Opinion ID: 3010322
Heading Depth: 2
Heading Rank: 2

Heading: the death certificate

Text: During his deposition, Manganiello explained that he enters cardiopulmonary arrest as the cause of death on 90% of his death certificates. He added: I'd probably put [cardiopulmonary arrest] on 100% of them, but I just sometimes run into the same problem . . . we're into right now. I'm just not sure what the big stigma is about cardiopulmonary arrest. 14 Cardiopulmonary means that the heart has to stop, as far as my opinion goes. And maybe I'm just signing my death certificates inappropriately. But I just feel that your heart stops. And why does your heart stop? It stops because some condition causes it to stop. That's why I sign them that way. It's my usual customary practice. Id. at 26. He remained emphatic on cross-examination, and he steadfastly insisted that Mancia did not die because of a heart attack. In Smakula v. Weinberger, 572 F.2d 127 (3rd Cir. 1978) we noted the common practice of completing death certificates in this manner. There, a miner died suddenly, and his widow applied for survivor's benefits alleging that the miner's death had been caused by black lung disease. The ALJ ruled that the widow had established causation, but the Appeals Council, acting for the Secretary, reversed, and the district court entered summary judgment for the Secretary. On appeal, we remanded with directions to award widow's black lung benefits as the reversal of the ALJ's determinations had not been based upon substantial evidence. The death certificate there stated that the miner died from coronary occlusion. That was the only cause of death given on the death certificate. We noted, however, that the entry on the certificate was sparse and unverified by clinical findings [and that] testimony at the hearing cast grave doubt on [the certificate's] reliability. Id. at 131. The mortician who arrived at the scene within 15 or 20 minutes of the miner's collapse testified that he took a death certificate to a local physician who filled in`coronary occlusion' as the cause of death, signed the certificate, and handed it back to [the mortician] Id. at 132. That doctor had never examined the miner, and had no basis for concluding that his cause of death was as stated on the death certificate. In affirming the ALJ's determination that the widow had established that the miner's death was caused by black lung disease despite the contrary statements on the death certificate we accepted the mortician's explanation that, in his experience,. . . standard procedure by the coroner's office was not to bother with examination of the bodies and perfunctorily attribute cause of death to a heart attack. Id. 15 In Hillibush v. Benefits Review Board, 853 F.2d 197 (3rd Cir. 1988), we stated We have previously determined that a death certificate listing coronary occlusion and neither listing any other contributing conditions, nor indicating that an autopsy or other physical examination had been made of the body, is inherently unreliable and does not constitute substantial evidence that the miner died of a coronary occlusion for purposes of determining a widow's entitlement to black lung benefits. In that case there was testimony that it is common practice, absent an autopsy, for coroners to enter coronary occlusion as the cause of death of miners. 853 F.2d at 204. We ruled [w]e hold that in the absence of an autopsy, a death certificate may not be used to preclude invocation of a presumption of a totally disabling respiratory or pulmonary impairment. Id. Although this case is distinguishable, our holding in Smakula and Hillibush is instructive in assessing the probative value of Manganiello's statements on the death certificate, and his credibility in explaining the entry. There, as here, there was lay testimony about the deceased miner's difficulty in breathing, and the degree to which that difficulty appeared to compromise his health and limit his daily routine. Similarly, there, as here, no doctor had ever attributed her husband's progressive respiratory difficulties to a heart ailment. Smakula, 572 F.2d at 133. More importantly, here, Dr. Manganiello related Mancia's stopped heart to his pneumoconiosis on the death certificate. [T]he fact that the immediate cause of death was cardiac arrest does not preclude the possibility that the miner had a respiratory or pulmonary impairment; the two conditions are not inconsistent with each other.9 Id. _________________________________________________________________ 9. Dr. Manganiello explained that coronary artery disease is not related to pneumoconiosis and that pneumoconiosis does not cause coronary artery disease, although it could be a risk factor for coronary artery disease. Deposition at 29. 16