The Tennessee Department of Health has reported a spike in complaints and licensure board discipline in recent years for cases related to physicians failing to timely sign death certificates.

Funeral homes and crematoria have referred next of kin complaints about physicians' delays in signing death certificates to the physicians’ licensing boards. Family frustration regarding the final disposition of their loved ones has fueled the complaints.

State law requires that in most cases death certificates shall be completed, signed, and returned to the funeral director by the physician in charge of the patient’s care for the illness or condition that resulted in death within two business days of the patient’s death using the Vital Records Information System Management (VRISM).

The only exceptions to the two business days requirement are if the cause of death cannot be determined within 48 hours and the physician notifies the funeral director, county medical examiner inquiries, or if the physician needs time to obtain a deceased’s veteran’s medical records from sources such as the deceased’s family or the Veterans Administration.

The physician licensing boards are responding with stricter enforcement, including reportable disciplinary action for even a second offense. According to a department regulator, a first offense for a physician failing to timely file a death certificate is typically a letter of warning. For a second offense, the Board of Medical Examiners will issue a reprimand, which is a formal disciplinary action reportable to the National Practitioner Databank (NPDB).

“Even a reprimand that is reportable to the NPDB can have downstream consequences for doctors,” said Yarnell Beatty, TMA Senior Vice President and General Counsel. “NPDB reports have career-long downstream effects regarding having to explain the action in applications for other state licenses, hospital privileges, medical malpractice insurance, and health plan networks. It can become a neverending headache.”  

The department noted that boards are becoming less tolerant of common reasons provided for delays. Explanations such as ignorance of the law, receiving notice of death while on vacation, or experiencing an expired VRISM password are not plausible defenses in the view of the licensing boards. Letters of warning and reprimands have been issued with more frequency for untimely death certificate filing, which the boards consider unprofessional conduct. 

Some tips for TMA members to avoid discipline for untimely death certificate filing:

• Keep your VRISM password up to date even if you infrequently file death certificates. Click here to access the “Reset Password” button. 
• If problems with VRISM arise, report them immediately to the VRISM Help Desk, 855-874-7686 or Health.VRISM@tn.gov to maintain a record.
• Review and respond to email notices of death remotely, even during extended absences. 
• Before an extended absence, designate another physician who can complete death certificates. TCA § 68-3-502 provides that, “In the absence of the physician, the certificate may be completed and signed by another physician designated by the physician or by the chief medical officer of the institution in which the death occurred.”
• Review TMA’s online Law Guide topic Death. Member log in required. 
• Additionally, TMA recently developed a FREE education course on best practices in death certification in partnership with the Department of Health. More information including a link to take the course may be found here.