An Act To Allow Nurse Practitioners To Sign Death Certificates
Maine Legislature, Session 122, LD 1568
Committee: Health and Human Services
Sponsors: PINKHAM, MAYO, PERRY
Amends: 22 MRSA §2841, 22 MRSA §2842, 22 MRSA §2843, 22 MRSA §2907

Legislative Document 
No. 1568 
H.P.I106 
House of Representatives, April 12,2005 
An Act To Allow Nurse Practitioners To Sign Death Certificates 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
11'/~ /J?11!P£~ 
MILLICENT M. MacFARLAND 
Clerk 
Presented by Representative PINKHAM of Lexington Township. 
Cosponsored by Senator MAYO of Sagadahoc and 
Representati ves: MARRACHE of Waterville, PERRY of Calais. 
Printed on recycled paper 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 22 MRS A §2841, first" as amended by PL 1989, c. 274, 
§2, is further amended to read: 
Except as authorized by the department or as required under 
section 1596, a certificate of each death of a fetus of 20 or 
more weeks of gestation whieh .that occurs in this State shall 
mY£t be filed with the clerk of the municipality where the 
delivery gee~FeQ occurred within 14 days after delivery and prior 
to removal of the fetus from the State. 
Sec. 2. 22 MRSA §2841, sub-§I, as amended by PL 1977, c. 232, 
§l, is further amended to read: 
1. 
Certificate filed by funeral director. 
The funeral 
director or other authorized person in charge of the disposition 
of the dead fetus or its removal from the State sha .... --&e .is. 
responsible for filing the certificate. 
In the absence of such a 
person, the physician, the certified nurse midwife, the nurse 
practitioner or other person in attendance at or after the 
delivery shall be responsible for filing the certificate. -~­
The person responsible for filing the certificate shall obtain 
the personal data 
from 
the best qualified person or source 
available 
and 
shall 
present 
the 
certificate 
to 
the 
person 
responsible for completing the medical certification of the cause 
of death. 
Sec. 3. 22 MRSA §2841, sub-§2, as amended by PL 1989, c. 274, 
§3, is further amended to read: 
2. 
Medical 
certificate 
by 
pbysician, 
certified 
nurse 
midwife or nurse practitioner. 
The medical certification sha;U, 
mY£t be completed and signed within 5 days after delivery by the 
physician. 
certified nurse 
midwife 
or 
nurse practitioner in 
attendance at or after the delivery, except when an inquiry as to 
the cause of fetal death is required by law. 
Sec. 4. 22MRSA§2842,sub-§2, as amended by PL 2003, c. 74, 
§l and c. 689, Pt. B, §6, is further amended to read: 
2. 
Medical certificate by pbysician or nurse practitioner. 
The medical certification of the cause of death must be completed 
in typewritten or legibly hand-printed style and signed in a 
timely fashion by a physician or nurse practitioner authorized to 
practice in the State who has knowledge of the patient's recent 
medical condition, in accordance with department regulations and 
other laws detailing who can certify and in what time frame, 
except 
when 
the 
death 
falls 
under 
the 
jurisdiction 
of 
Page l-LR0737(1) 
the medical examiner as provided in section 3025. 
If the patient 
was a resident of a nursing home licensed under section 1817 at 
the time of death and if the physieiaR health care provider in 
charge of the patient's care or another physieiaR health care 
provider designated by the physieiaR health care provider in 
charge had not examined the patient within 48 hours prior to 
death, 
or within 2 weeks prior to death in the case of 
a 
terminally ill patient, the physie.iaR health care provider in 
charge or another physieiaR health care provider designated by 
the physieiaR health care provider in charge shall examine the 
body prior to completing the certification of death process. 
Any 
physieiaR health care provider who fails to complete the medical 
certification of the cause of death fully, in typewritten or 
legibly hand-printed style and in a timely manner, or who fails 
to 
examine 
the 
body 
of 
a 
nursing 
home 
resident prior 
to 
certifying cause of death as required by this section must be 
reported to the Board of Licensure in Medicine el'.L. the Board of 
Osteopathic Licensure or the State Board of Nursing, whichever is 
appropriate, by the State Registrar of Vital Statistics of the 
Department of Health and Human Services. 
For the purposes of this subsection, the following terms have the 
following meanings. 
A. 
"Life-sustaining procedure" means any medical procedure 
or 
intervention that, 
when 
administered to 
a 
qualified 
patient, will serve only to prolong the dying process and 
does not include nutrition and hydration. 
B. 
"Terminally ill patient" means a patient who has been 
diagnosed as having an incurable or irreversible condition 
that, 
without 
the 
administration 
of 
life-sustaining 
procedures, will, in the opinion of the attending physieiaR 
health care provider, result in death within a short time. 
c. 
"Health care provider" means a physician authorized to 
practice in this State or nurse practitioner. 
D. 
"Nurse 
practitioner" 
means 
an 
advanced 
practice 
registered nurse 
who 
is 
a 
certified nurse practitioner 
authorized 
to 
practice 
without 
the 
supervu~on of 
a 
physician pursuant to Title 32, chapter 31. 
Sec. 5. 22 MRSA §2842, sub-§2-A, as enacted by PL 2003, c. 
433, §2, is amended to read: 
2-A. 
Medical certification. 
Notwithstanding subsection 2, 
with respect to a person who dies within the State naturally and 
for whom the physician Q~rse prac..-titioner was the attending 
physieiaR ~lth care provider, the medical certification of the 
cause of death may be completed and signed by a physician or 
nurse 
practitioner 
authorized 
to 
practice 
at 
the 
Veterans 
Administration Hospital at Togus or at another federal medical 
facility within the State or by 
a 
physician or an advanced 
practice registered nurse licensed to practice in New Hampshire, 
Vermont or Massachusetts, 
who, 
at the 
request of 
the 
Chief 
Medical Examiner, is willing to do so. 
Sec. 6. 22 MRSA §2843, first 1J, as amended by PL 1985, c. 231, 
§l, is further amended to read: 
Except as authorized by the department, no dead human body 
sha** ~ 
be buried, cremated or otherwise disposed of or removed 
from 
the State until a 
funeral director or other authorized 
person in charge of the disposition of the dead human body or its 
removal from the State has obtained a permit from the clerk of 
the municipality where death occurred or where the establishment 
of a funeral director having custody of the dead human body is 
located. The permit shal-l--ee 
.i~ sufficient authority for final 
disposition in any place where dead human bodies are disposed of 
in this State, 
provided that the 
requirements 
of Title 
32, 
section 1405 r are met in appropriate cases. No such permit may be 
issued to anyone other than a funeral director until the clerk of 
the municipality receives a medical certificate whish tl1at has 
been signed by a physician or 
£ 
medical examiner whish .th.a.t 
indicates that the physician or medical examiner has personally 
examined the body after death. 
A permit must also be issued if a 
nurse practitioner has signed the medi~al certificate indicating 
that the nurse practitioper has 
knowledge 
of the deceased's 
recent medical condition or was in charge of the deceased's care 
and that the nurse practitioner has personally examined the body 
after death. 
The authorized person may transport a dead human 
body only upon receipt of this permit. 
Sec. 7. 22 MRSA §2843, 3rd 1J, as amended by PL 2001, c. 574, 
§28, is further amended to read: 
A municipal clerk may issue a disposition of human remains 
permit to a funeral director who presents a report of death and 
states that the funeral director has been unable to obtain a 
medical 
certification of 
the 
cause 
of 
death. 
The 
funeral 
director shall name 
the attending physician. 
attendin~~ 
practitioner or medical examiner who will certify to the cause of 
death and present assurances that he or she has agreed to do so. 
The funeral director shall exercise due diligence to secure the 
medical certification and file the death certificate as soon as 
possible. 
Sec. 8. 22MRSA§2846, as amended by PL 2003, c. 672, §21, is 
further amended by adding at the end 2 new paragraphs to read: 
For the purposes of th~ chapJ;.!!r, "nurse practitioner" means 
.a~..Ya.nced practice registered nurse who is a certified nurse 
practitioner authorized to practice without the supervision of a 
physician pursuant to Title 32, chapter 31. 
For the ruu:Poses of tbi.!> chapter, "health care provider" 
means a physician or a nurse practitioner. 
Sec. 9. 22 MRS A §2901, sub-§4-A is enacted to read: 
4-A. 
Nurse 
practiti~r. 
"Nurse practitioner" means 
an 
~~d practice registered nurse wbo 
is 
a 
certified n~ 
practitioner authorized to practice without the supervision of a 
physician pursuant to Title 32, chapter 31. 
Sec. 10. 22 MRSA §2907, sub-§2, as enacted by PL 1969, c. 193, 
is amended to read: 
2. 
Time of death. 
The 
time 
of 
death 
sha~~ must 
be 
determined by a physician Qr nurse practitioner who attends the 
donor at his the don..Q..LJi death, or, if none, the physician .QL 
nurse practitioner who certifies the death. This physician sha~~ 
or nurse practitioner may not participate in the procedures for 
removing or transplanting a part. 
SUMMARY 
This bill authorizes a certified nurse midwife or a nurse 
practitioner who is present at a death or after a death to sign a 
death certificate in the 
case of 
a 
fetal death. 
The bill 
authorizes a nurse practitioner to sign a death certificate in 
the case of the death of a patient in the care of the nurse 
practitioner or in the case of the death of a patient whose 
recent medical condition is known to the nurse practitioner.