The Overlooked 90 Days After a Patient’s Death

Health systems are very precise when measuring clinical care. They track things like length of stay, time to antibiotics, readmission rates, and mortality. But once a patient dies and the chart is closed, the family enters a period that is rarely measured. In the next ninety days, the family will ask for medical records, get a final bill, plan a funeral, and form an opinion about the care their loved one received. Each of these steps involves a different department, but no one is responsible for the overall experience.

This gap is important to address for operational reasons. It’s also where a significant amount of legal risk is created.

Families Often Take Legal Action Over What Happens After A Death

There is long-standing and consistent evidence about why people sue, but it is often overlooked in how health systems are run. Vincent, Young, and Phillips (1994) surveyed 227 patients and relatives who were making negligence claims. They found that people decided to sue mostly because of insensitive treatment and poor communication after the incident, not just because of the injury itself. Of those who got an explanation, less than 15 percent thought it was good enough.

Hickson and colleagues (1992) talked to 127 families who filed malpractice claims after perinatal injuries or deaths. Nearly half thought doctors tried to mislead them. About a third said their doctors would not be open with them. A quarter felt there was a cover-up, and one in five said they filed a claim because they needed information they could not get any other way.

Thirty years later, the problem is still the same. ECRI’s 2025 report named ignoring patient and family concerns as the biggest threat to patient safety, even more than technology or staffing issues. Health systems now have the tools to spot this problem, but they rarely use them after a patient dies.

Three Areas Often Fail At Once

Every family that loses someone unexpectedly runs into the same three points of contact: the records, the bill, and the explanation. Each one is a small operational task on your end, but to the family, it’s the first real signal of how much you actually care.

The Medical Record

The first thing many families do is ask for the medical chart. The HIPAA Privacy Rule says the request must be handled within 30 days, with one possible 30-day extension. These deadlines are meant to be the maximum, not the goal, but most information release teams treat them as the target. The rule also says the executor or administrator of the estate is the personal representative, so the request usually comes from someone with legal authority.

This detail is more important than most release-of-information teams realize. State laws often make the same person both the estate representative and the one who can file a wrongful death claim. In Washington, for example, the personal representative files the claim for the beneficiaries, not individual family members. So, the person waiting for records is often the one who can sue. How quickly you respond sends a message, even if you do not mean it to.

The Final Bill

A few weeks after the death, the family gets an itemized bill. This bill often comes on top of other costs, such as hospice fees, equipment rentals, medications, transportation, and funeral expenses. The total cost of passing away can vary a lot depending on where the person died: at home, in a hospital, or in a nursing home. Your bill is just one more thing added to the pile, and families see it as part of the whole experience.

Most billing systems do not have special rules for accounts after a death. The account ages like any other, and collection notices go out on schedule. This means a family who just buried a loved one might get an automated collection letter. This is a system problem that can be fixed, but it causes a lot of the anger that leads families to seek legal help.

The Explanation

When a death is unexpected, someone needs to explain what happened. Often, this explanation is delayed while risk management decides if it is safe to talk. During this time, the family creates their own story about what happened. By the time the hospital offers a formal conversation, the family may have already hired a lawyer. Organizations can set clear rules for when and how these conversations occur, but most have not.

The Family’s Experience Is Shaped By Earlier Decisions

What happens after a death depends on what came before. If there was a clear plan, families usually have simple, procedural questions. If not, their questions become more investigative. This means advance care planning is important for managing risk, not just for population health, and changes what should be measured.

Completion rate is not the right thing to measure. A directive that is scanned into a system but never seen when needed does not help anyone. What matters is whether the right clinician saw the patient’s wishes before making decisions, and whether the care matched those wishes. This is harder to track, but it gives a more honest picture.

The Argument Against Transparency Has Been Tested

Some people argue that being open after a bad event will lead to more lawsuits. Kachalia and colleagues (2018) studied this by looking at four Massachusetts hospitals that used communication-and-resolution programs. They compared claims and costs before and after, and against hospitals that did not use these programs. Some hospitals saw fewer claims and lower legal costs, some saw no change, but none saw things get worse.

This finding is more limited than some advocates claim, and the study has been criticized for its methods. Still, it is the best evidence we have. Being transparent, apologizing, and offering compensation did not cost these hospitals more money. The argument against these programs is not supported by data.

Four Things To Start Measuring

You do not need new technology for this. You just need to use your current systems to focus on this period and make someone responsible for four key numbers.

These numbers are: the median days to fulfill a records request from a decedent’s estate, measured against your own target instead of the legal maximum; the percentage of decedent accounts put on billing hold before the first bill goes out; the time from death to the first bereavement contact, and whether someone is responsible for it; and the percentage of unexpected deaths that lead to a structured disclosure conversation within a set time frame.

You can calculate all four numbers with data you already have, but they are not on most quality dashboards. That gap is the main point.

Why Health Systems Should Take Responsibility

Health systems have spent years building tools to track clinical care. The time right after a death is the last part of the patient relationship that is left to chance, and it is when families decide how they feel about the care. The departments and data are already in place. What is missing is someone to take ownership and track these four numbers. Doing this is much cheaper than dealing with lawsuits later.