Inquest Bottleneck

I was reminded about one of the “services” we do for the living (survivors of the decedent “clients” of our office) yesterday during inquests. We generate the final death certificate for all individuals dying of “unnatural” causes (as well as many dying of “natural” causes, their doctors “generate” the bulk of the death certificates for “naturals”).

A death certificate doesn’t look like much, but it is a powerful piece of paper. Without it the estate cannot be settled, you can’t apply for Social Security survivor benefits, most often life insurance cannot be paid out, bill payment plans cannot be set up, people often cannot get on with their lives. It can be an incredible hardship and stressor for surviving spouses and families (not that they aren’t already under enough stress). Bills pile up with 2nd and 3rd notices, often with no recourse until the final death certificate is issued and certified by the proper clerk/registrar.

In the Coroner System, the inquest is often the bottleneck in the process of getting the permanent death certificate done. “Unnatural” deaths must go to inquest and have the cause and manner of death decided upon by a jury of 6 individuals. For a number of reasons it can take an unfortunate amount of time to get to inquest, e.g. getting through a backlog of pending inquests, getting completed investigations and documentation from outside agencies, getting medical records.

Over the last year, we have eliminated most of the backlog of “pending” cases, but it is still taking us 6-9 weeks to get to inquest. That timeframe is really untenable for many of these families waiting for death certificates. But even with that period time to inquest we still get complaints from law enforcement agencies that their investigations are still ongoing and their reports are not completed. Nonetheless, because of the real problems encountered by spouses and family, we will drive the time to inquest to 4 weeks over the next 2 months (and keep it there, if not better). It will take close follow through in my office. It will also require educating some outside agencies that we don’t need a totally completed investigation on their part (such as they would need for a criminal charge/trial), all we need is information to determine the cause and manner of death because that is all the inquest is to determine, and not whether someone or something is to blame.

I don’t want one more spouse telling me that they risk losing their house because we don’t have the death certificate done.