After a Connecticut nurse pronounced a patient's death, did a physician still have to examine the body before signing the death certificate?

Plain-English summary

The Connecticut Attorney General concluded that a physician signing the medical certification on a death certificate still had to personally view and examine the body, even when a registered nurse had already determined and pronounced the patient's death under the 1991 statute. The nurse's pronouncement and the physician's certification were separate acts. The death-certificate statute expressly prohibited a physician from signing unless the physician had examined the body and satisfied himself that the person was dead.

The opinion explained that a nurse could pronounce an anticipated death only under the limited conditions in Conn. Gen. Stat. § 20-101a(a). That section still called for a licensed physician to certify the death and sign the certificate within twenty-four hours of the nurse's pronouncement. It did not change the earlier certification rule in Conn. Gen. Stat. § 7-62b(c). The opinion answered the examination question directly and did not treat the nurse's pronouncement as a substitute for the physician's examination.

Currency note

This opinion was issued in 1991. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Historical summary

For physicians certifying deaths: The opinion said the signing physician had to personally view and examine the body and confirm death. Under the statutes then quoted, the physician also had to complete the medical certification within the applicable twenty-four-hour period.

For registered nurses: The opinion recognized a nurse's authority to determine and pronounce an anticipated death in specified hospice, nursing home, or home settings. The nurse had to attest to the pronouncement on the death certificate, but that act did not displace the physician's certification duty.

For funeral directors: The quoted death-certificate statute required the physician to return the medical certification to the funeral director or embalmer within twenty-four hours after death. The opinion's answer preserved that physician role even after a nurse's pronouncement.

Common questions

Can a doctor sign the medical portion of the death certificate without seeing the body if a nurse has pronounced death?

The Attorney General said no. The physician had to personally view and examine the body before signing, even after a lawful nurse pronouncement.

Could a nurse pronounce death at all under the law addressed in this opinion?

Yes, for an anticipated death under the settings and other conditions specified in § 20-101a(a). The statute also required the nurse to attest to the pronouncement and a physician to certify and sign the certificate.

Did the nurse's pronouncement extend the physician's certification deadline?

The opinion did not announce an extension. It quoted the rule requiring physician certification within twenty-four hours of the nurse's pronouncement, together with the death-certificate statute's twenty-four-hour return requirement.

Background and statutory framework

Conn. Gen. Stat. § 20-101a(a) allowed a registered nurse to pronounce an anticipated death under specified conditions and required a physician's later certification. Conn. Gen. Stat. § 7-62b(c) said no physician could sign the medical certification without personally viewing and examining the body. The Attorney General read the provisions together: the later nurse-pronouncement law did not remove the physician's examination duty.

Citations and references

The original opinion below quotes both statutory provisions and explains their distinct roles in pronouncement and medical certification.

Source

• Landing page: https://portal.ct.gov/AG/Opinions
• Opinion page: https://portal.ct.gov/ag/opinions/1991-formal-opinions/susan-s-addiss-mph-murs-department-of-human-resources-1991037-formal-opinion-attorney-general-of-con

Original opinion text

Susan S. Addiss, MPH, MUrS, Department of Human Resources, 1991-037 Formal Opinion, Attorney General of Connecticut

Attorney General's Opinion

Attorney General, Richard Blumenthal

December 12, 1991

Susan S. Addiss, MPH, MUrS

Commissioner

Department of Human Resources

150 Washington Street

Hartford, CT 06106

Dear Commissioner Addiss:

In your letter of July 30, 1991, you asked our opinion on the following issue:

In those situations where a registered nurse has determined and pronounced the death of a patient pursuant to Connecticut General Statutes, § 20-101a, do the statutes require a licensed physician to view and examine the body when preparing the medical certification potion of the death certificate?

It is our opinion that Conn. Gen. Stat. § 7-62b(c), requires a licensed physician to personally view and examine the body of the person to whom the medical certification relates, in order to ensure that such person is, in fact, dead.

Pursuant to Conn. Gen. Stat. § 7-62b(a), a death certificate must be filed for each death which occurs in Connecticut. Conn. Gen. Stat. § 7-62b(c) provides:

The medical certification portion of the death certificate shall be completed, signed and returned to the licensed funeral director or licensed embalmer within twenty-four hours after death by the physician in charge of the patient's care for the illness or condition which resulted in death. In the absence of such physician, or with his approval, the medical certification may be completed and signed by a designated associate physician , the chief medical officer of the institution in which death occurred, or by the pathologist who performed an autopsy upon the decedent. No physician shall sign and return the medical certification unless he has personally viewed and examined the body of the person to whom the medical certification relates and has satisfied himself that at the time of the examination such person was in fact dead. If a physician refuses or otherwise fails to complete, sign and return the medical portion of the death certificate of the licensed funeral director or licensed embalmer within twenty-four hours after death, such licensed funeral director or embalmer may notify the commissioner of health services of such refusal. The commissioner may, upon receipt of notification and investigation, assess a civil penalty against such physician not to exceed two hundred fifty dollars....

(Emphases added).

The above statute is clear and unambiguous. It requires a physician to sign the medical certification on the death certificate within twenty-four hours of death, and it prohibits a physician from signing the medical certification unless he personally views the body to ensure that the person is dead.

Conn. Gen. Stat. § 20-101a(a), which allows a registered nurse to make the actual determination and pronouncement of death in limited circumstances, is reproduced below:

A registered nurse, licensed under this chapter, in charge in a hospice or nursing home facility as defined in section 19a-251, or a registered nurse, licensed under this chapter or a registered nurse employed by a home health care agency licensed by the state of Connecticut, in a home or residence may make the actual determination and pronouncement of death of a patient provided that the following conditions are satisfied: (1) The death is an anticipated death; (2) the registered nurse attests to such pronouncement on the certificate of death; (3) the registered nurse indicated on such certificate the presence of a contagious disease, if known to be present at the time of the death; and (4) a physician licensed by the state of Connecticut under chapter 370 certifies the death and signs the certificate of death within twenty-four hours of the pronouncement by the registered nurse.

(Emphases added).

Under the above statute, a registered nurse may make the actual determination and pronouncement of death, but a licensed physician must still certify the death, and sign the death certificate within twenty-four hours of the pronouncement by the registered nurse. The physician's duties and obligations regarding the certification of death are set out in Conn. Gen. Stat. § 7-62b(c). Nothing in § 20-101a(a) alters the requirement that a physician personally examine the body and certify the death of an individual who was pronounced dead by a registered nurse.

It is a fundamental rule of statutory construction that statutes must be construed so as to give effect to the intent of the legislature. State v. Parmalee, 197 Conn. 158,161, 496 A.2d 186 (1985) (citation omitted). "When the words of a statute are plain and unambiguous, we need look no further for interpretive guidance because we assume that the words themselves express the intention of the legislature." Rhodes v. Hartford, 201 Conn. 89, 93, 513 A.2d 124 (1986) (citation omitted). The plain language of Conn. Gen. Stat. § 20-101a(a) indicates that a nurse's pronouncement of death does not relieve the physician of his duty and obligation to certify death and sign the death certificate. This statute does not purport to set out specific guidelines regarding the physician's protocol for certifying the death and signing the death certificate. That protocol was already established by the legislature in 1983 when it passed Conn. Gen. Stat. § 7-62b. When the legislature passed Conn. Gen. Stat. § 20-101a in 1987, "[t]he legislature must be presumed to have acted with existing relevant statutes in mind, and with the intention of creating a consistent body of law...." State v. Carbone, 172 Conn. 242, 256, 374 A.2d 69 (1977), cert. denied, 431 U.S. 967 (1977) (citation omitted).

Therefore, it is our opinion that a physician must personally view and examine the body of a person on whom he is certifying death on a death certificate, even when a registered nurse has determined and pronounced the death of that person, pursuant to Conn. Gen. Stat. § 20-101a.

Very truly yours,

RICHARD BLUMENTHAL

ATTORNEY GENERAL

Sharon A. Scully

Assistant Attorney General