§ Mr. MackinlayTo ask the Chancellor of the Exchequer if doctors completing death certificates are required to include in the certificate the fact that the deceased was a victim of MRSA, when this contributed to the cause of death. [19854]
§ Mrs. Angela Knight[holding answer 11 March 1997]The information requested falls within the responsibility of the chief executive of the Office for National Statistics. I have asked him to arrange for a reply to be given.
Letter from Tim Holt to Mr. Andrew Mackinlay, dated 13 March 1997:
The Chancellor of the Exchequer has asked me to reply to your recent question asking if doctors completing death certificates are required to include in the certificate the fact that the deceased was a victim of MRSA, when this contributed to the cause of death.Section 22 of the Births and Deaths Registration Act 1953 places duties on medical practitioners as follows:
in the case of the death of any person who has been attended during his last illness by a registered medical practitioner, that practitioner shall sign a certificate in the prescribed form stating to the best of his knowledge and belief the cause of death and shall forthwith deliver that certificate to the registrar.This requirement is included in the Instructions to certifiers, which are at the front of every book of medical certificates of cause of death (MCCD). The instructions further ask the certifier to give the sequence of conditions or events which led directly to the death in part I of the certificate, and to list any other conditions which contributed to the death, in part II. Beyond this, it is up to the judgement of the attending physician to decide what should be included. No particular disease or event is specifically named as being required to be included on the death certificate, although there are instructions about which causes and circumstances of death require referral to the coroner. Death certification is covered in undergraduate and postgraduate training for doctors. The Office for National Statistics (ONS) has recently produced a video (Death Counts) and documentation to help in this training.
If the certificate is completed correctly, the condition of the last used line of part I is the underlying cause of death, i.e. that condition or event which initiated the train of events leading directly to death. The underlying cause of death is selected and coded according to the rules of the Ninth Revision of the International Classification of Diseases (ICD-9), and this is the condition used in routine tabulations and statistics. When the ONS is asked for information on deaths owing to a particular condition, the answer is normally based on the underlying cause, because this is the cause most useful for public health and preventative purposes.
Since 1933, all the conditions mentioned on the approximately 580,000 deaths per year registered in England and Wales have been coded and stored in the mortality databases of ONS, where this additional information can be used for special analyses. Deaths due to methicillin resistant staphylococcus aureus (MRSA) infection are coded to a variety of ICD-9 codes for staph. aureus infection, depending on the body site affected. There is no specific code to denote methicillin resistance of the infecting organism, so this can only be identified by searching the text from the certificate.