It’s time for a new mini series, and I’ve often thought about explaining a bit around what paperwork is involved in death. On the outside it can look rather complicated and messy, with bits of official paperwork going here, there and everywhere before it is all done and complete. For my first few months at the mortuary it took me a while to understand what was needed and when. Sometimes even now a new type of form will come my way and throw me off too! For those who know, I’m yet to come across a Burial at Sea yet also.
To kick off this mini series, I thought I would start simple with the MCCD. Or medical certificate of cause of death. In a hospital based mortuary like our one, the MCCD is a common piece of paperwork which is produced for a large number of deaths. In our mortuary, the bereavement team handle all of the paperwork side for the hospital deaths so we do not necessarily need to be involved other than to confirm it is complete so we can release the patient. However, this changed slightly when the pandemic began and we needed to copy these certificates for patients who were being transferred to other facilities. In that time I saw a number of copies of these certificates on a daily basis.
The MCCD is a medical certificate which is completed and signed by the doctor to confirm the cause of death. The way in which it is structured is generally the same, with the full details of the patient being stated and then the cause of death stated in a particular way. The cause can be a singular item but can also be a list, or sequence, of causes which have contributed to the death. These are listed in parts, usually 1a, 1b, 1c, 1d and 2 which are completed as and when applicable. Without over complicating this, 1a-1d will list the immediate cause of death from most to least recent (or last in the chain through to first in the chain). Items listed under 2 will be any other health conditions or diseases which have contributed but not directly caused it.
The compulsory registration of deaths began in the UK in 1837 following the passing of legislation to ensure there was a register of all births, deaths and marriages. This originated as a way of ensuring property remained with the correct line of descent by being able to trace it effectively. In 1953 the Births & Deaths Registration Act passed which saw that registered medical professionals must complete the register for the cause of death. Please note that this is different to when someone is certifying a death, in other words when they confirm that someone is dead.
The MCCD as established is to be completed by the doctor who attended to that patient during their last illness or leading up to their death. If there is no suspicion, doubt or other need to refer this to the Coroner then the doctor will complete the form taking into consideration their own care of the patient alongside all medical notes and records for them. The bereavement offices of hospitals have books of these certificates which are completed and then taken out with their own individual certificate numbers. A bit like a raffle book with perforated edges. The impact of COVID-19 was considered and there were some minimal changes to this process in order to make the death registration process more straightforward. The length of time in which a doctor could have last seen a patient was extended slightly and some other forms were removed (ones I will try to cover in further parts to this series).
Looking ahead, and ignoring the pandemic slightly for now, there is a new way in which these certificates are produced coming into the mix and in some places it is already happening. Our hospital is yet to have a Medical Examiner (ME) position, but it is already a system established in many locations across the country and fully in Wales. From 2018, Medical Examiners were introduced as another layer of scrutiny against the MCCDs being produced. The very basic structure of this process is that every death will be looked at by the ME and their team of officers who will speak to the family, doctors treating the patient and examine the notes also to ensure there is agreement over what is written as the cause. The vision is that this will bring a greater transparency to the death registration process and ensure that the deaths being referred to the Coroner are the ones that need to be.
If you have any questions about this or would like me to discuss any form in particular in future parts then please get in touch. I have largely based the contents of this from my own knowledge, various talks I have attended and a quick search to verify the dates of the legislation I quoted. Please do get in touch if you feel I have made any mistakes or should confirm anything further too!