Committee advances bill letting physician assistants, APRNs and chief medical officers sign death certificates

Representatives advanced House Bill 10 82 to the Committee on Appropriations after witnesses, sponsors and state health staff discussed training, vendor costs and how expanded certifier access could speed issuance of death certificates.

The bill, presented by Representative Weinberg, would authorize physician assistants (PAs), advanced practice registered nurses (APRNs) and chief medical officers, in addition to physicians, to determine cause of death and sign the medical certification portion of Colorado death certificates. Weinberg said the bill "improves the efficiency and accessibility of Colorado's death certification process by expanding the list of qualified individuals who can complete and sign medical certifications for death certificate certificates." The bill also requires all qualified certifiers to register with the state's electronic death registration system before signing a death certificate.

The measure's sponsors and supporters told the committee that adding trained nonphysician clinicians could reduce administrative delays and help grieving families obtain documentation sooner. Representative Brown said APRNs and PAs are already integral to Colorado primary care: "Nurse practitioners handle 27% of our primary care visits and physician's assistants handle 15%." He and other witnesses said allowing these professionals to certify deaths would be especially helpful in rural areas and long-term care settings.

Witnesses speaking for the bill included Dr. Pradeep Raj Rai, chief medical officer for Care Synergy (which operates Pathways Hospice, Denver Hospice and Pikes Peak Hospice), who described how hospice teams share clinical and administrative burden and the importance of timeliness in completing death certificates. Mark Longshore, executive director of the Colorado Nurses Association, asked lawmakers to vote for the bill and noted state statutory language about primary-care signers, citing "the current 25 dash 2 dash 1 10" in his testimony about who should sign a certificate. Harlan David, a practicing PA in community health centers, said in his experience a PA often knows the patient's history and currently must route paperwork through a physician just to obtain a signature, which can delay funeral planning.

The Colorado Department of Public Health and Environment (CDPHE) explained that a vendor-built electronic death registration system will require programming changes to register and track the new certifier types; CDPHE said the fiscal note reflects those vendor development costs. CDPHE staff explained the costs are configuration and database changes to add APRNs and PAs as certifier categories and to capture licensing details during registration.

The committee adopted two stakeholder-driven amendments without objection. Amendment L002 requires APRNs and PAs to review training materials provided by CDPHE and to complete the training before signing a death certificate; the committee adopted that amendment by voice without objection. A subsequent technical, conforming amendment requested by the Department of Regulatory Agencies (DORA) was also adopted without objection. After amendment, Vice Chair Clifford moved the bill to Committee on Appropriations; Representative Bradley seconded. The committee recorded an 11–0 final vote: Bottoms Yes; Bradley Yes; Carter Yes; Espinosa Yes; Parey Yes; Froelich Yes; Block (Black) Yes; Mabry Yes; Ricks Yes; Clifford Yes; Madam Chair Yes. The bill was transmitted to Appropriations.

What the committee did not adopt or change: the bill does not alter existing statutory deadlines (witnesses noted the current law requires certification within 72 hours) and does not allow uncertified or unregistered practitioners to sign. The amendments clarified training and added technical conforming language requested by DORA.

The bill's supporters said the change aims to reduce delays for families and distribute administrative duties among qualified clinicians; opponents' concerns (expressed initially by coroner representatives) focused on training and potential workload for coroner offices, concerns later addressed by the training amendment and stakeholder drafting.

Votes at a glance: House Bill 10 82 (as amended) — Moved to Committee on Appropriations; outcome: approved 11–0.