Death Certification.pptx. MCCD ICD FORMS

MCCD FORMS 4 4A

1. Medical Certification of Cause of Death(MCCD) DR VARUN MODGIL, ASST PROF DEPTT OF FORENSIC MEDICINE DAYANAND MEDICAL COLLGE

2. DEATH … “ Complete , permanent and irreversible stoppage of respiration, circulation and brain functions ” Legal definition : ( under section 46 IPC=s. 2(6) B.N.S 2023 ) “ Permanent disappearance of all Evidence of life at any time after live-birth has taken place” (Section 2(b) of “The registration of births and deaths act, 1969”)

3. DEATH-PROCESS/PHASES Somatic death Molecular death

4. Brain Death: Beating heart, Breathing by arti ficial means, absence of encephalic electrical activity. criteria for brain death.. Philadelphia protocol(1969) Minnesota criteria(1971) Harvard Criteria(1968)

5. Circulation Tests Magnus test Diaphanous test I card's test Finger nail test Application of heat Cutting a small artery ECG

6. Respiration Stoppage Test Apnoea test Winslow test Stethoscope Mirror test

7. Brain-stem Death CERTIFICATION Pupillary reflex Oculocephalic reflex Vestibulo ocular reflex(caloric response) Corneal reflex Grimace reflex Gag reflex

8. Registration of Birth & Deaths Act (RBD), 1969 Death certification IMP PROVISIONS Section 10(3) Section 17(1)

9. WHAT IS DEATH CERTIFICATION? Death is not a moment Medical Certification of Cause of Death Scheme is an important tool of obtaining authentic and scientific information regarding causes of mortality

10. Should know… Cause of death Underlying cause of death Mechanism of death Manner of death Mode of death

11. CAUSE OF DEATH The cause of death is a disease, abnormality, injury or poisoning that contributed directly or indirectly to death Any circumstances of the accident or violence which produced any such injuries which is directly leading cause of Death Chronic Ischemic Heart Disease  Acute Myocardial Infarction Pulmonary Embolism CHAIN OF EVENTS

12. UNDERLYING CAUSE OF DEATH The disease or injury that initiated the chain of morbid events leading directly to death. The circumstances of the accident or violence which produced the fatal injury Pedestrian Hit By Truck  Multiple Fracture fat embolism

13. MECHANISM OF DEATH Physiological or biochemical derangement produced by the cause of death that results in death Hemorrhage, Septicemia, And Cardiac Arrhythmia

14. MANNER OF DEATH It is way, fashion or circumstances of death. Natural – when due to disease Cardiovascular condition e.g. MI Respiratory condition e.g. Asthma, COPD Tumor of brain with sudden hemorrhage Tumor of brain producing pressure Metabolic disorders e.g. uremia

15. Unnatural Accidental head injuries e.g. RTA Homicidal head injuries e.g. stab, lacerated, incised, firearm Suicidal head injuries e.g. firearm injury Poisoning e.g. Opium, alcohol

16. MODE OF DEATH It is stoppage or failure of vital system Coma :- failure of function of brain Syncope :- failure of function of heart Asphyxia :- failure of function of respiratory system

17. --KEY STEPS-- STEP 1 : ALWAYS read the case history and note the key events and conditions. Don’t forget to consider signs and symptoms as well as negative symptoms STEP 2 : ALWAYS establish a chronology of conditions which will list out the all disease and events in the order in which they occurred before death

18. STEP 3 : ALWAYS determine the underlying cause of death(COD) which is the disease or injury that started the chains of the events the lead to death of the individual Remember to always check which disease, injury or event came first STEP 4 : ALWAYS try to use ICD- 10 terminology , which is clear and universally accepted, when recording the underlying COD This also help avoid confusion between similar terms and abbreviations

19. A diabetic man who had been under insulin control for many years developed ischemic heart disease and died suddenly from a myocardial infarction . Depending on the physician’s documented medical diagnosis , the following certifications are possible and would be acceptable : : 1 . If the physician considered that the heart condition resulted from the long-standing diabetes, the sequence would be: • Part I (a) Myocardial infarction..........................1 hour due to • (b) Chronic ischemic heart disease..........5 years due to • (c) Diabetes mellitus..............................12 years

20. 2. If the physician considered that the heart condition developed independently of the diabetes, the certification would be: • Part I (a) Myocardial infarction................................................1 hour due to • (b) Chronic ischemic heart disease..............................5 years • Part II Diabetes mellitus….............................................12 years

21. A lady was admitted with 80% suicidal burns injuries died of septicemia after 3 days of admission. Part I(a) Septicemic shock ------------------3 days (b) Burn(80% superficial & deep)- 3 days (c) Intentional self harm by fire & flames-3 days back Part II ..............Nil Manner of death 1. Natural 2. Accident 3. Suicide 4. Homicide 5. pending investigation Self Harm By Fire  Burns Septicemic Shock

22. Case A 59 Years old male was admitted to the hospital with shock & with signs of septicemia along with gangrene of (Lt) foot. Patient had swelling of L t foot and fever since 3 days . He had H/O COPD due to chronic bronchitis and had Diabetes since 5 years. Patient had diagnosed as C/O carcinoma of pancreas and operated for the same 5 years back. Patient died 2 days after admission due to septicemic shock.

23. Case A 59 Years old male was admitted to the hospital with shock & with signs of septicemia along with gangrene of (Lt) foot . Patient had swelling of lt foot and fever since 3 days . He had H/O COPD due to chronic bronchitis and had Diabetes since 5 years . Patient had diagnosed as C/O carcinoma of pancreas and operated for the same 5 years back . Patient died 2 days after admission due to septicemic shock.

24. case 70 years old female was admitted to the hospital for fracture neck femur 6 hours back due to fall in a bathroom. She was known diabetic since 10 years and hypertensive since 15 years. Open reduction of the fracture was advised but operation was delayed for fitness, as BSL was not within normal limits. On 6th day, patient deteriorated becoming severely breathless and had sudden collapse showing signs of pulmonary embolism. Patient died after 5 hours

25. case 70 years old female was admitted to the hospital for fracture neck femur 6 days back due to fall in a bathroom 2 days back. She was known diabetic since 10 years and hypertensive since 15 years . Open reduction of the fracture was advised but operation was delayed for fitness, as BSL was not within normal limits. On 6th day patient deteriorated becoming severe breathless and had sudden collapse showing signs of pulmonary embolism . Patient died within hours

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27. BE AWARE OF COMMON ERRORS Inverted COD sequence with Underlying Cause of Death on top Recording Contributory Cause of Death in part I Leaving the time intervals column blank Not using ICD-IO terminology to record the Underlying Cause of Death Recording Underlying Cause of Death in part II Wrong COD sequence with intermediate causes of death mixed up

28. BE AWARE OF COMMON ERRORS Recording the mode of death instead of the immediate cause of death Recording Contributory cause of death as the Underlying cause of death Mistakes in entering the name, age, sex, date and time of death and socio-demographic information on the form Use of abbreviations Unclear handwriting Multiple cause of death entries on one line in the cause of death sequence

29. IMPORTANCE OF DEATH CERTIFICATE Mortality statistics and surveillance of specific disease An indicator for a serious outbreak . Legal record of fact of death

30. Legal and protective uses For claiming family allowance Hospital reimbursement Life insurance claims Obtaining a probate or succession certificate Settling inheritance/property claims Releasing provident fund claims Deleting the deceased name from the G overnment and official documents. For public safety, accident prevention and eradication programs .

31. Duty of the doctor Who attended the person in last 7 days. Fill the prescribed format form 4 . should not sign medical certificate of cause of death in advance No refusal / no delay. No fee. Forward to the registering authority . The death report (Form 2) and MCCD (Form 4/4A ) should reach the registrar with in 14 days of occurrence of death. Symptomatology or modes of death should not be recorded as cause of death without mentioning the underlying pathological cause

32. When not to issue 1. The injured is brought dead 2. A crime has already been registering by the police. 3. The police has already been informed about the case. 4. The cause of death is unknown . 5. When the brought dead is not examined or seen by doctor within 14 days.

33. Thank you