Many states require that death certificates be completed within 72 hours, and some, such as South Carolina, impose administrative penalties on doctors who don’t comply.
Georgia law requires funeral directors to complete their portion of the death certificate — which includes the decedent’s demographic information — within 72 hours, but it gives doctors up to 30 days to certify the death.
That is too long of a wait for families, critics say.
“We’ve been talking for quite some time about how to get the system expedited,” said state Rep. Rick Williams, R-Milledgeville, who runs a funeral home and crematorium in his hometown. “A lot of times, we’re just trying to track down a doctor.”
The time it takes to complete death certificates is an issue that has pitted funeral directors all over the state against the largest physician advocacy group in the state, the Medical Association of Georgia. (Alyssa Pointer / Alyssa.Pointer@ajc.com)
Credit: Alyssa Pointer/Alyssa.Pointer@ajc.com
Credit: Alyssa Pointer/Alyssa.Pointer@ajc.com
The issue has pitted funeral directors all over the state against the largest physician advocacy group in the state, the Medical Association of Georgia.
Funeral directors support legislation Williams introduced last session, H.B. 135, that would have strictly limited the amount of time for doctors to make determinations and triggered immediate complaints to the Georgia Composite Medical Board when a physician violates the law.
The funeral industry has a financial stake in the matter, as some families blocked from accessing assets cannot reimburse them for burial services.
“We've been talking for quite some time about how to get the system expedited. A lot of times, we're just trying to track down a doctor."
- Rep. Rick Williams, R-Milledgeville, who runs a funeral home
At issue with the Medical Association of Georgia is that doctors be allowed to continue to use their professional judgment in determining the cause of death and signing a death certificate. In some cases, physicians have not seen the patient for an extended period of time before the death, said Bethany Sherrer, legal counsel for MAG.
A physician makes a determination on the cause of death based on several factors, including their medical training, knowledge of medicine, the patient’s available medical history, symptoms and test results.
“One fear is that there could be repercussions for signing a death certificate without having the right information before it is completed,” Sherrer said.
The debate is expected to heat up soon.
State Rep. Sharon Cooper, R-Marietta, who chairs the Health and Human Services Committee for the Georgia House of Representatives, has vowed to take up in the issue in the upcoming legislative session.
She plans to invite funeral directors, doctors and MAG members to come up with solutions.
“We’re going to get everybody in the room and talk this out,’' Cooper said, “which I have found to be one of the most effective ways of solving a problem.”
Tracking it down
Concerns can arise when medical staff have little information about a patient and conditions that surrounded a death. Sometimes, people die suddenly in the emergency room, providing physicians with scant details to arrive at a cause of death.
Doctors who provide general medical care to hospitalized patients also can be more difficult to pin down because they may rotate among hospitals.
But few excuses could be made to explain the cause for the delays in obtaining the death certificate of Sandra Autry’s husband.
He was under hospice care, and making a determination by the doctor who attended him shouldn’t have taken over a month, said Cy Hume, co-owner of A.S. Turner Funeral Home and Crematory in Decatur, which arranged her husband’s burial and memorial services.
Instead, she says she got the run-around by hospice staff who each day told her to call another satellite office where the doctor was expected to work on that day. When she would call that office, she said she was told he was at another office.
At the same time she was making those calls, a third-party administrator for the funeral operator also was trying to reach the physician.
The death by natural causes was finally certified on May 21. That afternoon, Hume, the funeral home director, arrived at Autry’s doorstep to hand her the document.
Behind the scenes, though, the funeral director hadn’t stopped jumping through hoops.
To make it official, he had to fax the document to DeKalb County, where a clerk in the vital records department typed the cause of death into Georgia Vital Events Registration System or GAVERS, the Peach State’s single system for all vital records information. The web-based application is configured to share data with state and federal authorities on births, deaths, fetal deaths, induced termination of pregnancy, marriages and divorces.
All the rigmarole would not have been necessary, Hume said, “had the doctor done it through GAVERS from the get-go.”
Many physicians are not registered to use the system, though.
In 2011, the state spent $1.45 million to purchase GAVERS. But while it has 3,065 active users, a decade later only 92 are individual physicians with user identifications, state officials said.
In most other cases where physicians certified deaths electronically, they had designees complete the record, as allowed by state law.
The worry is that many doctors still rely on fax to submit medical certifications to funeral operators, who are then responsible for submitting the document to the county health department, which inputs it into GAVERS, funeral industry officials said.
“What would be helpful is that doctors be encouraged to sign up their offices to learn how to use GAVERS and then begin using it,” said Eddie Dressler, owner of Dressler’s Jewish Funeral Care in Atlanta.
One issue that should be explored is why more doctors are not registered with GAVERS, suggested Sherrer, MAG’s legal counsel.
She wondered if there are impediments for physicians who are not using the electronic system. Is the reason that physicians do not know about it or is it a workflow issue that can be solved somehow?
Several funeral directors told the AJC they had filed multiple complaints against doctors with the Georgia Composite Medical Board to try to spark compliance.
However, Hume said complaints are almost always dismissed with little consequences for doctors.
Williams, the Milledgeville legislator, said he filed a complaint that dragged on for three months. By the time the board held a hearing on it, the doctor had signed the certificate, and the case had been settled. No disciplinary action was taken, Williams said.
“They let us know ’if we can be of further assistance, please let us know,’ ” Williams said, “but they did nothing to that doctor who caused that death certificate just to sit there, which gave the family such a hard time.”
The issue has not been “a major point of focus” for the medical board, said LaSharn Hughes, its executive director.
Meanwhile, Sandra Autry has an appointment June 3 to speak with the U.S. Social Security Administration to shift her husband’s benefits over to her name.
Last week, she had dreaded the conversation, knowing that it would have gone nowhere without the medical certification. Now, she said, she can finally start to get her life back in order.
“Hopefully, Social Security will get this changed to his social security instead of mine.’'