Pronouncement of Death Regulations Update due to 2003
Wisconsin Act 273
Hospice Nurse Pronouncement of Death
PDF Version of BQA 04-019 (PDF
Date: August 31, 2004 -- DDES-BQA 04-019
FROM: Cris Ros-Dukler, Director, Bureau of Quality
John Kiesow, State Registrar, Section of Vital Records,
Bureau of Health Information and Policy, Division of Public Health
The purpose of this memorandum is to provide an update on pronouncement
of death regulations due to the enactment of 2003 Wisconsin Act 273.
IMPORTANT INFORMATION - What You Need to Know Before
You Implement Hospice R.N. Pronouncement of Death
On May 1, 2004, a new law went into effect, giving registered nurses
the ability to pronounce death in certain circumstances. This memo
serves to clarify some of the issues and misconceptions that have
arisen in light of the change in law. A copy of 2003 Wisconsin Act 273 can
be found at: http://www.legis.state.wi.us/2003/data/acts/03Act273.pdf.
If you receive this memo in a hard copy version, a copy of the new law is
Summary of the New Law:
The new law allows registered nurses working in hospice programs to
pronounce death under certain conditions. The only other parties
allowed to legally pronounce death in Wisconsin are doctors, Coroners/
Medical Examiners and Deputy Coroners/Medical Examiners. The new law also
requires the filing of a Notice of Removal of a Human Corpse (NOR) (HCF
5043) for hospice deaths occurring at a residence or CBRF. Prior law
required the form to be filed for a hospice death if it occurred in a
hospital, nursing home or stand-alone hospice facility but not for home or
CBRF deaths. If you are receiving this memo in a hard copy version, a
sample copy of that form is attached. If you are receiving this memo in an
e-mail, a separate form document is attached.
Who May Now Pronounce Death Under the New Law:
In addition to physicians, Coroners, Medical Examiners and Deputy
Coroners/Medical Examiners, a nurse may pronounce death under the
- The nurse is a registered nurse (R.N.) licensed in Wisconsin,
- The R.N. is employed by or under contract to a
Wisconsin-licensed hospice program, and
- The decedent dies while under hospice care and is under the
general care of a physician at the time of death.
Technically, a hospice may now initiate the death certificate (see the
last paragraph under Important Restrictions and Considerations). However,
this authority is rarely used by any of the institutions that have had
rights to do so. Since a majority of funeral homes initiate the death
certificate using a computer software program, it is impractical for
institutions, including hospice, to begin the death certificate.
Therefore, the Vital Records Section will not issue blank death
certificates to hospices.
Important Restrictions and Considerations:
For pronouncement of death:
- An R.N. who is not employed by a Wisconsin-licensed hospice program
cannot pronounce death. This situation is still covered under the
original pronouncement of death instructions. The R.N. calls a physician
for pronouncement of death.
- A hospice R.N. cannot pronounce death for a patient who is not under
hospice care at the time of death. Again, a physician (or
coroner/medical examiner) must be called for pronouncement of death.
- Other non-physician health care professionals (e.g., a physician
assistant, LPN or paramedic) cannot pronounce death.
- As is true for all other authorized parties who perform legal
pronouncements of death, the hospice R.N. pronouncing death cannot be
an immediate relative of the decedent.
A hospice R.N. cannot sign the medical certification of the death
certificate and cannot sign as the person acting as a funeral director.
New Requirements for Filing Notice of Removal (NOR) Forms
- The new law requires hospices to file NOR forms for deaths that
occur while the patient is under hospice care (even for home,
Adult Family Home or Community Based Residential Facility deaths)
no matter who pronounces death.
- The NOR is technically supposed to be started by the funeral
director. However, the hospice R.N. may initiate the document (just as
hospitals and nursing homes currently do) if the funeral director and
hospice personnel believe that it is in the best interest of all
parties to process the document that way. The Bureau of Health
Information and Policy will supply either a hardcopy master or an
electronic (Word) file NOR to hospice organizations requesting the
- No matter who initiates the NOR form, it must be signed by both
the hospice personnel and the funeral director.
- The hospice must send the completed NOR form to the local registrar
(the Register of Deeds or, in the case of a death in the city of
Milwaukee or West Allis, to the designated Health Office) within 24
hours of death.
- Since NOR forms cannot be pre-signed, the hospice worker must
either wait for the funeral director to arrive or return to the home
to collect the completed NOR so that it can be filed within the legal
- The hospice worker must make sure that only a Wisconsin licensed
funeral director (or an immediate family member) removes the body for
disposition purposes. Family members can conduct the funeral but
they must handle the transport and disposition themselves (they can
transport to a crematory).
Reporting Deaths to Coroners and Medical Examiners
- Section HFS 135.08, Wis. Admin. Code, directs a county Coroner or
Medical Examiner to establish procedures for the pronouncement of
death outside of a hospital or nursing home in that county. Those
procedures must not conflict with the law that now permits a hospice
R.N. to pronounce death under certain conditions. However, the
procedures may direct the pronouncer to notify the Coroner or Medical
Examiner of non-hospital, non-nursing home deaths and may specify
circumstances under which the Coroner or Medical Examiner will respond
to the death scene.
- Each hospice worker must know the rules for reporting home deaths in
the counties served, as well as the statutory requirements for
reporting deaths that are listed in Wis. Stat. § 979.01.
Notes on Reporting Deaths to Coroners and Medical Examiners and Health
Insurance Portability and Accountability (HIPAA) Requirements:
- A Coroner or Medical Examiner does not need consent for release of
medical information pursuant to a death notification or investigation
under HFS 135.08, or under Wis. Stats. §§ 979.01 or 979.10
(investigation and body examination required for cremation permit).
HIPAA exempts these activities from consent requirements.
- Some counties have Coroner/Medical Examiner "hospice advance
notification registries". In those counties, the
Coroner/Medical Examiner maintains a pre-death notification for
residential hospice deaths. Participation in that registry allows the
Coroner/Medical Examiner to treat the death as an anticipated death
that results in a reduced death-scene response by that office. In
those cases, the practice may continue with the written consent of
the patient. The Bureau of Health Information and Policy will
supply a model consent form to each Coroner/Medical Examiner.
- The following are misdemeanors (per Wis. Stats. §§ 69.24 and
979.01 (2) and could result in a fine of not more than $1,000 or
imprisonment for 90 days or both:
- Failure to file Notice of Removal forms.
- Allowing an unauthorized person to remove a body for disposition.
- Failure to comply with reporting requirements under Wis. Stat. §
979.01 (reporting deaths to the Coroner/Medical Examiner).
If you have questions regarding this memo, please contact Marianne
Missfeldt, Home Health and Hospice Nurse Consultant at (715) 836-4036 or firstname.lastname@example.org
or you may contact Peggy L. Peterson at (608) 267-7812.
cc: Medical Examiners/Coroners, Funeral Directors, Local Vital Records
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