Thursday, January 2, 2020

Making it up as they go: Falsifying Vermont death certificates

This article was published by the Australian Care Alliance on January 2, 2020.

As reported in a previous blog on the latest report on deaths by assisted suicide in Vermont, the report states:
100% of the death certificates listed the appropriate cause (the underlying disease) and manner of death (natural), per Act 39 requirements.
This is a curious statement as Act 39 as passed by the Vermont legislature and in force does not include any such requirement.

This matter was raised with the Vermont Department of Health. The reply seems to confirm that when it comes to reporting on assisted suicide officials simply make it up as they go along.

In reply to this query:

Page 2 of your report states:

"All 34 events have a death certificate on file with the Vital Records’ Office. One hundred percent of the death certificates listed the appropriate cause (the underlying disease) and manner of death (natural), per Act 39 (2013) requirements."

The reference to "Act 39 (2013) requirements" seems to be misleading as while there was a provision to this effect in S77 as introduced into the Senate this provision was deleted and does not form part of Act 39 of 2013 (Chapter 113, Title 18 of the Vermont Statutes).

On the face of it in the absence of such a provision deaths certificates in these circumstances should be handled in accordance with the provisions in 18 V.S.A. § 5205 or elsewhere in Chapter 107, Title 18.

Could you please advise if there is some other legal authorisation for the completion of a Vermont

death certificate in the event of a death following ingestion of a lethal poison, albeit in apparent accordance with the provisions of Chapter 113, Title 18 of the Vermont Statutes, recording the manner of death as natural and the underlying condition as the sole cause of death with no reference to the effect of the lethal poison in causing that death?
The official reply from the Vermont Department of Health reads:
18 V.S.A. § 5293(a) states, "Except as otherwise required by law, information regarding compliance shall be confidential and shall be exempt from public inspection and copying under the Public Records Act." In addition, decisions made between patient and doctor are protected health information under both state and federal privacy laws. If a death certificate were to make reference to a prescribed dose under Act 39, it would be visible to the public and therefore violate both general and specific provisions of state law. A physician listing the underlying disease and manner of death [as natural] is both appropriate and preserves the confidentiality due the patient.
This reply is extraordinary.

Firstly, 18 V.S.A. § 5293 deals with the information collected and reported on pursuant to the Rule which makes no reference whatsoever to death certificates. It does however refer to the cause of death in requiring the prescribing physician to specify in a follow up form.

Whether the patient died as a result of the ingestion of the prescribed dose; as a result of the underlying disease; or whether the cause is unknown to the physician.
The legislative history of Act 39 indicates that the legislature considered but rejected an explicit provision mandating the falsification of death certificates for deaths following ingestion of a lethal poison prescribed under its provisions:

See the struck out paragraph on p.10 of the Bill as passed by the Senate and House which read:

Notwithstanding any other provision of law to the contrary, the attending physician may sign the patient’s death certificate, which shall list the underlying terminal disease as the cause and manner of death.
An alternative provision was proposed but later withdrawn:
The patient’s death certificate shall list the underlying terminal disease as the cause of the death and shall list the manner of death as natural.
It is alarming that the unelected officials of the Vermont Department of Health are choosing on their own authority to not just act as if this latter proposal was the law in Vermont but to brazenly claim that it is in an official report to the legislature and to praise physicians for their 100% compliance falsifying Vermont death certificates in accordance with unfounded statement of the law.

The general instructions to physicians regarding the accurate completion of death certificates place great emphasis on the importance of a comprehensive recording of ALL the causes contributing to a death.

Certify the cause of death as accurately as possible.

The manner of death describes the circumstances surrounding the death. In Vermont and in most of this country there are only 5 choices:

  • Natural
  • Accident
  • Suicide
  • Homicide
  • Pending Investigation (only available to medical examiners)
  • Could Not Be Determined
  • All cases that are not due exclusively (100%) to natural disease MUST, by law, be reported to the Medical Examiner's Office (1-888-552-2952). If an injury in any way contributes to the person’s death, no matter how long ago that injury was sustained, the death is not considered natural.
Stated very simply, a cause of death is the disease or injury responsible for starting the lethal sequence of events which ultimately lead to death. A competent cause of death must be as etiologically specific as possible. Etiologically specific causes of death are the disease entities studied in basic pathology courses

The mechanism of death is the altered biochemistry or physiology whereby the cause exerts its lethal effects. Mechanisms are not specific and can NEVER replace or substitute for a cause of death. Mechanisms can never stand alone on a death certificate and always need an underlying cause of death. Always ask yourself what the mechanism is due to in order to find the underlying cause of death.

Medical judgment and common sense are required for certifying the cause of death.

Truthfulness, completeness, and reasonable accuracy should be the goal. Convenience and expedience should not play a role when certifying causes of death.
Unless of course it is under an assisted suicide law when:
medical judgement, commonsense, truthfulness, completeness and reasonable accuracy must all GIVE WAY to the convenience and expedience of falsifying public records to pretend that deaths by the ingestion of a lethal poison are entirely natural.

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