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