State funeral directors are concerned about a lack of integrity in cause-of-death determinations on a growing number of Oklahoma death certificates, said Richard Dugger, president-
Because of a huge backlog of cases, the Oklahoma City office of the state medical examiner's office increasingly has been waiving jurisdiction in cases that appear to be natural deaths and leaving it up to local physicians to sign off on the causes of those deaths, Dugger said.
"We've got physicians, who haven't seen patients in 14 months, in some cases ... who are being asked to sign documents when they truly don't know an actual cause of death," Dugger said.
Some of those doctors are refusing to sign, and rightfully so, he said.
"What we're concerned about is this doctor-shopping scenario where a doctor is the attending physician on record, but hasn't seen a patient in 30 days and is not going to sign the document," Dugger said.
"So now, I'm going to go find a doctor who is going to sign the document. There's no integrity to that — none at all. And that's going on in rural Oklahoma all over the state. It's very concerning."
A cause of death determination often has important ramifications, he said.
Because insurance policies often cover only specific things or have exclusions, the cause of death on a person's death certificate can make a difference of hundreds of thousands of dollars in how much money the deceased person's family receives, he said.
"That family has to have some peace of mind," he said. "The medical examiner's office has a responsibility to the taxpayers of Oklahoma to be sure that the cause of death is accurate on that document."
Dugger said he believes it is the responsibility of the medical examiner's office to determine causes of death when individuals die who haven't seen a doctor within 30 days. He said board rules require that.
Timothy Dwyer, chief investigator for the medical examiner's office, sees things differently.
"It's a touchy subject and we have to look at these on a case-by-case basis," he said. "The recurring theme is that the primary care physicians simply don't want to sign a death certificate, even though it's their legal responsibility to do so."
Dwyer said it is the medical examiner's job to establish a medical history and make sure there has been no trauma or suspicion of foul play. Once it is determined the death is natural, it is proper for the office to waive jurisdiction and leave it up to the person's attending physician to determine a cause of death, he said.
By law, attending physicians are required to sign off on a cause of death within 48 hours after the medical examiner waives jurisdiction, but the law has no teeth and nothing happens to doctors who refuse, Dwyer said.
Dwyer provided The Oklahoman with a letter the office shares with physicians that says a death certificate is a "legal and not a scientific document," so it is sufficient for a doctor to determine a "probable" cause of death without dissecting a body or performing other tests that would be necessary to determine an anatomical reason for the death.
There were some 20,000 deaths in Oklahoma last year and the medical examiner's office performed autopsies on 1,800 to 1,900 of them, Dwyer said. It would be cost prohibitive to perform autopsies on every body, he said.
Timeliness of cause of death determinations is also an issue in Oklahoma.
The medical examiner's office currently only has six of its nine pathologists' positions filled and there is a backlog of cases, said Cherokee Ballard, spokeswoman for the office.
Dr. Andrew Sibley, who was offered the job of chief medical examiner Thursday, told his governing board it usually takes four to 12 weeks to get toxicology tests back, which is generally the biggest hold up in getting final cause of death determinations.
Even after those tests are completed, however, the results often sit on pathologists' desks for days before they have time to complete the paperwork because of manpower issues, he said.
"I'm as frustrated by it and behind as anybody else," Sibley said.
Sibley said they've tried to hire more pathologists, but the applicants interviewed recently have been people who were rejected previously for what he believes were valid reasons.
"We need to do good to get good people and we don't have that reputation right now," Sibley said.
Dugger said timeliness in obtaining final death certificates can be a problem for families, since life insurance companies won't pay benefits until an actual cause of death is determined. However, Dugger said he is confident that problem will be rectified once additional pathologists are hired and new facilities are built.
"Our concern is the integrity of the documents," he said.