Chapter 3
Problems with the current system

Lack of responsibility for the quality of the system

3.32While a number of government agencies have various responsibilities for matters related to death certification, none currently have responsibility for oversight of the system as a whole or for the quality of the outputs. There is no nationally consistent death certification training for doctors; no process for checking whether all deaths are certified or notified to the Registrar-General; and limited processes for checking the accuracy and quality of the cause of death information provided and for ensuring that appropriate deaths are referred to the coroner.

3.33Currently, the only check on death certification documentation before a body is disposed of is by medical referees prior to cremation. Before a body is cremated, a medical referee must complete the Permission to Cremate form stating that he or she is satisfied that the Act and Regulations have been complied with, that the cause of death has been definitely ascertained (or the death has been referred to the coroner) and that no reason exists for any further inquiry or examination. However, no equivalent process exists when a body is to be buried.

3.34In Issues Paper 23 we asked whether the medical referee system for cremation is providing sufficient safeguards. Two-thirds of submitters who addressed this question said it did not and considered that a better system should be implemented. Many of these submitters were medical organisations or professionals. Some submitters considered the system to be a “rubber-stamping exercise”. Others thought that the system could provide a check on the accuracy of cause of death data but doubted its ability to catch deaths that require further investigation. In consultation, we were told that, while many referees do an excellent job, they are limited in their ability to detect problems because they often do not have access to the medical notes of the deceased person. That means that they can only detect errors that are apparent from the post-death documentation.

3.35The remaining one third of submitters supported the current system but expressed reservations, such as the need for improved systems for appointment, training, monitoring and support. They supported the “local” nature of the system because it was efficient and quick. There was, however, broad support for the extension of any system to all deaths, not just those where the body will be cremated; and for there to be greater national oversight of the system.