The Iowa Board of Medicine receives several complaints each year concerning unsigned death certificates. Failing to promptly sign a death certificate, as required by Iowa law, can lead to frustration for families who are already experiencing hardship and can cause unnecessary delay for funeral homes and others. Importantly, failing to timely and properly sign a death certificate constitutes grounds for disciplinary action against an Iowa medical license. Below is the basic information you need to know when providing care to a patient who passes away.
Medical Certification: who is required to sign a death certificate?
The signing of death certificates in Iowa is governed by Iowa Code section 144.28. Depending on the cause of death, different people may be required to provide medical certification. There are two types of “causes of death” that trigger different signing requirements: “natural” causes and “nonnatural” causes. Iowa Admin. Code r. 641–97.6.
A “nonnatural” cause of death means “the death is a direct or indirect result of physical, chemical, thermal, or electrical trauma, or drug or alcohol intoxication or other poisoning.” ICA § 144.28(1)”a.” When a cause of death is “nonnatural” as defined here, or the decedent is an infant, a state or county medical examiner will perform an inquiry into the death, and may certify a death certificate. Importantly, however, a medical examiner may ultimately defer back to the medical provider to provide the required certification. ICA § 144.28(1)”e.”
A “natural” cause of death is a death due to a disease or the aging process and not due to external causes. Iowa Admin. Code r. 641–95.1. In the event of a natural death, any of the following health professionals may provide medical certification as to the cause of death:
- A physician (M.D. or D.O.)
- A Physician Assistant; or
- An Advanced Registered Nurse Practitioner (ARNP)
The key factor in determining who must sign the death certificate is whether the provider “is in charge of the patient’s care for the illness or condition which resulted in death.” ICA § 144.28(1)”b.”
How does someone sign/certify a death certificate?
Anyone required to provide medical certification of a death certificate must do so through the Electronic Death Registration System (EDRS) within the Iowa Vital Events System (IVES). See Iowa Admin. Code r. 641–97.3(3). All such providers are required to enroll in EDRS. More information on EDRS can be found here: https://idph.iowa.gov/health-statistics/vital-records/drportal. Medical certifiers may assign staff to assist in the data entry process within EDRS, however the final entry must be reviewed and submitted by a medical certifier.
All registered users of the EDRS should make sure their contact information is up-to-date to reduce delays.
When must a death certificate be signed by the medical provider?
When the manner of death is determined to be natural, within seventy-two (72) hours after receipt of the death certificate from the funeral director or individual who initially assumes custody of the body (i.e., a medical examiner). IAC § 144.28(1)“b.” This period begins when the death certificate is transferred to the certifier through the IVES system.
When an inquiry is required by the county or state medical examiner, the medical examiner shall investigate the cause and manner of death and shall complete and sign the medical certification within seventy-two hours after determination of the cause and manner of death. IAC § 144.28(1)”e.”
Can I be subject to discipline for failing to comply with these requirements?
Yes, failing to timely sign a death certificate when you are required to provide medical certification of death constitutes grounds for disciplinary action against your Iowa medical license.