HJAR Nov/Dec 2020

38 NOV / DEC 2020 I  HEALTHCARE JOURNAL OF ARKANSAS POLICY In order to mount effective responses to both, it is important to know howmany peo- ple are dying, why they are dying and who is most at risk. In this column, I will discuss how the death reporting process works and how it could be improved. When a person dies, the cause of death must be certified on a death certificate by a physician, medical examiner or coroner. Typically, a physician will do the certifying when a person under the care of healthcare professionals or family members dies of nat- ural causes. Amedical examiner or coroner usually will do the certification when the death is from something other than natural causes, such as an injury or suspected foul play, or when the death is unattended. In Arkansas, the office of coroner is a county-level elected office carrying a four- year term. Acoroner is not required to have any medical knowledge or educational certi- fication, although deputy coroners, who are COLUMN POLICY hired to work alongside county coroners, are required to obtain state or national certifica- tion. Coroners do not perform autopsies, but they may refer cases to the Arkansas State Medical Examiner’s Office—housed in the Arkansas State Crime Laboratory, a division of the state Department of Public Safety—for autopsies. Law enforcement and judicial of- ficers also have the authority to refer cases for autopsies. The state medical examiner and associate medical examiners are required to be physi- cians who are eligible to practice medicine in Arkansas. Medical examiners in the state are also required to have postgraduate training in human pathology and at least one year of experience in medical-legal practice. A death certificate in Arkansas must list the immediate cause of death, defined as the final disease or condition resulting in death; any intermediate causes of death, defined as conditions that link the immediate cause DEATH REPORTING: Accurate Data Essential in COVID-19 Pandemic, Opioid Crisis of death to the underlying cause of death; the underlying cause of death, defined as the disease or injury that initiated the train of events leading directly to death or the circumstances of the accident or violence that produced the fatal injury; and any con- tributing causes of death, defined as other significant conditions contributing to death but not resulting in the underlying cause. For example, a death certificate might list pulmonary embolism, a blood clot in the lung, as the immediate cause of death; myo- cardial infarction as an intermediate cause of death; arteriosclerotic heart disease as the underlying cause of death; and emphysema and alcoholism as contributing causes. Adeath certificate must also list the man- ner of death, which is the certifier’s opinion as to whether the death was from natural causes or from an injury resulting from an accident, homicide or suicide. The certi- fier may note that the manner could not be Death reporting is a key component of the public health responses to the COVID-19 pandemic and the opioid overdose epidemic.