For Health Professionals

Support for Signing Death Certificates in Natural Deaths

If a patient has relevant medical history (including chronic diseases such as hypertension, diabetes, or COPD) and the death is clearly natural, it does not require referral to the coroner, even if you are unsure of the exact terminal event. An educated guess based on the circumstances of the death and the person’s medical history is sufficient for determining the cause of death and completing the death certificate.

If you are unsure of what to put as the cause of death for a clearly natural death, the on-call forensic pathologist can discuss the case with you and recommend appropriate wording. The forensic pathologist can be reached through the Christchurch Hospital switchboard.

Coroner Referrals

All non-natural deaths, and those that may be from non-natural causes, require referral to the coroner. Examples include:

• Deaths due to injury or where an injury may have contributed to death, except in people over age 70 who die from complications resulting from a simple fall
• Deaths occurring as the result of a harsh environment such as drowning or cold exposure
• Cases raising concern for abuse or neglect
• Drug overdoses/toxicity

Deaths occurring during or shortly after surgery or anaesthesia only require coroner referral if the death was unexpected. In most cases, if the surgery was high-risk (e.g. cardiovascular surgery) or the person had known comorbidities (e.g. ischemic heart disease), and no concerns have been raised regarding the standard of care, then the death is not considered unexpected and a death certificate can be issued by the treating physician.

If you have questions about an apparently natural death, speak with the on-call forensic pathologist before referring the case to the coroner. The coroners in New Zealand are lawyers and will not be able to discuss the medical aspects of the case, whereas forensic pathologists are medical doctors with subspecialisation in autopsy and death investigation and can assist with deciding whether a referral to the coroner is needed or if a death certificate can be completed by the treating clinician.

Autopsies for Non-Coronial Deaths (Hospital-based Autopsies)

If a death occurs in hospital and does not qualify as a coroner case but you or the family have questions around how the death occurred, a hospital-based autopsy may be appropriate. The on-call forensic pathologist can discuss with you whether an autopsy would be beneficial. Please contact the Christchurch Hospital mortuary with any questions about requesting a hospital-based autopsy.