For a long time now it has been suspected that causes of death listed on official documents may actually be false. A survey of medical residents in New York City has shown that half of the residents that have previously written a death report have used a diagnosis that they believed was wrong. The survey, which was led by Dr. Keith Rose of St. Luke’s-Roosevelt Hospital Center in New York City was completed by 521 residents who base their studies in areas of internal medicine, general surgery, and emergency medicine at twenty-six institutions located across the city. One of the major problems is that septic shock is not considered as an acceptable cause of death within the record system that the state of New York uses. According to a report published in the CDC’s Preventing Chronic Disease publication, about 70% of those who responded to the survey stated that they were forced to use an alternative cause of death due to septic shock not being one of the provided options. Other data showed that 40% of respondents stated that the admitting office told them what to write as a cause of death other than what they thought to be true. Approximately 30% stated that the medical examiner told them what to write. Only about 20% of the medical residents were aware that they could use words such a “presumed”, “probable”, or “undetermined”. About 3% of residents have ever changed a death certificate when new information was discovered at a later point.