the cause and manner of death are not determined at the time of the autopsy (in other words, pending further investigation), copies of the autopsy, investigative and toxicology reports will usually be available a few weeks after the cause of death is determined and a death certificate is filed.
Reports are released only after all the reports (autopsy, investigative, and toxicology) and the death certificate have been completed. We do not prepare preliminary reports.
If you desire these reports concerning your patients, please write, or telephone this office with your request.
If when you receive the reports you have questions, please call our office at (630) 407 2600.
Although we determine and finalize the information on the death certificate, our office does not provide certified copies of the death certificate.
You may request certified copies of the certified death certificates from the DuPage County Health Department.
The laws have been written to release the treating physician from liability or risk in the event of death of the patient. The purpose of this legislation is to allow the treating physician to comply with the needs of the Coroner to investigate the cause and manner of death.
The law is copied below:
45 CFR 164.512
[HIPAA Regulations Regarding Public Health Information section 164.512(g)(1) (g) Standard: Uses and disclosures about decedents. (1) Coroners and medical examiners. A covered entity may disclose protected health information to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other duties as authorized by law. A covered entity that also performs the duties of a coroner or medical examiner may use protected health information for the purposes described in this paragraph.