Important events, or vital statistics , in a person’s life, such as birth and death dates, are used by the government, public health agencies, and other institutions to determine population trends and needs. The reporting agencies and services include the Department of Health and Human Services, Centers for Disease Control and Prevention, the National Center for Health Statistics, and the Public Health Service. The mortality rate , also called the death rate, is the ratio of the number of deaths to total population in a given location. The morbidity rate is the number of sick people or cases of disease in relationship to a specific population. The Mortality and Morbidity Weekly Report, a list of illness and death rates for a variety of illnesses, is published every week by the Centers for Disease Control (CDC) in Atlanta, Georgia. The CDC is always on the lookout for outbreaks of disease in major cities and all the states. Therefore, the CDC needs to have accurate input from physicians and healthcare officials of statistics relating to deaths and illness.
The physician’s duty to report these events is a duty owed the public— public duties . These duties include reports of births, stillbirths, and deaths; communicable illnesses or diseases; drug abuse; certain injuries, such as rape, gunshot, and knife wounds; animal bites; and abuse of children, spouses, and older adults. Additional information includes data such as marriages, divorces, and induced termination of pregnancies.
Office personnel such as nurses, medical assistants, and school nurses may carry out many of these reporting duties. The collection of this information should be taken seriously. The data —or facts, figures, and statistics—represent information about the individual patient’s life. In addition, some of the data are of a highly sensitive nature, such as the facts concerning rape, abuse, and death.
Even though office staff may actually perform the paperwork requirements of the law, the ultimate responsibility for reporting health statistics and abuse remains with the physician.
Recommendations for completing legal records such as birth and death certificates are summarized in Table 7.1 .
Physicians, primarily those assisting at births, issue the certificate of live birth that will be maintained during a person’s life as proof of age. A valid birth certificate is required to receive many government documents such as a Social Security card, passport, driver’s license, and voter registration.
TABLE 7.1 Recommendations for Completing Legal Records and Certificates
|· 1. Request information from the state registrar for specific requirements on completing certificates.|
· 2. Type all documents when possible. If the record is completed manually, then print using black ink.
· 3. Make sure that all blank spaces are completed.
· 4. Verify all names for correct spelling.
· 5. Use full original signature, not rubber stamps.
· 6. File original certificates or reports with the appropriate registrar. Copies or reproductions are not acceptable.
· 7. Avoid abbreviations.
· 8. Do not alter the certificate or make erasures.
· 9. Keep a copy in the patient’s file.
A physician must sign the certificate of live birth. For a hospital birth, the certificate is filed by the hospital at the county clerk’s office in the state in which the birth took place. If the delivery occurs at home, the midwife or person in attendance at the birth can file the birth certificate at the county public health department. While the time frame to submit a birth certificate varies somewhat from state to state, in most cases it must be done within the first week of the baby’s life. Some states impose a criminal penalty if the birth and death certificates are not properly completed and handled. If the birth has not been registered within a year, then the physician, midwife, or any other person in attendance at the birth may have to go to court to provide proof of the birth.
Physicians and others who attend a birth, such as midwives, are required to report certain diseases in newborns. Ophthalmia neonatorium is a serious eye condition present at birth that causes inflammation, swelling, redness, and an unnatural discharge in an infant’s eyes. If untreated, it may result in blindness. Evidence of this disease must be reported within 12 hours after birth. A test for the condition of phenylketonuria (PKU) is another test required by state health departments on newborns. PKU can be treated with dietary restrictions. In addition, some states also require testing for sickle cell anemia.
Some states impose a criminal penalty if a birth and death certificate are not handled correctly.
Physicians sign a certificate indicating the cause of a natural death. The Department of Public Health in each state provides the specific requirement for that state. For example, in the case of a stillbirth before the twentieth week of gestation, the physician must file both a birth and death certificate in some states. In other states, neither is required if the fetus has not reached the twentieth week of gestation. And in some states only a death certificate is required for a stillbirth after the twentieth week. In the case of a live birth with a subsequent death of the infant, both a birth certificate and a death certificate are necessary in all states.
The physician who had been attending the deceased person usually signs the death certificate, stating the time and cause of death. The physician must include the following information on the certificate:
· The date and time of death
· The cause of death: diseases, injuries, or complications
· How long the deceased person was treated for the disease or injury before dying
· The presence or absence of pregnancy (for female decedent)
· If an autopsy took place
In most states, a death certificate must be signed within 24 to 72 hours after the patient’s death. After the physician has signed the certificate, it is given to the mortician, who files it with the state or county clerk’s office.
Because funeral arrangements and burial cannot take place until the death certificate is signed, it is important that the physician sign as soon as possible.
The death certificate provides proof that a death has occurred. It is often required to confirm information concerning veteran’s benefits, Internal Revenue Service (IRS) information, insurance benefits, and other financial information when settling an estate. If a funeral home provides the burial, they will often obtain copies of the death certificate for the family to submit to agencies, such as the IRS. The death certificate must be signed as soon as possible after a person’s death. The time and date of the death are important facts and must be accurate.
In some deaths, a coroner or health official must sign a certificate. See Table 7.2 for a listing of cases that need a coroner’s signature.
TABLE 7.2 Cases Needing a Coroner’s Signature
|· No physician present at the time of death|
· A violent death, including homicide, suicide, or accident
· Death as a result of a criminal action
· An unlawful death such as assisted suicide
· Death from an undetermined cause (unexpected or unexplained)
· Death resulting from chemical, electrical, or radiation injury
· Death caused by criminal abortion, including self-induced
· Death occurring less than 24 hours after hospital admission
· No physician attending the patient within 36 hours preceding death
· Death occurring outside of a hospital or licensed healthcare facility
· Suspicious death, such as from a fall
· Death of a person whose body is not claimed by friends or relatives
· Death of a person whose identity is unknown
· Death of a child under the age of two years if the death is from an unknown cause or if it appears the death is from Sudden Infant Death Syndrome (SIDS)
· Death of a person in jail or prison
A coroner is the public health officer who holds an investigation, or inquest , if the death is from an unknown or violent cause. The coroner or medical examiner completes the death certificate if the deceased has not been under the care of a physician. In some states, the coroner will also investigate an accidental death, such as one resulting from a fall. A medical examiner is a physician, usually a pathologist, who can investigate an unexplained death and perform autopsies. An autopsy , which is a postmortem or after-death examination of the organs and tissues of the body, may have to be performed to determine the cause of death.
Unless the death results from suspicious causes, such as a homicide, an autopsy cannot be performed on a body without the consent of the surviving person who has the “first right” to the body. This person is usually a family member who is responsible for burying the deceased person.
Physicians must report all diseases that can be transmitted from one person to another and are considered a general threat to the public. The report can be made to the public health authorities by phone or mail. The communicable disease report should include the following:
· Name, address, age, and occupation of the patient
· Name of the disease or suspected disease
· Date of onset of the disease
· Name of the person issuing the report
The list of reportable diseases differs from state to state, but all states require reports of tuberculosis, rubeola, rubella, tetanus, diphtheria, cholera, poliomyelitis, acquired immunodeficiency syndrome (AIDS), meningococcal meningitis, and rheumatic fever. In addition, some diseases, such as influenza, need to be reported if there is a high incidence within a certain population. Sexually transmitted diseases (STDs) or venereal diseases, such as syphilis, gonorrhea, and genital warts, must also be reported to protect the public. Employees in food service, day care, and healthcare occupations are more carefully monitored for contagious diseases by public health departments.
A listing of childhood vaccines and toxoids that are required by law (the National Childhood Vaccine Injury Act of 1986) are found in Table 7.3 .
Many pediatricians also recommend that every child receive H. influenzae type b vaccine (HiB), hepatitis A vaccine, varicella (chicken pox) vaccine, and pneumococcal (pneumonia) vaccine (PCV7). In most states, newborn infants also receive erythromycin applied to both eyes and a Vitamin K injection to prevent hemorrhagic diseases of the newborn.
TABLE 7.3 Required Children’s Vaccines
|· Diphtheria, pertussis (whooping cough), tetanus toxoid (DPT)|
· Measles, mumps, rubella (MMR)
· Poliovirus vaccine, live
· Poliovirus vaccine, inactivated
· Hepatitis B vaccine (HBV)
· Tuberculosis test
The National Childhood Vaccine Injury Act, passed by Congress in 1986, requires a physician or healthcare administrator to report all vaccine administrations and adverse reactions to vaccines and toxoids. The physician must report information directly relating to the vaccine and toxoid, such as the manufacturer and lot number. In addition, the name and address of the person administering the vaccine and the date of administration should be documented in the patient’s record.
Duty to Report AIDS, HIV, and ARC Cases
All states have statutes or regulations that require healthcare providers to report cases of AIDS to the local or state department of health. Most states also require that human immunodeficiency virus (HIV) and AIDS-related complex (ARC) cases be reported as well. Who should report the cases varies. In some states, it is the duty of the attending physician or laboratory that performs the test. Other states may require hospitals, clinics, blood banks, and other facilities to report positive cases.
To date, Minnesota is the only state that has a self-reporting provision requiring healthcare workers who are diagnosed with HIV to report the fact to the health department or commissioner of health within 30 days of learning the diagnosis. In addition, the Minnesota law requires healthcare workers to report, within 10 days, of other healthcare workers who are infected (Minn. Stat., §214.18(2),(4).).
Many states have confidentiality statutes that allow notification of an HIV patient’s spouse, needle-sharing partner, or other contact person who is at risk of the infection (California Health and Safety Code 121015). A physician who wishes to notify a contact person under one of these laws should always discuss such plans with the patient first. The physician may wish to remind the patient of the moral obligation to others. Patients should always be informed that there are some statutes that impose criminal liability on someone who is an HIV carrier and knowingly engages in activities that could spread the virus to others