Medical Examiners Report Demands to Remove COVID From Death Certificates

Medical examiners and coroners across the country have reported receiving requests to remove COVID-19 as the cause of death on death certificates, usually by a victim’s family members.

In an interview with MedPage Today, James Gill, MD, chief medical examiner for the state of Connecticut, said he’s been asked to make that change a handful of times for a variety of reasons, and each time he’s declined.

For one family, he noted, the reason was their misconception that “the hospital gets more money if it’s a COVID death.”

It’s not unusual for family members to ask that a death certificate be altered in other cases, such as suicide, and even though it’s inappropriate, it’s understandable, he said. In the early days of the AIDS epidemic, family members would ask for official documents to omit any mention that the deceased had HIV or died of AIDS. More recently, this has occurred in cases of an accidental drug overdose.

“I can understand that sensitivity,” said Gill, who brought up the issue during a briefing organized by the College of American Pathologists (CAP). “We certify many, many deaths due to infections, [but] I’ve never had a family call me up and say, ‘I don’t want that bacteria or that virus listed on the death certificate.’ That’s a public health issue. And we have a duty to make sure these deaths are properly certified. And we have to resist those challenges.”

Gill, who is chair of CAP’s forensic pathology committee, added that he’s heard of some jurisdictions where “they do accommodate the family and change the death certificate. And I really think that’s inappropriate. [COVID has] become a political diagnosis, it’s become a political issue, and it should really be a medical healthcare issue.”

Gill also said it’s not unusual for families to have some guilt that they didn’t do more to prevent a death or prevent the spread of the virus. “Part of that guilt can sometimes turn into denial,” he noted.

In other cases, Gill will get a request to insert COVID-19 as the cause of death, even if the person died of something else “because there’s the FEMA [Federal Emergency Management Agency] relief money for burial expenses for COVID deaths. The federal government will reimburse, I think, up to $9,000 for funeral expenses.”

He explained that families have also contacted his office when someone died who “may have been positive for COVID a year ago. And now they’re dying of cancer … and they want COVID on the death certificate because they think it’s somehow related. We explain to them that unless COVID causes or contributes to a death, we don’t put it on the death certificate.”

Amy Karger, MD, PhD, of the University of Minnesota and chair of CAP’s point-of-care testing committee, said she has also heard reports of clinicians being asked to omit COVID diagnoses from medical charts.

“The degree to which some people are in denial about the virus itself is pretty remarkable,” she said during an interview after the briefing.

In one case, a provider told her the family didn’t want a COVID diagnosis on the patient’s chart because “they really felt like it wasn’t real … that it was just made up and that their relative had died of something else. It’s just pneumonia, and nothing to do with COVID,” she said. They insisted it was “a conspiracy theory to bring down Trump. This is not a real virus, all that type of misinformation.”

Various reports have echoed these sentiments. Last year in Montana, for example, a highly visible county health official and internist, Ann Bukacek, MD, questioned COVID-19 as a cause of death and publicly argued that federal officials have told medical examiners to attribute deaths to COVID when the person died from another health condition.