MCCD - Medical Certification of Cause of Death

Legal provisions, guidelines and methodology of medical certification of cause of death.

1. Medical Certification of Cause of Death (MCCD) Dr Ashutosh Potdar, HOD, Dept of FMT, D. Y. Patil Medical College, Kolhapur

2. Objectives – Why MCCD? Essential document for disposal of dead body. Important legal document for inheritance, insurance & other legal purposes. To know the disease specific mortality rates in given population. Essential component of demographic studies of population.

3. Objectives – Why MCCD? Assessing the effectiveness of public health programs. Provide feedback for future health policy and its implementation. Deciding the priorities of health & medical research programs.

4. Legal Implications Registration of birth & death acts (RBD) act- 1969 : Certification by medical practitioner who has attended the deceased during his last illness.

5. Legal Implications Section 10(3) : In event of death Medical practitioner should issue MCCD in the prescribed form stating to the best of his knowledge & belief. Issued without charging any fees. Issued in: - FORM No. 4 : Deaths in Nursing home - FORM No. 4A : Non institutional deaths

6. No MCCD should be issued in case of - Unnatural, - Unexpected, - Unexplained and - Unattended deaths

7. Status in India Only 20% of total deaths are certified Most of the certificates are not properly filled and gross wrong entries are made, thereby hampering the very objective of MCCD

8. Components of Death Certification Death Certification by a medical officer comprises of two components: 1. Certifying the fact of death (or declaring dead) & 2. Identifying the cause of death [this is called Medical Certification of Cause of Death (MCCD)]

9. 1. Certifying the fact of death (or declaring dead) As a minimum, a full set of observations should be undertaken and documented In particular placing a stethoscope on the patient’s chest [Remember ABC = airway, breathing and circulation]

10. 2. Identifying the cause of death [this is called Medical Certification of Cause of Death (MCCD)] Identifying the cause of death is a vital step in death certification

11. It is important to differentiate between the Mode, Manner and Cause of death in an individual On a death certificate, only the  Cause of death  and  Manner  of death  are to be filled and not  Mode of death

12. Mode of death vs. Cause of death Cardiac failure (Syncope) Respiratory failure (Asphyxia) Brain function failure (Coma) Absolutely wrong to use these three phrases in MCCD. Occasionally used with mentioning of the underlying pathological cause.

13. Cause of death Definition : A cause of death is a disease, abnormality, injury or poisoning that contributed directly or indirectly to death. 1.Immediate cause of death 2. Antecedent (or intermediate) cause of death 3.Underlying cause of death 4.Contributory cause of death

14. Immediate cause of death The final complication resulting from the underlying  cause of death, occurring closest to the time of death and directly causing death

15. Antecedent (or intermediate) cause of death A disease or condition that occurred as a result of the underlying cause of death but was not the final complication or immediate cause of death

16. Underlying cause of death The condition that triggered the chain of events leading to death; temporally, the most remote condition; etiologically specific

17. Contributory cause of death Person who has died may be suffering from some other disease etc., but this condition has certainly not set the chain of events leading to his death, but might have contributed to his death. Such disease are known as contributory cause of death which are entered in Part II of MCCD. 17

18. Types of MCCD form Institutional  deaths to be filled in Form No 4 Non-institutional  deaths and all still births to be filled in Form No 4(A) Format conforms to the standard prescribed by the World Health Organization (WHO )

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20. Medico legal cases Brought dead or suspicious death A fter declaring death, inform the police Certificate should not to be issued to relatives of deceased Post-mortem examination is done MCCD issued to police

21. Information on cause of death: confidential Detachable portion of certificate: only the fact of death without disclosing the cause of death

22. Guidelines Fill in the appropriate FORMS – 4 / 4A (as per RBD Act 1969) Write legibly to avoid being misread Do not use abbreviations to state the cause of death Avoid indefinite or inadequate terms

23. Interval between onset & death Space is provided against each condition recorded on the certificate If known- exact period should be written Or approximate period : like - From birth, Several years, Unknown

24. Female Death Women of child bearing age group ( 15-49yrs) - Information on pregnancy and delivery is needed in case of death Even though pregnancy may have nothing to do with death

25. Maternal death Nature of complication. Time of death in relation to delivery. Abortion : Spontaneous Induced - Legal - Illegal

26. Special conditions NEOPLASM: - Morphological type – benign / malignant - Site of origin of primary growth. - Site of metastasis. BLOOD DISORDERS: - Type & nature of any deficiency. - Whether hereditary. 31

27. Summary MCCD form to be filled & signed by attending physician only Do n ot to sign MCCD in advance or without viewing or examining personally General information regarding sex & age at the time of death is equally important Completed certificates should be sent to local Registrar of the area

28. Summary In medico legal cases- certificate should be given to the Police Underlying cause should be given at the bottom line of Part I Avoid registering two or more conditions in a single line

29. Summary Write the name of the disease in full & legibly Do not use abbreviation

30. Points – you must know Do not delay in issuing MCCD Do not charge any fees Do not withhold issuance even if dues are not cleared

31. Thank You