Retrospective evaluation of cause of death errors and possible consequences in death certificates from a forensic medical perspective

Aim: The aim of this study was to identify the errors made in the notification of death in cases of natural death in which death certificates (DC) were issued by physicians who were not trained in forensic medicine in our hospital, to identify the cases that required mandatory reporting but were not reported, and to discuss the possible consequences of these errors. Material and Method: A retrospective analysis was conducted on cases of natural deaths that occurred between January 1, 2023, and December 31, 2023, where the DCs were issued by physicians without training of forensic medicine specialization at our hospital. A total of 220 cases were randomly selected from those that met the inclusion and exclusion criteria. By reviewing past hospital records, new causes of death were determined without knowledge of the cause of death in DCs, cases requiring mandatory reporting but not reported were detected and errors made in recording the causes of death in the DCs were evaluated. These errors were categorized based on their impact on the selection and interpretation of the underlying cause of death, using a scale from 1 to 4. Errors classified as 1 and 2 were considered minor, while those classified as 3 and 4 were considered majör. Results: Only 10.5% of the 220 reviewed DCs were completed without errors. It was determined that 89.5% of the DC's contained any errors; 13.2% contained minor errors; and 89.5% contained major errors. The most frequent error type was the recording of an incorrect underlying cause of death (Error 4c), found in 61.4% of erroneous DCs, followed by the absence of an acceptable cause of death in Part I (Error 4b) at a rate of 56.4%. It was determined that incorrect documentation of the underlying cause of death (Error 4c) would lead to differences in the cause of death lists on 54.9% of the DCs, thus affecting the statistics. The rate of deaths requiring mandatory reporting (Error 4e) was found to be 13.5% (n=30); among these cases, 17 involved sudden, unexpected, or unexplained deaths, 8 raised suspicions of violent death, 3 suggested death due to medical malpractice, and 2 indicated suspected poisoning. A statistically significant difference was found for each error in the error rates based on the hospital department where the DCs were completed. Notably, all DCs (n=49; 100%) issued by emergency department physicians contained errors, all of which were classified as major errors under Error 4. Conclusion: Errors or deficiencies in death notifications can impact not only statistical accuracy and the planning of public health policies but also lead to undesirable legal consequences in matters such as inheritance and insurance. In particular, failure to mandatory reporting may result in undetected crimes or erroneous judicial outcomes due to incomplete examinations. To reduce the error rate in death notifications, standardized approaches should be adopted, physician awareness should be increased, forensic medicine specialists should be more actively involved in death-related processes, and forensic medicine training programs should be structured to meet this need.