Medicalcertificationofcauseof death.pptx

Medical certificate for cause of death i.e. MCCCD Forensic medicine and toxicology.This pdf highlights how to fill and mccd form difference between cause of death,manner of death

1. Medical Certification of Cause of Death (MCCD) Dr. Sruthi Latha Saiju Junior Resident Dept. of Forensic Medicine & Toxicology

2. CONTENTS Objectives Legal implications Status in India Components of MCCD In medico-legal cases

3. Objectives of issuing a MCCD Essential document for disposal of a body Important legal document for inheritance, insurance & other legal purposes. To know the disease specific mortatily rates in given population. Essential component of demographic studies of population. Assessing the effectiveness of public health programmes. Provide feedback for future health policy and its implementation. Deciding the priorities of health and medical research programs.

4. Legal Implications Registration of birth & death acts (RBD) -1969: Certification by medical practitioner who has attended the deceased during his last illness. 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. Fine – Rs.50 [S.23(3)] Issued in : - FORM No. 4: Deaths in hospitals/nursing home - FORM No. 4A: Non institutional deaths

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

6. A birth or death has to be reported for registration, within 21 days of occurrence. Birth and Death registration is to be done at the place of occurrence . Any death, after the expiry of 21 days, but within 30 days of occurrence , shall be registered on payment of a late-fees. After 30 days of occurrence, but within one year shall be registered only with the written permission of the officer and with payment of late fee. If not been reported within one year of its occurrence, shall be registered only on orders of First Class Judicial Magistrate and payment of late fees.

7. Status in India Only 22.5% of total deaths are certified.( As per annual Report on Vital Statistics of India based on Civil Registration System, 2020) 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)] - 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 .

9. Certification of death 3 imp matters: - cause of death – disease or injury responsible for starting the sequence of events, which produce death - mechanism of death – physiological, biochemical, pathological process produced by cause of death, which is incompatible with life - manner of death – i ) natural, ii) accidental, iii) homicidal, iv) suicidal, v) undetermined

10. Classification of cause of death According to the sequence and quantum of their contribution to death - Immediate cause – final disease or injury causing death { I(a) } A common error is to list mechanism of death - Intermediate cause – disease or condition that preceded and caused the immediate cause of death { I(b) } - Underlying cause – a disease or condition present before, and leading to, the intermediate or immediate cause of death { I( c ) } - Contributory cause – conditions contributing to death but not directly causing death { II }

11. In certifying the causes of death for Part II, any disease, abnormality, injury or late effects of poisoning, believed to have adversely affected the decedent should be reported, including: • Use of alcohol and/or other substances. • Smoking history. • Environmental factors, such as exposure to toxic fumes, history of working in the some specific industry, professional exposure to toxins, specific animals etc. • Recent pregnancy, if believed to have contributed to the death. • Late effects of injury, including head injury sequelae • Surgical information, if applicable. • Any iatrogenic underlying cause.

12. The following gives the pertinent details required to be spelt out in the medical part of the certificate corresponding to the major cause group of mortality; 1. Infections: Acute, sub-acute or chronic, name of the disease and/or infecting organism, the site if localised ; mode of transmission, where relevant. 2. Neoplasms : The morphological type if known; malignant, benign etc., site of origin of primary growth and sites of secondary growths. 3. Maternal deaths : Nature of complication: whether obstruction occurred during labour ; timing of death in relation to delivery; for abortions, whether spontaneous or induced, legal or illegal, if induced. 4. Perinatal deaths : Condition in fetus or infant; conditions in mother or of placenta, cord or membranes, if believed to have affected the fetus or infant

13. 5. Injuries: Type, site, complications. 6. Poisoning: Substance involved; whether accidental (if suicide or homicide is ruled out). 7. Adverse effects of drugs in therapeutic use: State this fact and name or drug, nature of adverse effect, complications; condition treated. 8. External cause of accidents : For transport accidents, state vehicle involved, whether deceased was driver, passenger, etc. Description of accident place of occurrence, for other accidents, specifies circumstances and place of occurrence. 9. Old age or senility : This should not be given if a more specific cause is known. If old age was a contributory factor it should be entered in part II only.

14. A death may be due to a pulmonary embolus, as a consequence of hip surgery, resulting from a injury from a fall, resulting from cerebral infarction. Person may be having CCF for long Immediate cause – Pulmonary embolus Intermediate cause – hip surgery Underlying cause – injury from a fall, cerebral infarction Contributory cause - CCF

15. A 63 year old man with chronic duodenal ulceration died of peritonitis a few days after an operation for duodenal perforation, carcinoma of the bronchus also being present. I (a) Peritonitis 3 days (b) Perforation of duodenal ulcer 1 week (c) Chronic ulcer of duodenum 4 years II Oat-cell carcinoma

16. On 03.05.2024, a 60 year old female was admitted with a “strangulated Femoral Hernia” which had started 4 days earlier. She came complaining of abdominal pain and fecal vomits. Apparently, the small intestines were perforated even before. On 4th May, she underwent a release of hernia and the recession of the intestines, with an end to end “Anastomosis”. On 5 th May, she started developing signs of “peritonitis”, and following that dies on 14. 05.2024. PART – I (a) Peritonitis, acute 12 days (b) Perforation of small intestine 15 days. (c) Strangulated Femoral Hernia PART-II …………………………………….

17. A 59 year old woman died of asphyxia following inhalation of vomitus some hours after suffering a cerebellar hemorrhage . Three years previously she had been diagnosed as having adrenal adenoma with aldosteronism which manifested itself as hypertension. Congestive heart failure was also present. I (a) Asphyxia by vomitus mins (b) Cerebellar haemorrhage hours (c) Hypertension 3 years (d) Aldosteronism 3 years (e) Adrenal adenoma 3 years II Congestive Heart Failure

18. Medico legal cases Brought dead or suspicious death After declaring death, inform the police Certificate should not be issued to relatives of deceased Post –mortem examination is done Information on cause of death: confidential Detachable portion of certificate: only the fact of death without disclosing the cause of death

19. 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

20. Female Death Women of child bearing age group (15-49 yrs ) – Information on pregnancy and delivery is needed in case of death. Even though pregnancy may have nothing to do with death MATERNAL DEATH Nature of complication Time of death in relation to delivery

21. Summary MCCD form to be filled & signed by attending physician only Do not 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. Underlying cause should be given at the bottom line of Part I Avoid registering two or more conditions in a single line. Write the name of the disease in full & legibly Do not use abbreviation

22. Points to be kept in mind Do not delay in issuing MCCD Do not charge any fees Do not withhold issuance even if dues are not cleared.

23. REFERENCES Physicians Manual on Medical Certification of Cause of Death Anil Aggrawal’s Textbook of Forensic Medicine and Toxicology 2 nd edition Reddy’s Essentials of Forensic Medicine and Toxicology 35 th edition The Registration of Births and Deaths Act, 1969

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