Legal Pronouncement of Death
HOSPICE AND PALLIATIVE CARE
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Representative Riesberg reconvened the committee. He spoke to two handouts, a packet of articles regarding end-of-life care and what other states are doing, and a report titled "End-of-Life Care: Services, Costs, Ethics, and Quality of Care" from the Congressional Research Service (Attachments F and G).
01:08 PM -- Issues Surrounding the Legal Pronouncement of Death and Other Aspects
Dr. Robert Bux, El Paso County Coroner and President of the Colorado Coroner's Association introduced himself to the committee. He provided details regarding the role of the coroner when hospice patients expire. Senator Newall asked Dr. Bux about the process in which counties select a coroner. She asked if he thought the process which Colorado uses is the best. Dr. Bux stated that there are two ways in which counties select a coroner, through an election process, or by appointment. Dr. Bux responded that he has worked under both systems and both have their advantages and disadvantages. He explained Colorado's selects a coroner via the election process. He stated that all 64 counties in Colorado have direct access to a forensic pathologist if needed. He explained that the coroner's big concern is who is going to sign the death certificate and who is designated to pick up the body from a hospice center. He stated that often times it depends on who the family calls after the family member expires. He stated that if the coroner's office has been notified of the patient's residence in the hospice center, the coroner will be notified of the death. He stated that at times, family members call 911 and then the police show up which delays the process for the coroner. He stated that in El Paso County, hospice care centers register their patients with the coroner's office. Senator Tochtrop asked if a body can be cremated if a death certification has not been signed. Dr. Bux replied that a body cannot be buried or cremated until a death certificate has been signed.
Janelle McCallum, Vice President of Clinical Operations, Denver Hospice, introduced herself and spoke to a handout regarding the various counties and their requirements on what to do when a hospice patient expires (Attachment H). She stated that if a person expires and it is due to an injury or trauma, the death is suspicious for some reason, they always call the coroner. She described other incidents when the hospice care center would alert the coroner to a patient's passing. She stated that each county coroner has different procedures. She confirmed that some counties require the hospice center to pre-register hospice patients, and some counties do not require registration. She explained that each county has different procedures; some counties require that a coroner investigate all deaths in a hospice, and some do not. Ms. McCallum stated that some coroners take the deceased patient's medication or driver's license, but there is little consistency among the counties.
Ms. McCallum spoke to issues regarding who can pronounce a person's death and sign a death certificate. Ms. McCallum spoke to an opinion from the Colorado Attorney General's office to the Board of Nursing that discussed if a nurse can determine death and pronounce death (Attachment I). The committee discussed circumstances regarding the pronouncement of death.
Dr. Bux stated that he does not believe legislation is necessary to require that all coroners have the same process in place regarding the legal pronouncement of death. He spoke to incidents where a person may be paralyzed or unconscious, and questions are not asked because a patience is not registered with the coroner's office. He stated that many people have slipped through the cracks. He stated that when a patient of hospice is registered with the coroner's office, it is easier on the hospice organization because the information is provided and is on record. There was some discussion regarding standardization of pre-registration for hospice patients. Senator Williams asked questions regarding the opinion from the Colorado General Attorney's Office regarding when and if nurses may pronounce death. She stated that the committee should request a new opinion on the matter, as the one Ms. McCallum referred to was from 1993.
Michael Kirtland, Colorado Bar Association - Elder Bar, introduced himself to the committee. He stated that his perspective focuses on the family of the hospice patient. He stated that they would like to see consistency among coroner's offices. He stated that it would be preferable that the information come from the end user rather than top down from the legislature. Dr. Bux spoke to other models that could be put in place. He cautioned the committee that the state might have to spend a lot of money and resources for a new system, but in the end, it might not be effective. He stated that not one size fits all. Senator Newall asked the current salary of a coroner. Dr. Bux provided a range of salaries and stated that the salaries are determined by county commissioners. Senator Tochtrop also noted that the General Assembly has to approve the salaries. Ms. McCallum brought up the impending Medicare cuts to the hospice providers. She stated she was very concerned about the upcoming cuts to the budget.
Dr. Bux stated that he does not feel comfortable allowing certain medications to stay in the home. He stated that he would prefer to take the medications of the deceased patient with him. He stated he does not have an opinion on the drugs themselves, but is concerned that the medications get into the wrong hands and then are sold on the street. He also commented on why the coroners take the deceased individual's driver's license. He stated they usually take the driver's license and punch a hole in them. Ms. McCallum responded that with the amount of deaths that occur in a hospice, it would be burdensome for a coroner to come out every time to confiscate medications or driver's licenses. She stated that it is her understanding that the medications are the property of the deceased and the deceased's estate. She stated that she does not want to have the burden of transporting the drugs, but they would prefer to destroy the drugs in the home. Dr. Bux stated that El Paso County does not allow medications to be left in the home.
Mr. Kirtland explained some of the processes that families deal with after death. The committee discussed some of the various issues that families deal with, including what to do with medications and what mortuary to send the body to. He stated that there is a check list that is provided to families by mortuaries that helps family members know the various tasks they need to take care of after a family member expires. The committee took a brief recess.