As Former Chief Justice Gloria Musu Scott, 3 Others Trial Continues
FLASHBACK: Former Chief Justice Glaoria Scott during the early stage of her trial
By Garmah Never Lomo, garmahlomo@gmail.com
Following a submission made by state prosecutors into a conflicting death certificate on for the Physician Assistance who attended to the deceased Charloe Musu and the medical doctor who signed the death certificate to appear in court and testify on behalf of the state.
Criminal Court “A” last Thursday October 26,2023 granted submission after the head of Liberia Medical and Dental Council (LMDC), Dr. Benetta Collins Andrew appear in court and testified that the death certificate was correct.
After the submission for state prosecution witnesses to appear in court, defense lawyers objected to the submission on grounds that death certificate wasn’t valid. And it was based such argument between both prosecution and defense lawyers that the court subpoenaed the head of the Liberia medical and Dental council to appear in court and explain the processes or procedures leading to the signing of the death certificate.
Dr. Andrew taking the witness stand clarified that When it comes to Death Certificate, first of all it is a medical legal instrument that is used to attest the fact and cause of death, it is important to first of all establish that this piece of paper has several serious implications, it can be used to get data for research that will informed Public Health Strategist, it can also be used by family to get funding for their dead ones and it could be used in situation like this for issue of litigation and even though the practice or the ethics surrounding signing of death certificate, varies from one jurisdiction to another, there are basic principles that cut across medical practice universally.
“So, as per the practice, it is important to note that there are different kinds of certificates before coming to our jurisdiction.”
Dr. Andrews further said that the first one is for a patient who has been chronically ill and managed by a specific physician, if the patient dies in his facility, that physician is responsible to sign the death certificate of the expired patient, if he is not available, his designee or the current doctor or the medical director of the institution can peruse the record and sign on the attending doctor’s behalf; in the case of emergency.
She explained that when a person is brought to the emergency room, the medical practitioner that sees that patient is responsible to sign the death certificate talking about worldwide so it can be the physician assistant, the nurse, the coroner, the doctor who saw the person last or the medical director.
She explained:
For our case in Liberia, there has been system issues with the current certificate that is being used as death registration so our system says that only the Medical Doctor can sign, that being said, it does mean that the medical doctor can sign out of the blue sky and we are not like develop country where we have lot of doctor, Liberia has not meet the WHO threshold of number of doctors to patient to sometimes you have one doctor that is covering the hospital at every time and we have physician assistant and other mid-nurse that work under the supervision of the physician.
The head of the Liberia Medical and Dental Council added that First of all, signing of death certificate is not an emergency in any part of the world, some countries go from 15 hours minimum, some have 30 or 90 days because the death certificate does not determine the final cause of death, it can be utter anytime when the cause of death is established. So in our case, the doctor is supposed to sign.
Narrating further in her testimony, Dr. Andrews said if the doctor is not available at the time the patient expired, technically whoever is there supposed to do a complete history of that patient, complete physical examination of the patient, detailed laboratory where applicable and then he put same to the physician in charge when he is available, then that physician in charge supposed to take his or her own time to peruse the medical record, if possible examine the body to ensure that indeed that patient x died, then they can write an accompanying report attached to the physician or whoever report and then signed, that report should be further approved by the medical director of that hospital.
But when we took over as Chairperson of the LMDC, we raised issue on the form of the death certificate of the Ministry of Health to review the form and the Ministry paid heed and the process with reversing the current death certificate so now that will be a portion for regular hospital death, dying within few hours in emergency room, when everything is set, it should be in placed by the 1st of November so this actually has a system error, it also has a place where it says that patient was seeing after death. So to conclude, the Doctor is supposed to sign and he supposed to do due diligence.
- Madam Witness, you were talking about universally and then you talked specifically about Liberia and then you also talked about what you people are developing is coming into place in November. Now, what I want to find out is per our case where a physician assistant saw the body and as you look at that certificate, the Medical Doctor signed and he put there that he did not see the body, in that situation based on what you have explained, is that appropriate?
So, professionally, this Death Certificate should not be alone but should be attached to the medical record and what to do is to subpoena the hospital and asked whether the medical doctor review the medical report before signing the death certificate. But for our current system, it is authenticated.
According to the Medical Doctor, he said that he did not see the body but he signed that death certificate, in that case, is it medically correct?
- It is not a yes or no for me, per our present medical system, the doctor is the one to sign so his duty was to go back to what the physician assistant wrote, and if possible, he should sign. But this is allowed in our system.
- You are saying that this should be attached with the physician assistant report? A. No, this is correct as per the current system.
Madam Witness, in your testimony before this Court, you told the Court that the medical doctor can only sign the death certificate if he has personally examined the dead body, and if he was not the person who examined the body, he must have verified the information by his own examination before he can sign the death certificate, am I correct?
THE COURT: The objection will be overruled based on the fact that the question is asking for confirmation or denial, am I correct if he is correct she will say yes and give reason and if he is not, she will say and give explanation so she must answer.
- The key word for me is verified so I said he/she must verify the record to make sure that the physician assistant record is correct. Examination of the patient’s medical record and confirming the physician assistant report can surface but if applicable or possible, he could see the body but the medical record could do the trick.
- Madam Witness, where a doctor certifies that as indicated on the medical certificate in this case, “I, Dr. Guilavogui Mamady hereby certify that I have medically attended to the above deceased and that the particulars and the cause of death written are true to the best of my knowledge and belief”. Kindly say what is the implication of that statement?
Not the best evidence as the instrument would be Oral testimony does not vitiate a written instrument Entrapment
THE COURT: For the Prosecution to say this witness is not the best witness, this witness is the best witness because this witness has been brought here to tell this Court the implication of that instrument to enable this court to make an informed decision.
Notwithstanding, this witness has commented on that instrument, because this witness has stated where the doctor is busy and tell the physician assistant to attend to the deceased and the deceased passes, whatsoever instrument that physician assistant will prepare, that medical doctor should reviewed and certified it before signing.
So by implication, it means that the medical doctor who signed the death certificate reviewed the records of that death certificate presented to him so if the parties so desire, we can subpoena the record of that deceased so as to authenticate whether that death certificate commensurate with the record as prepared by that hospital and therefore this witness must not answer that question.