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Originally posted by PedsCCM
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Ah, I see how this myth persists. Firstly, only one person may sign to medically certify the death certificate. Who exactly may sign is outlined by state law but almost always defaults to the attending physician at the time of death (for deaths in the hospital) or the coroner/medical examiner if certain criteria are met (physician cannot determine cause of death, death may be related to suicide, homicide, etc). The vast majority of death certificates are filled out by attending physicians or APPs (if allowed by state). Importantly, only one person can sign to certify cause of death. https://statutes.capitol.texas.gov/d...htm/hs.193.htm includes the relevant Texas statutes in case you're interested. So to claim that COVID is incorrectly listed in the cause of death means that a physician (or other provider) is intentionally lying and committing fraud - or is incompetent. No individual or group reviews and certifies the physician's certification. My county coroner does not review the death certificates that I sign and nobody but me is allowed to alter them. If a case goes to the coroner, I am not allowed to sign the cause of death. Amendments to death certificates can only completed by the certifying physician.
Next, what is listed on the cause of death? It importantly should never list every diagnosis the patient might have. Death certificates are pretty uniform and adhere to a federal standard regardless of state. See below the first google result - which is accurate. You list the IMMEDIATE CAUSE of death and conditions leading to this final, immediate cause. Part II has other "significant conditions contributing to death". In sum, everything listed should contribute directly or indirectly to the proximal cause of death.
In short, there is no mysterious "them". Hospitalists and ICU docs and EM docs fill out the medical sections of death certificates and certify the cause of death. This (often immediately) is available to the state health department and the funeral home. The info gets reported through Vital Records systems in each state and is then passed on to the CDC. K82 you're getting a lot of push back because this was a COVID denier trope early in the pandemic and it either suggests massive fraud committed by docs on scale - and against their own self interests! - or some other truly bizarre conspiracy. I can only assume the folks pushing this don't understand the system as it is insanely improbable.
*nothing I've written assumes that the numbers we have are perfectly accurate. There are undoubtedly errors. I just find it beyond improbable that massive over counting driven by hospital system revenue has occurred.
It was mid 2020 and I had heard that any death was being counted as a Covid death if the pt tested positive for Covid at death. I was at a Medical Executive Committee meeting and I asked Administration how our system was counting them. I gave the example of an MVA death that tested positive for Covid and asked how this would be classified. This is a large multi state health care system. Administration at the meeting wasn't sure. None of the other Dept Chairs were sure. Administration said they would look into it and get back to me. I followed up with the VP for patient affairs and he followed up for me with higher ups in the finance/data divisions. He got back to me and said that, yes, patients that died from whatever direct cause were being counted as a Covid death if they tested positive for Covid at death. I definitely got the impression that they thought that that was how they should be collating the data. From that point on I realized that the data on Covid deaths was pretty muddled, this is not a small health care system. Its been well over a year since I looked into this. I have no idea if they are still handling our data in the same way or if this was adjusted. I'm not involved in this directly so I have only what was told to me to rely on. Take it for what's its worth. Again, no insult or impunity was intended.
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