• 의료법학
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• 제10권2호
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• pp.115-150
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• 2009

The Article 17 (1) of the Medical Service Act states that no one but medical doctor, dentist or herb doctor shall prepare medical certificate, post-mortem examination, certificate or prescription. Though medical certificate, post-mortem examination or certificate is a private document issued by doctor personally, it is accepted as reliable as public document. Therefore, for medical certificate, post-mortem examination or certificate, unlike other private document to guarantee authenticipy of the content, the Article 233 of the Criminal Act states the Crime of Issuance of Falsified Medical Certificates. In other words, the Criminal Act Article 233 states that If a medical or herb doctor, dentist or midwife prepares false medical certificate, post-mortem examination or certificate life or death, one shall be punished by imprisonment or imprisonment without prison labor for not more than three years, suspension of qualifications for not more than seven years, or a fine not exceeding thirtht million won. The subject of the Crime of Issuance of Falsified Medical Certificates is only a medical or herb doctor, dentist or midwife and the eligibility requirements are specified in the Medical Service Act. Medical certificate is the medical document to be issued by medical doctor to certify the health status and show the Jugdement about the result of the diagnosis, Post-mortem examination is the document to be listed by medical doctor to confirm medically about human body or dead body, and Certificate life or death is a kind of medical certificate to verify the fact of birth or death, the cause of death, such as Birth Certificate, Certificate of Stillbirth or Certificate of Dead Fetus. To constitute the crime of Issuance of Falsified Medical Certificates, it is necessary for the contents of the certificate to be substantially contrary to the truth, as well as it is needed the subjective perception that the contents of the certificate are false. The Supreme Court Decision 2004DO3360 Delivered on March 23, 2006 declared that although the Defendant did not MRI scan, etc. for precise observation about the disability status of Mr Park, it was difficult to believe that the contents of the Disability Certificate of this case were contrary to the objective truth or the defendant had perception that the contents of the certificate were false. I don't agree with the Supreme Court Decision, because the Supreme Court confirmed the decision by the court below despite the Supreme Court should have made the court below retry the reason why the Defendant did not MRI scan, etc. for precise observation about the disability status of Mr Park.

• 보건행정학회지
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• 제21권2호
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• pp.329-348
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• 2011

This research analyzed 168,010 cases of death of the aged over 65 from 244,867cases of death excluding 7 unknown age cases from 244,874 all age cases of death by using the death data of the National Statistical Office for 2007 to figure out factors affecting the quality of causes of death statistics of the aged and to suggest the ways of improving the quality of death statistics of the aged in korea. This research tried to derive factors affecting ill-defined cause of death category in acordance with WHO's guidelines and to find causes of lowering the accuracy of causes of death statistics of the aged. This research identified the problems of causes of death statistics of the aged by using both demographic characteristics such as sex, age, marital status, educational attainment, residential region, region size and factors of death items as independent variable to find causes of ill-defined cause of death of the aged. Logistic regression analysis was executed to calculate the hazard ratio about the ill-defined causes of death of the aged and multiple regression analysis was conducted to derive factors affecting the ill-defined cause of death by regional groups through using these independent variables such as the component ratio of over age 65, female death rates, doctors insitutions rate, medical institutions rate, attaching rates of death certificate by neighborhood. As a results of this research, R-code was the highest of ill-defined causes of death, accounting for 82.1%, and senility death(R54) of R-code was the highest, accounting for 91.2%. through subdivided order distribution of the ill-defined causes of death of the aged. As ill-defined causes of death by regional groups, attaching rates of death certificate by neighborhood was the most important factor(p<0.05) and also showed regression model's description with 83.8% ($R^2$=83.8%). Furthermore, Jeon-nam was the highest in the regional groups and these regions such as Je-ju, Jeon-buk, Chung-nam were not only attaching the death certificate by neighborhood but also were high at the rate of ill-defined causes of death. Therefore, this research found that both reconsideration about death certificate by neighborhood and education for doctors who write death certificate were needed the most.

• 대한응급의학회지
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• 제29권5호
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• pp.529-550
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• 2018

Objective: This study investigated the most common errors on death certificates written by resident trainees of the emergency department and evaluated the effects of education on how to write a death certificate. Methods: A casebook of 31 deaths was prepared based on actual death cases in the emergency room in 2016. Ten residents completed 31 death certificates for the death casebook without any prior notice and then received education on 'How to write the death certificate.' They completed the death certificates again for the same casebook after receiving the education and the number of errors on all death certificates was again determined and divided into major and minor errors. The average number of error types was compared before and after the education. Results: Major errors occurred in 55% of all death certificates, but decreased to 32% after education. Minor errors decreased from 81% before education to 54% after education. The most common major error was 'unacceptable cause of death' (mean${\pm}$standard deviation [SD], $10.2{\pm}8.2$), and the most common minor error was 'absence of time interval' (mean${\pm}$SD, $24.0{\pm}7.7$), followed by 'absence of other significant conditions' (mean${\pm}$SD, $14.6{\pm}6.1$) before education. Conclusion: Education on 'how to write a death certificate' can help reduce errors on death certificates and improve the quality of death certificates.

• Journal of Preventive Medicine and Public Health
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• 제38권4호
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• pp.443-448
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• 2005

Objectives : This study was done to evaluate the reliability of education and occupational class between using the health survey and the death certificate data. Methods : The 1998 National Health and Nutrition Examination Survey (NHANES) was conducted on a cross-sectional probability sample of South Korean households, and it contained unique 13-digit personal identification numbers that were linked to the data on mortality from the Korean National Statistical Office. The data from 263 deaths were used to estimate the agreement rates and the Kappa indices of the education and occupational class between using the NHANES data and the death certificate data. Results : The simple and weighted Kappa indices for education were 0.60 (95% CI=0.53-0.68) and 0.73 (95% CI=0.67-0.79) respectively, if the educational level was grouped into five categories: no-formal-education, elementary-school, middle-school, high-school and college or over. The overall agreement rate was 71.9% for these educational groups. The magnitude of reliability, as measured by the overall agreement rates and Kappa indices, tended to increase with a decrease in the educational class. The number of non-educated people with using the death certificate data was smaller than that with using the NHANES data. For the occupational class (manual workers, non-manual workers and others), the Kappa index was 0.40 (95% CI=0.30-0.51), which was relatively lower than that for the educational class. Compared with the NHANES, the number of non-manual workers for the deceased who were aged 30-64 tended to be increased (8 to 12) when using the death certificate data, whereas the number of manual workers tended to be decreased (59 to 41). Conclusions : The socioeconomic inequalities in the mortality rates that were based on the previous unlinked studies in South Korea were not due to a numerator/denominator bias. The mortality rates for the manual workers and the no-education groups might have been underestimated.

• 대한수사과학회지
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• 제3권1호
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• pp.43-49
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• 2008

사망진단서의 상당수가 부적절하게 기록되고 있다. 이의 원인으로는 사망진단서 작성에 관한 교육의 부족과 사망진단서 작성자의 무관심 등에서 비롯된 것으로 보인다. 사망진단서 오류는 우리나라의 사망 환자 통계의 신빙성을 떨어뜨리고, 보건 정책 등에 올바르게 반영되지 못하는 결과를 가져오게 된다. 2005년 1월 1일부터 12월 31일까지 1년간 대구 소재 A병원에서 발급된 사망진단서 298건을 연구 대상으로 사망진단서의 오류를 조사하였다. 주오류중 사망기전만 기입한 경우 26건(8.7%), 경쟁 원인 기입은 28건(9.4%), 부적절한 진단은 34건(11.4%)이었다. 1개 이상의 주오류를 가진 경우는 88건(29.5%)이었다. 부오류는 시간 간격을 기입하지 않은 경우가 296건(99.3%), 직접사인과 선행사인은 기록하고 중간선행사인을 제외하였거나 직접, 중간선행, 선행사인에 같은 진단을 기입한 경우는 58건(19.5%), 한 칸에 2개 이상의 진단을 기입한 이중진단인 경우가 56건(18.8%) 등이었다. 오류가 없는 사망진단서는 88건으로, 전체 진단서 298건 중 29.5%밖에 되지 않았다. 사망진단서 작성의 정확성을 기하기 위하여 올바른 교육 프로그램 마련 및 교육의 강화가 절실히 요구된다.

• 한국의료질향상학회지
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• 제11권1호
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• pp.4-14
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• 2004

Background : To examine the problems involved in writing practice of death certificates, we compared the determination of underlying cause of death for vital statistics using recorded underlying cause of death in issued death statistics. Methods : We collected 688 mortality certificates issue in year of 2,000 from 3 university hospitals. And we also collected vital statistics from ministry of statistics. The causes of death were coded by experienced medical record specialists. And causes of death determined at ministry of statistics for national vital statistics were mapped to causes of death recorded at each death certificates. The rate that underlying causes of death for vital statistics were derived from underlying causes of death recorded at issued death certificates were analysed. Results : 64.5% of underlying cause of death for could be derived from underlying cause of death recorded at issued death certificates, 8.6% derived from intermediate cause of death, and 3.9% derived from direct cause of death. In 23% of cases, underlying cause of death could not be derived using issued death certificates. The rate that underlying cause of death for vital statistics could be derived from underlying cause of death recorded at death certificates was different between 3 university hospitals. And the rate was also different between death certificates and postmortem certificates. We classified the causes of death using 21 major categories. The rate was different between diseases or conditions that caused death too. Conclusion : When we examined the correctness of death certificate writing practice using above methods, correctness of writing could not be told as satisfactory. There was difference in correctness of writing between hospitals, between death certificates and postmortem certificates, and between diseases and conditions that caused death. With this results, we suggested some strategy to improve the correctness of death certificate writing practice.

• Journal of Trauma and Injury
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• 제32권3호
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• pp.127-135
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• 2019

Purpose: This study was to investigate errors of death certificate (DC) issued for patients with trauma. Methods: A retrospective review for DC issued after death related to trauma at a training hospital trauma center was conducted. Errors on DC were classified into major and minor errors depending on their influence on the process of selecting the cause of death (COD). All errors were compared depending on the place of issue of DC, medical doctors who wrote the DC, and the number of lines filled up for COD of DC. Results: Of a total 140 DCs, average numbers of major and minor errors per DC were 0.8 and 3.7, respectively. There were a total of 2.8 errors for DCs issued at the emergency department (ED) and 5.4 errors for DCs issued beyond ED. The most common major error was more than one COD on a single line for DCs issued at the ED and incompatible casual relation between CODs for DCs issued beyond ED. The number of major errors was 0.5 for emergency physician and 0.8 for trauma surgeon and neurosurgeon. Total errors by the number of lines filled up for COD were the smallest (3.1) for two lines and the largest (6.0) for four lines. Conclusions: Numbers of total errors and major errors on DCs related to trauma only were 4 and 0.8, respectively. As more CODs were written, more errors were found.

• 한국학교보건학회지
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• 제19권1호
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• pp.1-15
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• 2006

Purpose : This study was to identify the incidence, trend, and situation of the unexpected sudden death of elementary, middle, and high school students in school for 17 years from 1988 to 2004 in seoul. Methods : We used the data of The Seoul Safety Mutual aid Association in seoul. Subjects were 53 unexpected sudden death in school from elementary, middle, and high school students, and we explored the gender, month, a day of the week, year, contents of situation, and medical certificate of death. Statistic analysis were chi-square test, Cochran-Armitage trend test, and the tool was SAS 9.1.Results : There were 53 unexpected sudden death students(male 42 and female 11). The incidence of male students was higher than that of female during 16 years except in 1995. The incidence occurred in middle school students were 31 (58.5%) of 53 and were also most frequent in middle school students in both of male and female students. In 1990, the incidence was 8(15.1%) students, 6(11.3%) in 1992 , and 5(9,4%) in 2000 respectively. The frequency of unsuspected sudden death in March was 11(20.8%) of 53 students, 11 (20.8%) in September, 7(13.2%) in October. In Thursday, it was 12(22.6%) of 53 students. Only 14(26.4%) students of 53 died during general life, but 39(73.6%) were related to excercise. The diagnosis of 14 students died during general life were cardiac arrest 7(50.5%), brain disorder 3(21.4%) which were based on medical certificate. But the diagnosis of 39 students died during or after excercise were brain disorder including cerebral hemorrhage 9(23.1%), heart disease 9(23.1%), cardiac arrest 8(20.5%), and unknown 6(15.4%), respectively. Conclusion : The incidence of unexpected sudden death were more frequent in male students, in middle school, and in excercise-related situation and the trend was similar for 17 years. Therefore, to prevent the unexpected sudden death, it needs to further study substantially the risk factors of unexpected sudden death including past history, life-style, nutrition and development, family history, and learning environment.

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.793-796
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• 2014

Background: This study aimed to examine possible effects of implementing a national query program on site-specific cancer mortality rates. Materials and Methods: A total of 2,874 query letters were sent out by the Department of Statistics, Ministry of Health and Welfare of Taiwan between January 2009 and December 2011 to medical certifiers who reported "neoplasm with uncertain nature" on the death certificate asking for more detailed information for coding. Results: Of the 2,571 responses, in 1,398 cases (54%) medical certifiers were still unable to determine the nature of the neoplasm. There were four neoplasm sites for which more than 50% of the responses changed the category to malignant, the gastrointestinal system (73%), urinary system (60%), stomach (55%) and rectum (53%). The liver was the cancer site that showed the largest absolute increase in the number of deaths after the query; however, the brain showed the largest relative increase, at 12%. Conclusions: Different neoplasm sites showed different magnitudes of change in nature after the query. Brain cancer mortality rates exhibited the largest increase.

• 농촌의학ㆍ지역보건
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• 제35권1호
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• pp.89-98
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• 2010

의과대학 본과 4학년 학생들의 사망진단서의 작성 능력을 살펴보고자, 2007년 5월부터 8월까지 충청도, 전라도, 경상도의 4개 의과대학 본과 4학년 학생 380명을 대상으로 설문조사를 실시하였다. 설문지는 사망진단서 작성을 위한 10개의 사례들과 사망진단서 작성 양식, 그리고 사망진단서 작성과 관련된 교육 경험에 관한 문항들로 구성되었다. 교육 유형별 사망진단서 작성 정확도를 평가하기 위해 학생들이 기술한 사인들이 기준사인과 일치되는 정도와 기재내용의 오류 등을 파악하였다. 설문 미응답자 61명을 제외한 232명의 분석결과는 다음과 같다. 10개 사례에 대한 4단계 사망원인 평균 일치 개수 즉 CD는 $9.6{\pm}3.8$이었다. 4단계 사망원인들 중 최하단에 기재한 원사인의 평균 일치 개수 즉 UC1은 $4.8{\pm}1.7$이었고, 학생들이 기술한 4단계 사망원인들 중에서 사인분류사에 의해 선정 된 원사인의 평균 일치 개수 즉 UC2는 $5.6{\pm}1.5$이었다. UC1과 UC2는 사례중심 교육집단이 이론교육집단 보다 높았다. 주오류의 세부 내용별로 살펴보면 '선행사인 미기입'의 오류를 가진 경우(78.9%)가 가장 많았으며, 다음으로 '한 칸에 두개 사인 기입'(48.3%), 'II부에 I부 기입'(43.1%) 등의 오류를 범하는 경우 등이 많았다. 주오류와 부오류 모두 사례중심교육집단이 이론교육집단보다 평균 오류의 수가 더 적었다. 결론적으로 의과대학 본과 4학년 학생들의 사망진단서 작성능력은 사망진단서 작성 방법에 대한 교육 유형에 따라서 차이가 있으며, 사망원인통계의 정확성 향상을 위해서는 사망원인작성에 대한 교육이 이론 위주보다는 다양한 사례를 경험할 수 있도록 구성될 필요가 있다.