Contents

Chapter 3
Problems with the current system

Inefficiencies and lack of clarity in the processes

Problematic forms

3.15Doctors have consistently reported frustration at the nature of the documents that must be completed after a death. Of particular concern is the number of different forms, the duplication of questions across some of those forms and the lack of national consistency in the forms used. Some of the language is archaic and some of the questions are difficult to answer.35 We note that, of the submitters who answered the relevant question in Issues Paper 23, there was unanimous support for simplifying and modernising the MCCD.

3.16Funeral directors have repeatedly told us that there are often difficulties in deciphering the doctor’s handwritten cause of death on the MCCD. Funeral directors must transcribe the cause of death from the MCCD in order to complete the notification to the Registrar-General. In addition to unclear handwriting, doctors often use abbreviations and non-standardised language, which introduces risks in accurately transcribing the cause of death in the notification to the Registrar-General.

Timing of the death certificationTop

3.17There is some confusion around timeframes for completing the MCCD when death occurs as a natural consequence of illness. Section 46B(2) of the Act says that the doctor must complete the MCCD immediately after the doctor learns of the death. In an attempt to provide greater certainty as to this requirement, the former Chief Coroner, Judge Neil McLean, suggested that MCCDs should be completed “within 24 hours”, but that opinion is not determinative. If a doctor learns of the death of a patient on the weekend or during holidays, it can be very difficult to comply with the statutory requirement, even if that means within 24 hours.

3.18We have received strong submissions that delays to funeral preparations caused by the current death certification process are having unacceptable consequences for bereaved families. This is a particular problem for Māori and in rural areas. For example, we were told that there are ongoing difficulties in some regions in locating doctors to certify death, even when the death is a natural consequence of illness, which is leading to increased and unnecessary involvement of the coroner. That in turn increases the delay in returning the deceased body to whānau.

3.19It is an important Māori cultural practice to take immediate care of deceased whānau members. This type of cultural requirement is recognised in section 3(2)(b) of the Coroners Act 2006, which states that the Act recognises both:

(i) the cultural and spiritual needs of family of, and of others who were in a close relationship to, a person who has died; and
(ii) the public good associated with a proper and timely understanding of the causes and circumstances of deaths.

3.20We consider that recognition of this important cultural practice is part of the wider goal in ensuring that death certification processes operate efficiently and effectively for all groups in New Zealand.

No legislative system for verifying identityTop

3.21Currently, there are no legislative requirements for verifying the identity of a deceased body. While there is the occasional media story, usually from overseas, of bodies being “mixed up”, during the course of this project, we have not identified any recent New Zealand examples. We therefore assume that problems of this nature are very rare, if they occur at all.

3.22When the Police attend a sudden death, their hierarchy of procedures for formally identifying the body is:

3.23When a person dies in hospital, it is usually simple to verify their identity and identification documentation is transported with a deceased body to the mortuary. However, when a person dies in the community of natural causes, the systems for verifying identity are imprecise and rely upon the personal practices of the doctors and funeral directors involved.

3.24If the certifying doctor is the deceased person’s usual doctor and examines or views the body after death, identity can be confirmed and noted on the MCCD, which will usually be transported with the body to the funeral director. However, if the MCCD is completed without viewing or examining the body, in theory, there is no assurance that the person who died is in fact the doctor’s patient. However, as the doctor will only complete the MCCD without viewing the body if the death was expected (because otherwise the doctor cannot be satisfied that the death was a natural consequence of illness), the risk is negligible.

3.25If an alternative doctor completes the MCCD, that doctor may not know the patient and so may not be able to visually identify the deceased body. Alternative doctors will presumably have a variety of personal practices for verifying identity, but it is likely that most will rely on what they are told without making additional checks.

3.26It is impractical, if not impossible, for identity to be confirmed to a point of absolute certainty in all cases, nor is there evidence of a problem with mistaken identification of deceased bodies in New Zealand. Accordingly, it should be acceptable for doctors issuing a MCCD to use available information if they are reasonably satisfied of its reliability, and the legislation should reflect this. For example, if Police attend a car accident and initially identify the deceased body by reference to a driver licence and this is then confirmed through visual identification by someone claiming to be a close relative of the deceased (such as the spouse or a parent), there should be no need for further steps unless there is cause for suspicion.

Confusion over requirements before the body can be movedTop

3.27We have encountered significant confusion amongst doctors and funeral directors about whether the MCCD is required before a funeral director may move a deceased person from the family home or an aged care facility to the funeral home.

3.28The Burial and Cremation Act 1964 (the Act) provides that a body must not be buried, cremated or otherwise disposed of unless the MCCD (or a coroner’s authorisation) has been obtained.36 In addition, a person having charge of a body must not transfer charge of it to another person unless the MCCD has been obtained.37 However, this rule does not apply in some circumstances, including where someone transfers the body to a funeral director.38

3.29Despite that exception (and perhaps because of the confusing statutory language), there appears to be a widespread view amongst doctors and funeral directors that the Act requires the MCCD to be produced prior to the funeral director moving the body. Families and aged care facilities often place pressure on funeral directors to quickly move a body from the place of death and so doctors come under pressure to provide the MCCD quickly. That can be difficult when the death occurs out of normal business hours or when the doctor is on leave. Consequently, a widespread practice has developed in which the funeral director will move the body if the doctor has been contacted by telephone and has confirmed that the patient’s death was a natural consequence of illness and that they will complete the MCCD as soon as possible.

3.30Funeral directors have told us that this situation puts them in a difficult position. If more information subsequently comes to light and the doctor decides that the death should instead be referred to the coroner, the body may have already been embalmed, which will decrease the ability of any subsequent autopsy ordered by the coroner to help determine the cause of death. While we consider that the law currently does not prevent removing the deceased body, or even embalming it prior to obtaining the MCCD, these requirements should be clarified.

Payment for the MCCDTop

3.31The current legislative system provides no formal method of payment to doctors for completing death certification documentation. In fact, it states that the Crown is not liable for the costs incurred by a person in supplying information required for the MCCD.39 Doctors usually charge for completing the Cremation Certificate (which is recovered from the family or the deceased’s estate by the funeral director). In relation to the MCCD, if the death occurs in a hospital, the time taken to complete the documentation is covered within the doctor’s normal duties. If the death occurs in the community, most general practitioners do not charge because they consider this to be a final service to their patient. A few general practitioners apparently do charge for that service through the funeral director’s invoice to the family, and some recover their costs via other government payments already received in respect of particular patients. As we discuss in Chapter 6, a coherent system for payment may assist in establishing consistently high standards of practice in relation to death certification.
35In particular, the Cremation Certificate asks what the “mode” of death was. Submitters said that it was not clear what the “mode of death” means and that it is often confused with the cause of death.
36Burial and Cremation Act, s 46AA(1).
37Section 46F(2).
38The wording of this exception is awkward. A person does not have to comply with the requirement to obtain a MCCD before transfer in the following circumstance: “a person having charge of a body who is not a funeral director transferring charge of it to a funeral director”. This means that ,when the family, Police, or medical staff transfer charge of a body to a funeral director, it is not necessary for the MCCD to have been completed in advance. However, the funeral director may not transfer the body to a different funeral director until after the MCCD has been completed. There are also exceptions where the body is being transferred to a constable; where the body is being transferred to a doctor for a post-mortem; or where the body is being transferred to a hospital.
39Burial and Cremation Act, s 46D.