I didn’t realize this when creating this post earlier, but I just want to add the point here that the fact that they switched the death certificate from paper to electronic and this means that the old rules in the training document I found below can’t be followed apparently. So I think this is a major change in itself.
Next paragraph in the article:
Third, COVID-19-attributed deaths are deemed ‘natural’ by new rules released by the chief coroner on April 9 (see ‘Condition Set Three,’ below). In all but an extremely small number of cases, natural deaths are exempt from any further investigations or post-mortems. (Over the last 30 years post-mortems have become rare, but to almost completely remove the possibility is another matter.)
What is the Managing Resident DeathsTeam (MRDT)?
The MRDT is a dedicated resource individual (or team) in each long-term care (LTC) facility assigned to provide efficient, proactive, and respectful disposition of the deceased during the COVID-19 outbreak.
They were re-arranging the process with the implied justification that there were expecting a lot of deaths.
What is the role of the Office of the Chief Coroner (OCC) in the process?
During the COVID-19 outbreak, a special team will be available at Office of the Chief Coroner (OCC Team) to assist with efficient, proactive and respectful disposition of deceased persons. The OCC Team will assist with the completion and delivery of the Medical Certificates of Death for natural hospital deaths and deaths in long-term care (LTC) homes.
This team “assists” with the completion of the Certificates of Deaths. The deaths are referred to as “natural.”
This Ontario government page has Common Questions About Death Investigations:
A coroner is called to investigate deaths that appear to be from unnatural causes or natural deaths that occur suddenly or unexpectedly. Additionally, a coroner may become involved when concerns are raised regarding the care provided to an individual prior to death.
Continuing with the COVID document:
Is this change going to be more work for the LTC home staff?
Changes being introduced should result in a more efficient process for managing resident deaths in long-term care homes.
•Transferring deceased residents directly into the care of the funeral service sector is an efficient process and replicates existing practices
•It reduces pressure on the health care and LTC systems to manage the storage of deceased persons
•It minimizes entry of individuals (funeral service providers) into the LTC facility.
•It decreases exposure and risk of transmission to funeral service providers in scenarios with potentially limited personal protective equipment (PPE)
•It allows front-line staff to rapidly resume direct patient care.
Notice that the first point is worded to give people the idea it’s not a new procedure for Ontario (“replicates existing practices” refers to what incident where?), but it is new or it wouldn’t be mentioned. It’s just the way they are selling it. They’re expecting an emergency situation and justifying it that way, which is what the other points are supposed to be about.
The first point is that they want to transfer the bodies to the funeral home directly. This is not normal.
The second point implies that there is going to be a problem with where to put the bodies, which is meant to justify the first point.
The protocols around COVID-19 based on the perception that it is very contagious and fatal end up justifying some of the other points. The population of Canada for example is 37,747,023 and the number of deaths attributed to COVID since March is 8749 (as of July 9, 2020). That is 0.02% The leading cause of death in Canada is cancer and the number of deaths due to cancer in 2019 is estimated at 82,100 (0.2% of the population or ten times higher, just cancer). That’s 225 deaths per day due to cancer alone, which I would assume is very similar right now in 2020. So that’s a lot of people dying every day–from various illnesses besides cancer–many of those in a populous province like Ontario, but they’re not getting media attention like COVID. The reason is that COVID is being used to force on us a new way of life.
Who should be on the Managing Resident Deaths Team (MRDT)?
One of the points is:
Ability to facilitate completion and submission of documents to OCC Team
But that must refer to other documents besides the death certificate (see below)
Does the MRDTonly work with COVID deaths?
•No. During the COVID-19 outbreak period, the MRDT will manage all deaths occurring in LTC homes.
•This process applies to both LTC homes where a COVID-19 outbreak has been declared as well as LTC homes not under outbreak protocols
So this team makes sure these new procedures are carried out for all deaths in their care home.
Who can pronounce death?
•There is no legal requirement that would prevent an RN or RPN from pronouncing death, as clarified by the College of Nurses of Ontario (CNO). However, only a physician or a Registered Nurse (Extended Class) can certify death.
•The Office of the Chief Coroner will certify all deaths in LTC using the information provided to on [sic] the MRDR team during this outbreak
So this is not normal, right? Instead of the body waiting for a physician or Registered Nurse (Extended Class) to certify death, it is moved quickly to a funeral home while paperwork is sent to the Office of the Chief Coroner who certifies the death. There is no physician present.
I looked up this document:
Handbook on Medical Certification of Death Prepared for: Registered Nurses (Extended Class)
Office of the Registrar General | Ministry of Consumer and Business Services | August 2010
The Preface states:
Physicians and coroners share the responsibility for completing the medical certificate of death. By extending this role to the RN(EC) in certain circumstances, it is expected that they will be able to ease the burden on families where a person receiving palliative care dies at home, in a long term care facility or in other circumstances where the deceased’s physician is not available.
Page 1 explains that an RN(EC) can only sign the death certificate in very specific circumstances. Otherwise a physician or a coroner must complete the death certificate.
Page 2 refers to the rule about when to call a coroner for investigation:
The Vital Statistics Act has an expectation that deaths due to causes other than natural disease must be reported to a coroner for investigation . . .
Death except by disease (5) If there is reason to believe that a person has died as a result of any cause other than disease, or has died as a result of negligence, malpractice or misconduct on the part of others or under such circumstances as require investigation
This part might be important because deaths could be investigated for different reasons:
Is the death due to non-natural causes (such as accident, homicide, or suicide)? For example, an injury (e.g. hip fracture) that precedes a terminal medical event (e.g. pneumonia) is considered to be non-natural, and therefore a coroner must be notified to determine if the death may be attributable to the initial injury.
•Was the death sudden and unexpected (i.e. not reasonably foreseeable)? The sudden death of a terminally ill patient, or DNR patient would generally not fit this category. The threshold for calling the coroner should be relatively low. The coroner may determine that an investigation is not required, but this should be his/her decision, not the hospital staff person’s.
•Is trauma (including a fall in hospital, fracture etc.), overdose, poisoning, intoxication related to this death?
•If the deceased was from a Long Term Care facility, is this a threshold case (i.e. the tenth death from that institution)? The LTC facility should be contacted to determine whether the coroner should be notified.
•Have family members expressed concerns or have there been controversies about treatment decisions? Where family dynamics have created difficulties or concerns for hospital staff, a coroner might be the appropriate independent “third party” to assist in diffusing contentious issues and volatile situations after the death.
If the answer to any of these questions is “Yes”, the death should be reported to the coroner.
The Coroners Act allows the coroner some discretion in certain circumstances as to whether he/she will investigate the death. In other cases, an investigation and possibly an inquest may be mandatory.
Where a death has been reported to the coroner, and has been accepted for investigation, the coroner will have the legal obligation to complete the medical certificate. Non-coroner physicians should not complete a medical certificate in these circumstances
So, as far as the COVID-19 events, and someone dies under this COVID-19 set of rules, I think family members who are wodering about any of the special circumstances should consider acting on these laws.
It’s interesting what it says on page 3 about the importance of death registration.
The first part has to do with the individual’s death and their rights and others’ rights, and burial, property, ect. The second part is emphasizing “morality statistics” which “form the basis of the oldest and most extensive public health surveillance system” which has been run for a long time by people who are influenced by those holding to Fabian doctrines on usefulness to society. It seems reasonable to keep track of causes of death in order to help prevent sickness–if that was actually how things worked–but as we have seen, these death certificates can also be used by those who have a power agenda. And for people who doubt that, they can read The Open Conspiracy by H. G. Wells and listen to the words of George Bernard Shaw. Society is something that is managed and rights unfortunately need to be defended against those who manage it.
This page gets into details about how the information could benefit others. Sounds good but information is power as they say. Values aren’t automatically determined by statistics or other facts, right? One kind of person counts the suicide statistics and evaluates a policy one way and another type of person looks at those statistics with a completely different set of values and acts accordingly. They can be used for good and bad. The dominant ideology in our world–since claims to be doing good by setting itself up in the place of God to replace older values about human life and about life in general.
This might be very relevant to people examining COVID-19 events (page 3):
The personal information on vital records is protected against unwarranted or indiscriminate disclosure under the Vital Statistics Act, R.S.0. 1990, c.V.4, the Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c.F.31 and, at Statistics Canada, under the Statistics Act, R.S. 1985, c. S-19.
I think we should look into challenging whatever we can challenge that’s taking place under the COVID regime, and personal privacy infringements are part of that. We should examine these three Acts. I linked to federal acts but there might be one or two of them that are provincial and have similar names.
. . . Uniform principles must be applied in the reporting of cause(s) of death, which then must be recorded on the form recommend[ed] by the World Health Organization. . .
So the WHO was part of this whole system.
In the prescribed circumstances, if a RN(EC) attends the deceased during his or her last illness, he or she must . . . and then there is a set of rules to follow. But notice that they were attending the deceased during their illness.
The cause of death section of the Medical Certificate of Death, in use in Canada’s provinces and territories, is standardized in accordance with the World Health Organization (WHO) guidelines. From this, the causes of death are classified, according to the World Health Organization’s International Classification of Diseases, Injuries and Causes of Death (ICD).
So we’ve been living in a globalist system for a while that has been building itself up.
I don’t see why they need the WHO to define these concepts except that it makes for uniform standards across the globe–for better administration of the globe:
An important concept in classifying causes of death is the underlying cause of death. The underlying cause is defined by the World Health Organization as “the disease or injury which initiated the train of morbid events leading directly or indirectly to death, or the circumstances of the accident or violence which produced the fatal injury.” However, information on the other diseases or conditions that led to death and the other significant conditions that contributed to death are also important. The cause of death section is thus designed to record information on all significant diseases or conditions of the deceased, whether or not they are the underlying cause. The analysis of all conditions on the Medical Certificate of Death is especially important in studying diseases or conditions that are rarely the underlying causes of death, but often contribute to death, such as pneumonia or diabetes
. . . The certifier thus has both the responsibility and the opportunity, by using care and attention in the completion of the certificate, to ensure mortality statistics reflect both the underlying cause of death and multiple causes of death.
Page 6 has General Instructions:
The medical certificate is an important legal document and permanent record detailing the fact and circumstance of death. . . . Per the Vital Statistics Act you are required to use original forms supplied by the Office of the Registrar General and not a copy. . . .
I noticed one (at least) of the guidelines seems very pertinent:
It is essential that the Medical Certificate of Death:
•Is prepared accurately according to the directions in this handbook;
. . .
Is an original, not a reproduction, of a current version of the Medical Certificate of Death (see Appendix I);
. . .
•No copies are made after the medical certificate has been completed and certified and
•The original, not a reproduction, accompany the body of the deceased upon transfer to the funeral home to be provided to the funeral director.
I think this might be very important. This is the normal procedure and perhaps it is even required. So what does it mean if there isn’t even a completed death certificate accompanying the body?? Under the COVID rules, who is completing the death certificates? How is it being completed? Where is it physically? Who is sending it to the funeral home? Is it accompanying the body? Shouldn’t the person certifying the death be with the body?
I have to just insert here the answer that the death certificates were switched to an electronic format and that is part of the explanation for the discrepancies here. So it’s a big deal that they switched it to electronic format in itself.
Page 9 is very relevant:
This educational document clearly considers Breast Cancer as a suitable UNDERLYING CAUSE for “respiratory failure” – so how many times did certifiers NOT do this because of the COVID regime telling them to put COVID-19 as the underlying cause?
Example A medical diagnosis of a terminal illness made by a medical practitioner of Breast Cancer with metastases for an 87 year old woman who develops pneumonia, leading to respiratory failure.
A reportable sequence: 1a) Respiratory failure (immediate cause on (a))Due to, or as a consequence of b) Primary Breast Cancer (underlying cause reported on the lowest completed line)
And the other two examples are just similar. So many times did certifiers put COVID-19 as the underlying cause during these months when they believed it was really cancer, or if they would have normally put cancer.
Another example includes pneumonia even:
A reportable sequence including an antecedent cause (any intervening causes occurring between the immediate and the underlying cause of death: 1a) Respiratory failure(immediate cause on (a)) Due to, or as a consequence of b) Pneumonia (antecedent cause) Due to, or as a consequence of c) Primary Breast Cancer (underlying cause reported on the lowest completed line)
A reportable sequence including more than one antecedent cause: 1a) Respiratory failure(immediate cause on (a)) Due to, or as a consequence of b) Pneumonia (antecedent cause) Due to, or as a consequence of c) Metastases to lung (antecedent cause) Due to, or as a consequence of d) Primary Breast Cancer (underlying cause reported on the lowest completed line)
Did doctors usually test very ill people for viruses in the past before filling out death certificates? It doesn’t sound like it. What validity does the test have if the doctor is aware of the person’s condition? Can they really tell that the COVID-19 illness is present and how different does it look from these examples?
What kinds of delays are going to be caused with the death certificates if suddenly everybody has to be tested? Were all deceased persons tested if they were not already tested?
Lots of questions. What is legitimate and what is not?
This post seems to answer the question I have about whether the certifier is required to be in attendance to the body:
Alternatively, physicians should also be aware that provincial and territorial legislation does not necessarily require that physicians formally attend to the body to certify the death in every case. If it is appropriate, physicians can rely on the patient’s file and on information reported to them by other health professionals who attended to the patient during his or her last illness. Physicians in these cases should carefully review the record and make the necessary inquiries to satisfy themselves that the information is correct, especially as it relates to the cause of death. Physicians may, however, wish to attend to the body to certify the death if they feel they have insufficient information or if they have questions about the circumstances of the death. Physicians who complete a medical certificate without making reasonably necessary inquiries could expose themselves to liability.
But it sounds like they are usually expected to be in attendance to the body (like the RN(EC) but at least to make necessary inquiries. So, during the COVID long term care home deaths, were any physicians or RN(ECs) ever in attendance with any deceased? how many certifiers were there in Ontario at a central coroner’s office? Was there just one of them certifying all the deaths based on information sent remotely from the care homes? Did the death certificates get filled out off-site, and then how did they get to the funeral homes? If they were sent electronically, were there amendments to the law to allow that?
Sorry for all the questions.
Some of the questions are answered by the fact that they had switched the death certificates to an electronic format. I will just try to clarify that along with other points but it means there is a huge difference between the old rules and standards compared to whatever is happening. So this is a big change in itself.
To be continued