Leaked document suggests doctors told ‘no requirement’ to record Covid-19 on death certificates Leaked hospital guidance tells medics filling in death certificates that ‘pneumonia or community-acquired pneumonia are acceptable’ to put

Doctors at an NHS trust have been told there is no need to list Covid-19 on death certificates of coronavirus patients, according to leaked documents.

The hospital guidance, obtained by not-for-profit organisation Good Law Project, tells medics filling in death certificates that “pneumonia or community-acquired pneumonia are acceptable” to put as the direct cause of death.

The “guidance for death certification of proven Covid-19 patients during the current pandemic” says proven coronavirus deaths must be reported to the hospital site manager. But under the header “general principles” it states: “There is no requirement to write Covid-19 as part of the medical certificate of cause of death (MCCD).”

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The document states Covid-19 may be mentioned in another area of the form relating to indirect causes of death ‘should the doctor wish’. The unnamed trust’s guidance contradicts that issued by the Government, coroners and the NHS, which says Covid-19 is an “acceptable direct or underlying cause of death” on a death certificate and that “‘it would be satisfactory’ to give Covid-19 as the cause of death even if it is only suspected and no confirmed test results are available”.

The official guidance also says a medical practitioner can fill in the MCCD with these details if they are able to ‘state the cause of death to the best of their knowledge and belief’.

A spokesman for the Department of Health said: “This appears to be an altered version of official guidance. Guidance from the UK Government is clear that ‘Covid-19 is an acceptable direct or underlying cause of death for the purposes of completing the Medical Certificate of Cause of Death’.”

A spokeswoman for NHS England said: “The circulating document forwarded to you by The Good Law Project appears to be a trust’s interpretation put into writing.It is not ours, nor is it official, and we do not know which trust it has come from.

What the leaked guidance from an NHS Hospital Trust says: Doctors are asked to use the standard MCCD (Medical Certificate of Cause of Death) form to certify death. ‘Pneumonia ‘or ‘community acquired pneumonia’ are acceptable at 1(a) on the MCCD. There is no requirement to write COVID 19 as part of the MCCD. It may be mentioned at 1(b) on the form, should the doctor wish. Doctors should involve the Coroner and Coroners’ Officers only in exceptional circumstances. If the certifying doctor has information from the patient’s history and information of the circumstances involving the pre-mortem illness that suggests on the balance of probabilities that pneumonia is the most likely cause of death then the doctor should issue a MCCD. Pneumonia would be appropriate on a MCCD at 1(a). Should the doctor be unwilling to provide a MCCD then he/she should contact the Coroners’ Officers and discuss the circumstances of the death; it may still be possible to proceed with issuing a MCCD. Should this process not result in a MCCD then an investigation or inquest process will be triggered.

The Good Law Project said coronavirus deaths could be going unreported, lowering the official toll reported to the public, if doctors do not follow the Government’s guidance.

“If doctors are being gently discouraged from reporting deaths as Covid-19, we have no way of knowing if the Government figures on deaths from coronavirus – the daily in hospital figures as well as the weekly Office for National (ONS) figures – are accurate,” the group said in a statement.

“The Good Law Project has instructed lawyers to write to the NHS hospital trust today, asking them to clarify the guidance urgently. So far we’ve only seen the guidance from one trust. We have no idea if hospital trusts up and down the country are issuing the same guidance.”

Whistleblower

It comes after concerns were raised earlier this week that medics and GPs are failing to record Covid-19 on death certificates. A whistleblower in the south of England told Channel 4 News that some doctors were listing long-term conditions such as dementia instead even if they suspected coronavirus.

The latest figures show there are now more than 103,000 confirmed cases of coronavirus across the UK with 13,729 recorded deaths, although the true figure is thought to be much higher as the Government’s figures currently only include coronavirus deaths in hospitals.