Texas Attorney General Opinion: LO93-028 Page: 2 of 3
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Honorable Eddie G. Shell - Page 2 (LO-93-28)
medical certification from the physician who was last in attendance on the decedent if the
death occurred with medical attendance." Id. 193.004(a).
On its face, section 193.004(a) authorizes only that physician last in attendance on
the decedent to provide the required medical certification if the death occurred with
medical attendance. See Attorney General Opinion C-124 (1963) at 3 (stating that to sign
death certificate as physician person must be licensed by State Board of Medical
Examiners). Thus, section 193.004(a) precludes the registered nurse who was in
attendance at the death from providing the required medical certification. Section
193.004(a) also precludes the justice of the peace from providing the required medical
certification.
Our conclusion that the registered nurse who pronounced a patient dead pursuant
to section 671.001(d) of the Health and Safety Code may not provide the medical
certification section 193.004(a) requires is consistent with the legislative history of section
671.001(d). The legislature enacted that section as Senate Bill 823 in 1991. See Acts
1991, 72d Leg., ch. 201, 1. Senate Bill 823 and its companion bill, House Bill 983,
initially were introduced essentially in the form that the legislature ultimately enacted.
Notably, in public hearings before the House Committee on Public Health, Representative
Madla, the sponsor of House Bill 983, affirmed a witness's testimony that the bill, if
enacted, would not authorize a registered nurse to sign a death certificate. Hearings on
H.B. 983 Before the House Comm. on Public Health, 72d Leg. (Mar. 18, 1991)
(statement of Representative Madla, sponsor) (affirming statement of Ann Calvert, Texas
Hospice Organization) (tape on file with House Committee Coordinator); see also id
(statement of Susan Pascoe, Texas Nurses Ass'n). Instead, according to Representative
Madla, a physician would continue to be necessary to sign death certificates. Hearings on
H.B. 983 Before the House Comm. on Public Health, 72d Leg. (Mar. 18, 1991)
(statement of Representative Madla, sponsor).
Representative Park subsequently proposed to amend section 193.004(c) of the
Health and Safety Code to authorize a registered nurse to certify the death certificate if the
physician who last attended the patient could not certify the death certificate and if the
same registered nurse had pronounced the patient dead. Committee Amendment No. I to
H.B. 983, 72d Leg. (1991). In the end, however, the legislature did not adopt
Representative Park's amendment. In our opinion, therefore, the legislature explicitly
chose not to authorize a registered nurse to provide the medical certification section
1Subsection (a) of section 193.005 of the Health and Safety Code provides that, "['f a death or
fetal death occurs without medical attendance, the funeral director or the person acting as funeral director
shall notify the local registrar of the death." (Emphasis added.) The local registrar is directed to "refer
the case to the local health authority for immediate investigation and certifcation." Health & Safety Code
193.005(b). In the absence of a local health authority, the local registrar "may complete the death
certificate or fetal death certificate and return from the statement of relatives or other persons having
adequate knowledge of the facts." Id. Under certain circumstances, the local registrar may require that an
inquest be performed. Id. 193.005(c) - (e).
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Texas. Attorney-General's Office. Texas Attorney General Opinion: LO93-028, text, April 13, 1993; (https://texashistory.unt.edu/ark:/67531/metapth276614/m1/2/: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.