S.C. coroner exploring fix in reporting of nursing home deaths

YORK COUNTY -- Errors in how some nursing home deaths are reported have led to time-consuming investigations - oftentimes months after a death - for coroners across the state.

York County Coroner Sabrina Gast is exploring ways to fix the situation, which will likely lead to more work for her office, she said.

Nursing homes, like hospitals, have physicians who are authorized to sign death certificates. If the cause of death is unnatural and may warrant an investigation, the coroner, by law, must be notified.

Some accidental deaths are going unreported because of doctors categorizing the deaths as natural.

"I'm not sure that anyone was doing anything wrong," said Richland County Coroner Gary Watts of when he first realized the errors.

A doctor might be called in to sign off on pneumonia, "which is obviously a natural death," Watts said. But a line or two down on the death certificate might indicate that the patient was "bedridden for three weeks" after falling and breaking a hip, which is an accidental death, he said.

The certificate is then sent to S.C. Department of Health and Environmental Control for storage in vital records.

Oftentimes months later, coroners will learn of the mistake when the Department of Health and Environmental Control, after discovering the error, sends the certificate to them with an order to investigate. Sometimes a family member will inform them the death certificate is wrong.

Similar mistakes resulted in 15 to 20 death investigations last year in York County, Gast said. "That's a lot for us," she said.

Starting an investigation months after the death, some close to a year later, makes it difficult to conduct an efficient investigation, she said.

Correcting the problem

In other counties, coroners have asked DHEC to revoke a power it gives to nursing homes, said Thom Berry, DHEC spokesman.

For every death, a permit for transporting the body to a funeral home - called a burial transit permit - must be issued.

With DHEC's permission, nursing homes often issue the permit. In the event of a natural death, the nursing home never has to contact the coroner, so the coroner doesn't always know someone has died.

That's the way accidental deaths "slip through the cracks," Watts said.

Watts and other coroners have asked DHEC not to give that power to coroners instead.

That way, nursing homes will always have to call the coroner for the permit, giving the coroner a chance to ensure the cause of death was reported accurately and determine whether an investigation is warranted.

Lancaster County Deputy Coroner Karla Knight said she hasn't had any problems with the nursing homes reporting deaths correctly, but said it "isn't good business practice" to make the mistake of reporting accidental deaths as natural, even unintentionally.

'Families want closure'

Determining whether a death is natural or accidental is not so "cut and dry," said Jim Petty, executive director of Park Pointe Village, a Rock Hill retirement community that has a skilled nursing facility on site.

"Lives are very fragile when you're in your late 90s, and there could be a series of events that lead to a death," he said. Conditions such as dementia and Parkinson's disease may "contribute to the end of life" by leading to accidents, he said.

If the county coroner is given authority to issue the burial transit permits, it won't be a "difficult issue," Petty said.

He said he only hopes the coroner would be able to provide "quick and efficient procedures for the end of life," not prolonging an already difficult situation for bereaving families. "That's a very emotional moment and you don't want to bog that down with bureaucracy," he said.

Oftentimes families stay with the deceased until the body is moved to a funeral home, he said. Only then do they go home, contact family and friends, and begin the grieving process, he said.

"Families want closure," he said. "I would hate to see families wait and wait and wait."