Attending Physician Wouldn't Sign Death Certificate

[Sue Damonas, BSN]

A patient of mine died yesterday and the attending refused to sign the death certificate because the patient was on Hospice. I called the medical director who agreed to sign it but was puzzled why the attending wouldn't sign it. When I called to speak to the attending he refused to talk to me. I've never had this happen before. Has this happened to any of you?

[Hospice Nurse LPN, BSN, RN]

Was hospice called when the patient died? The hospice nurse usually makes all the calls and our hospice medical director signs all death certs.

[sharlynn]

In Arkansas, the Hospice RN signs the death certificate.

[doodlemom]

In Arkansas, the Hospice RN signs the death certificate.

Are you sure it is the death certificate that the nurse signs? The death certificate is a legal document that the funeral home will prepare for signature which is then filed with Vital Statistics. I have never heard of any one but a physician being able to sign this document. Our nurses pronounce and sign a death note that includes time of death, circumstances, and medications that we dispensed of - but it is a document that is filed in the patient's chart.

[caroladybelle, BSN, RN]

In some places, nurses can pronounce the patient, but usually a doctor has to sign the death certificate as it generally contains a cause of death. And that would generally involve an MD determination/medical diagnosis and out of nursing scope.

In some places, when a patient gets admitted into hospice services, the medical director/MD for the hospice becomes the "attending" for basic hospice services. The standing orders that hospice nurses follow usually are under this MDs signature/authority. And as death is usually part of those services, the medical director often signs the death certificate.

While the patient's regular MD may still see them, they are often not "responsible" for things regarding hospice care....and death may fall in the that category.

[Hospice Nurse LPN, BSN, RN]

Quote

Originally Posted by sharlynn 

In Arkansas, the Hospice RN signs the death certificate.

WOW! In Louisiana, the nurse pronounces, but the MD must sign. Yes, even an LPN can pronounce here.

[leslie :-D]

sorry, but a nurse cannot sign the actual death certificates.

we fill out the pronouncement forms only.

leslie

[aimeee, BSN, RN]

Sounds like the attending needs a doctor to doctor call from your medical director to clarify what their respective roles are.

[sharlynn]

Are you sure it is the death certificate that the nurse signs? The death certificate is a legal document that the funeral home will prepare for signature which is then filed with Vital Statistics. I have never heard of any one but a physician being able to sign this document. Our nurses pronounce and sign a death note that includes time of death, circumstances, and medications that we dispensed of - but it is a document that is filed in the patient's chart.

THE death certificate. We notify the coroner of the death by phone. The certificate goes to the funeral home with the body. If we make a mistake, the family has no death certificate to collect insurance until the nurse corrects it. This is Arkansas and Hospice RN only.

[JadeOpel]

In Maryland only a MD can sign a death cert. A nurse can write info in the patients chart expired time ect... But a doctor must sign the death cert. In the case according to my understanding the attending should have signed the cert. hospice or not.