Vital Statistics Commission of Jamaica - Planning Institute of Jamaica

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Audit of Vital Registration and Vital Statistics Systems: Jamaica RHA staff indicated some concern about the accuracy and timeliness of the information obtained, especially from clinics. By the time RHA gets the information from the hospitals and clinics, it is at least one month old. When information is missing from the hospital reports, RHA staff indicated that they call the hospital to obtain the information. However, there does not appear to be a mechanism for checking the accuracy or consistency of the data coming in. The data are taken at face value. An important concern raised by RHA staff involved missing discharge summaries in the hospital medical records. To check this, we looked at a few randomly selected medical records during our visit to Spanish Town hospital to assess whether or not discharge summaries were present. In all records reviewed, discharge summaries were present. The RHA’s also investigate possible maternal deaths. The results of the investigation are passed on to the MOH, but we found no evidence that this information was getting back to the RGD to correct death records certified in error. The MOH is also conducting research to assess the quality of registration data for both births and deaths. We talked with research staff in the Division of Health Promotion and Protection about some of these studies. While the studies were informative, we found no mechanism in place to ensure that the results were being communicated to RGD and used to improve data collection and reporting. Suspicious (Violent, Unnatural) or Sudden Deaths The Coroner becomes involved in the process of data collection in the case of violent, unnatural, or sudden deaths where the cause is unknown. When a death of this sort occurs, the police are responsible for notifying the coroner, for the investigation into the circumstances of the death, and for providing a report to the coroner of the findings of the investigation. In addition, all deaths occurring within custodial facilities, such as prisons and orphanages, are the responsibility of the coroner. The coroner upon notification of the death may then order a post mortem examination of the body. It is important to draw a distinction between the cause or mechanism of death (e.g., gunshot, suffocation, poisoning) and the manner of death (e.g., homicide, suicide, accident, etc.). The cause of death is often readily apparent and easily determined from a post mortem, whereas determination of the manner of death often requires more extensive and sometimes lengthy investigation. In some cases, because of problems in garnering cooperation with witnesses, investigations into the manner of deaths have taken up to five years to be completed. Ministry of Justice (MOJ) systems for tracking cases are all manual. As a result, there are limited capabilities for evaluating backlogs and systemic problems. At this time, no data analysis is being performed to identify problems. The MOJ is in the process of installing and implementing a new information system (JEMS) for tracking cases. It is hoped that this new system will be able to be implemented in the coroner’s offices and interface with systems in RGD to facilitate the registration of deaths. The primary interaction between the coroner and RGD involves the transmission of Form D. As with Forms A, B, and C in the Registration Act, Form D is specified in the Coroner’s Act. Changes to this form can be made at the discretion of the Minister of Justice (see Coroner’s Act, Section 34b). 7
Audit of Vital Registration and Vital Statistics Systems: Jamaica Recently an amendment to the Coroner’s Act was passed that addresses some problems in the information collection process. Specifically addressed is the time interval in which the police are required to report to the Coroner. The police must now provide notification of any sudden or suspicious death to the Coroner within 48 hours of discovery and a report of their investigation within 21 days of notification (or seek an extension). In addition, a medical practicioner contracted to do the post mortem is given 48 hours to provide a report to the Coroner. This should have the effect of increasing the timeliness of the reporting of the fact of death and even perhaps the cause of death to the Coroner. However, the new act does not address the timing of the filing of Form D by the Coroner with the RGD. The Coroner’s Act, section 10, paragraph 1 gives the Coroner absolute discretion as to when Form D will be sent. The Act (Sections 10 and 15) also states explicitly that Form D is to be sent by the coroner to RGD, but apparently, the standard practice is for the coroner to give Form D to a family member to take to the LDR ostensibly because Form D does not contain much of the information needed for registration of the death. The problem is that Form D is often not picked up by the family. It is often difficult to obtain cooperation from families for registration information because there is no penalty for non-compliance and there is no need to obtain a burial permit since registration is not required for a burial permit in these cases. Only if there is an estate in question or a will to be probated is the family inclined to ensure registration procedures are completed. To address this gap, RGD parish officers present frequently to the coroner’s office to obtain all Form Ds not picked up by family members, but there is no written policy, formal expectation, or established frequency for these visits. Form D is manually logged at the coroner’s office in a paper logbook. There is no reconciliation to registrations reported by the RGD and the coroner’s office does not keep copies of Form D once they are sent to RGD. The coroners with whom we spoke claim that approximately three to four Forms D are lost per month by (or in transit to) the RGD, although there was no way for us to verify this claim. The current tracking and reporting system provides aggregate volume numbers only, and does not include the circumstances surrounding the causes, locations, etc. of deaths. If a juried inquest is held, the results are reported using Form E, Coroner’s Certificate of Finding of Jury, which is routed by the coroner to the RGD, but again, there is no tracking of delivery or reconciliation with RGD records. Form E would have the final determination as to the manner of death. There is some confusion as to whether RGD is allowed to make corrections to the information provided on Forms D and E if this information is found to be in error. We were told by one staff member at RGD that they could not make changes to the form and indeed, the coroners we talked to indicated that sometimes RGD would send a family member back to the coroner’s office with the form to effect changes. Another RGD staff member, however, indicated that changes could be made to the form by RGD staff. The Coroner’s Act, Section 28 states that the coroner can authorize the RGD to correct errors of fact, although these must be made in the margins of the Form. It is unclear whether the Act requires this authorization to be given in writing or whether such authorization could be given verbally. Statistical information on criminal acts, including violent deaths, is also gathered by the statistics divisions of district police departments. On a daily basis statistics are FAXed to the 8
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Vital Statistics Commission of Jamaica - Planning Institute of Jamaica

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