8.1In Chapter 3 we described the high rate of error found around the world in determining the cause of death and in referring deaths to the coroner for further investigation. We also described how that high error rate is likely to also occur in New Zealand, but because there is no central agency responsible for the quality of outputs from the death certification process, there is no data about the reliability of reporting.
8.2Currently, the only check on the quality of cause of death documentation is performed by the medical referee before a body is cremated. In Chapter 3 we described the limitations of this system, most notably that it only applies when a body is to be cremated. Medical referees are also limited in their ability to detect errors because of the processes they work within, particularly the lack of formal access to medical notes. Additionally, there are a range of practices amongst medical referees, there is no formalised training or support for them and there is no systematic quality control. The medical referee system is not designed to measure the quality of the outputs from the death certification process generally or to use the information and experience they develop in an education system for certifying doctors.
8.3There was very strong support in submissions on Issues Paper 23 for a robust system of checks on the documentation of all deaths, irrespective of whether a body is to be buried or cremated. There was also strong support for a different system from the current medical referee system, although there were differing views as to the characteristics of a new system. We have analysed a range of options designed to improve the accuracy of cause of death determinations. These options are discussed below.