The final referral: A 1-year retrospective review of death referrals through the lens of forensics

Background. Under South African (SA) law, all unnatural, sudden and unexpected deaths, as well as procedure-related deaths, must be reported to the SA Police Service and referred to the Forensic Pathology Service (FPS). In the Western Cape Province, referrals to FPS require completion of the FPS100 form by a senior medical practitioner. Objective. To assess the appropriateness, completeness and legibility of FPS100 referral forms submitted to Tygerberg Forensic Pathology Services over the course of 1 year in the Western Cape Province, and to evaluate whether the suspected presumed cause of death was in line with the World Health Organization’s standards. Methods. This was a cross-sectional retrospective review of all FPS100 referral forms submitted to the Tygerberg Forensic Pathology Mortuary over 1 year. An experienced forensic pathology medical practitioner reviewed the appropriateness, completeness, legibility, commissioning status and accuracy of presumed cause-of-death classifications reflected on the FPS100 referral forms received. Results. Of the 1 252 cases accompanied by a referral form, 81.6% were deemed incomplete, with 22.3% uncommissioned, rendering them inadmissible in court. Even though most of the referrals were legible, over 43% indicated misclassified formulations of the presumed causes of death. Conclusion. The study revealed significant deficiencies in FPS referrals, including incomplete or uncommissioned forms and frequent misclassification of presumed causes of death. These shortcomings undermine the legal validity of the referral forms, and may delay medicolegal processes and even result in direct subpoenas to referring medical practitioners. The findings highlight the urgent need for strengthened training for medical practitioners across all levels of experience, and for the implementation of standardised referral protocols. Equally important is enhancing awareness of the medicolegal value of FPS involvement, and the critical impact of accurate, high- quality referrals.