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Law Office of Jeffrey J. Downey: Death Certifications in Nursing Home

Why You Should be Concerned - A Case Reviewed Estate of Ekaterina Ioffe v. the Hebrew Home, et al

MCLEAN, Va., Oct. 10, 2019 /PRNewswire/ -- On May 25, 2018, Ekaterina Ioffe fell off her bed while being cared for by a nurse aide at the Hebrew Home of Greater Washington in Rockville, Maryland. The aide failed to secure the side rails while caring for the resident and accidentally rolled her off the bed. Ms. Ioffe fell to the floor suffering a head injury. As she bled out her nose, she went into respiratory distress and died within minutes of the fall.

The nursing facility, the Hebrew Home, had an attending doctor, Mina Fazli, MD, complete the death certificate rather than referring the matter to the Maryland Medical Examiner's Office. Dr. Fazli noted that the patient's immediate cause of death was dementia and that she died of "natural causes." This week, the children of Ms. Ioffe filed a lawsuit alleging negligence, negligent misrepresentation and civil conspiracy for the injury and for inaccurately recording Ms. Ioffe's cause of death in an attempt to protect the nursing home. It is one of the first cases ever filed seeking to hold a certifying doctor liable for issuing a false death certificate. Review the complete lawsuit here,

Unfortunately, this is not an isolated incident, explains the Ioffe's attorney, Jeffrey J. Downey. When residents die in a nursing facility, the death certificate is typically completed by an attending doctor or medical director of that facility. This physician may have a potential conflict of interest in reporting a cause of death that exposes the facility to potential legal liability. For this and other reasons, death certificates for nursing home residents are often inaccurate or misleading. Various studies have suggested that errors in death certification occur in approximately 33% to 41% of cases in the U.S. Pritt BS, Hardin NJ, Richmond JA, Shapiro SL. Death certification errors at an academic institution. Arch Pathol Lab Med 2005;129:1476–1479. [PubMed]; Sehdev AE, Hutchins GM. Problems with proper completion and accuracy of the cause-of-death statement. Arch Intern Med. 2001;161:277–284.

Death certificates serve a vital function of providing data for epidemiologic health purposes as well as providing loved ones with an important aspect of the decedent's medical history. Reporting of injuries or adverse events, like fractures, pressure wounds (bed sores) or death, also impacts the facility's rating on websites like

Cause of death opinions can impact a facility's legal liability. Often, the certificate is the only evidence regarding cause of death. If a nursing home patient suffers a hip fracture from a fall and dies 3 months later from related complications, it is a good bet that the facility's medical director is not going to list the fracture as a contributing cause of death.

When a family member dies in a nursing home under suspicious circumstances implicating neglect, the family should be proactive in pursuing an independent cause of death analysis. Do not hesitate to inquire who is doing the death certificate and whether that person is affiliated with the nursing home. Depending on the State, a family can request that a medical examiner become involved in the cause of death certification. Under Maryland law, an accidental injury, like a fall, is a basis for requesting the participation of a medical examiner. Md. Code, Title 4 (Health General) § 4-212

For more information on this issue, contact the Law Office of Jeffrey J. Downey, or visit Phone 703-564-7318, Email:  Serving clients in Maryland, Virginia and Washington D.C.


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SOURCE Law Office of Jeffrey J. Downey



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