Another 16 deaths at the Launceston General Hospital (LGH) in Tasmania will be referred to the coroner following an investigation, with the Greens labelling the development "deeply distressing".
It means 22 deaths will be reviewed as a result of the investigation.
Greens MP Cecily Rosol said hearing that additional cases at the LGH would be referred to the coroner was "shocking".
"Our thoughts go out to all the affected families and loved ones," she said.
"Hearing this news must be extremely difficult and raise many questions.
"We … recognise these circ*mstances will be difficult for staff at the LGH, too."
She said the Greens found the matter "deeply distressing" and would be following it closely.
"While we believe the government needs to do much better at communicating proactively on important matters of public interest like this one, we thank them for providing this update soon after we raised the matter."
Edited death certificates a 'serious matter'
The independent review was launched following allegations aired at a parliamentary inquiry that a senior staff member edited death certificates resulting in some deaths not being referred to the coroner.
Health Minister Guy Barnett confirmed the additional cases on Friday following questions from the Greens about the progress of the investigation.
Mr Barnett said it was a "serious matter".
"I can advise that there will be another 16 referrals to the coroner as a result of that further work," he said.
"That report has been provided to my department secretary, and I've had a verbal briefing on that, and I am looking forward to receiving the final report in coming days."
Mr Barnett said work was underway to inform the families of those whose deaths had now been referred to the coroner.
He said the investigation indicated a sole staff member at the hospital was responsible for the edited documents, and there were no systemic concerns.
Allegations senior staff member edited death certificates
Under current practices, a death must be referred to the coroner if it was unexpected or from an injury, accident or medical procedure.
This is determined by the patient's medical certificate of cause of death (MCCD), which is completed by the treating medical practitioner.
In a letter to the Department of Health, outlining preliminary findings in May this year, healthcare governance expert Debora Picone, who is leading the review, said some certificates had been edited.
"During the review of the initial 21 cases, it was observed that a former LGH staff member who was employed as a senior specialist medical practitioner completed or edited the MCCD on multiple occasions," she wrote.
She said there were few instances where a staff member at that level would be required to complete or edit the report.
"It is the treating medical team that has the most in-depth knowledge about the deceased, their medical conditions and cause of death, and that team is in the best position to write the most accurate MCCD and/or report to the coroner," Dr Picone wrote.
At the time of writing, she said the panel recommended a further review, which had since been completed.
"Given that this panel has uncovered irregular practices by the former staff member, specifically the certification and/or alteration of MCCD without attending to the patient prior to or after death or accurately documenting alleged conversations with the coroner's office, the panel will now undertake a comprehensive review of further MCCD certified by the former staff member," she wrote.
Allegation raised by hospital nurse
Allegations of irregular death certificates were first made public by Amanda Duncan, a nurse and midwife at the hospital, during a parliamentary inquiry into ambulance ramping in February.
She accused former executive director of medical services Peter Renshaw of falsifying death certificates in cases which should have been referred to the Coroner.
She told the inquiry that:
"Doctors and nurses have stated to me the cause of death Dr Renshaw documented on the deceased's medical certificate defied basic common sense.
"Further, staff stated to me that the nature in how Dr Renshaw made this determination was, in their view, unethical."
Dr Renshaw held the hospital's top job from 1989 until his retirement in 2022.
The Medical Board of Australia suspended his medical practitioner licence in May.
In a statement at the time, a spokesperson for the Australian Health Practitioner Regulation Agency (AHPRA) said the National Board only has the "power to suspend a practitioner using interim, 'immediate action' powers, while it undertakes an investigation or other process" but did not expand on the nature of the investigation.
The ABC has attempted to contact Dr Renshaw for comment.
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