Ombudsman proposes revision of regulations and guidelines
 
3.9.2010

Deceased forgotten for over four months in cold-storage facility

The University of Helsinki's Department of Forensic Medicine must follow the length of time for which corpses are kept in their cold-storage facilities and the grounds on which this is done so that the corpses are not forgotten in them, Parliamentary Ombudsman Petri Jääskeläinen points out. He does not find it sufficient or appropriate that cold-storage facilities are inspected only, for example, in conjunction with cleaning; monitoring must be regular and systematic.

An inspection of the Department of Forensic Medicine's cold-storage facility in summer 2008 revealed a corpse that had been brought there over four months earlier. Forgetting that the deceased was in storage had been made possible by the fact that he had not been entered in the information system for corpses for which a forensic obduction had been ordered.  The police had not considered an obduction necessary when they clarified the circumstances of the death in the deceased's home.

The Ombudsman considers it indispensible that the Department of Forensic Medicine has clear procedural guidelines also concerning the storage of corpses that have not been entered in the information system for corpses for which a forensic obduction had been ordered. The Department is responsible for the corpses stored in its facilities irrespective of whether or not obductions of them have been ordered.
 
The Ombudsman has asked the University of Helsinki's Department of Forensic Medicine and the National Institute for Health and Welfare to inform him, by the end of November 2010, of what measures they have taken to redress the situation.

Clear instructions for next of kin on what to do so that a deceased person's body donation will can be implemented

The deceased person's widow was of the impression that her spouse's body had been handed over to the University of Helsinki's Institute of Biomedicine, because the deceased had made a will donating his body for medical teaching and research purposes and the will had been forwarded along with the body to the Department of Forensic Medicine. 

So that wills in which persons donate their bodies can be implemented, next of kin must be given more precise instructions than at present on what to do after the death of their loved ones, the Ombudsman stresses.

Precise instructions are needed in especially situations in which death has occurred in the home. The next of kin must then be active and themselves see to it that they receive a death certificate and a burial permit from the doctor sufficiently quickly. The University's Institute of Biomedicine can use a body for teaching and research purposes only if it is able to embalm the body within three days of death at the latest. Embalming done later than that does not succeed. However, a deceased person's body can not be handed over to the Institute before a doctor has written a death certificate and issued a burial permit.

In this case, the doctor who had treated the patient in the hospital had written a death certificate and issued a burial permit on the fourth day after the death. For this reason, the corpse was no longer suitable for teaching and research purposes.

According to the University of Helsinki's Institute of Biomedicine, the instructions can be added to the form used for a body donation will. 

The Decree on establishing the cause of death and the Ministry of Social Welfare and Health's Guidelines on determination of death are mutually contradictory

The Ombudsman intervenes in another of his decisions in the fact that the Decree on establishing the cause of death and the Ministry of Social Welfare and Health's Guidelines on determination of death are mutually contradictory. He considers it essential that the Ministry takes measures to remove this contradiction.

The Decree requires that, upon receiving notification of a death, a doctor must without delay conduct an external examination of the body to determine the cause of death.

According to the Ministry of Social Affairs and Health guidelines, on the other hand, a doctor must determine the cause of death of a person who has died in a social welfare or health care institution as soon as possible, and on the following weekday at the latest. When a death has occurred at the weekend, Monday has generally been considered to be the following weekday.

The Decree on establishing the cause of death states that only a certified or licensed physician or a medical student who has been granted permission and is performing a doctor's tasks for the State, a municipality or a joint authority can certify a death. In practice, the body of a person who has died during an on-call period in a social welfare or health care institution can be transferred to a cold-storage room pending a doctor's official determination of death when a member of the nursing staff has "tentatively" determined the person's lifelessness. The Ministry has not issued guidelines on a procedure of this kind. 

Nor is there any guideline on storage of the corpse during the time between determination of death by a nurse and the official determination of the death.

The Ombudsman considers it a shortcoming that neither an Act nor a Decree contains a provision concerning handling of the corpse before a determination of death by a doctor. 

He has asked the Ministry for a report, by the end of November 2010, on what measures it has taken in also this matter.

Additional info will be provided by Senior Legal Adviser Kaija Tanttinen-Laakkonen, tel. + 358 (0)9 4321.