Earlier this month, the Department for Constitutional Affairs published a draft Coroners Bill for England and Wales. The bill will give coroners new powers to obtain evidence for investigating deaths, and will give them access to more medical expertise when making decisions on cases.
While GPs wait for the legislative changes needed to bring the system into effect, they still need to be aware of the current system for reporting deaths, writing reports and appearing at inquests.
In England and Wales, the registrar of births and deaths has a statutory duty to report certain deaths to the coroner. Referrals to the coroner are also made by a variety of individuals, including GPs in a number of circumstances (see box).
If asked to write a report for the coroner, GPs should put together a detailed, factual, chronological account based on the medical records and your knowledge of the deceased. Avoid jargon and medical abbreviations and specify the nature of your contact with the deceased, for example, clinical NHS patient. Be as clear as possible about which details are based on memory, contemporaneous notes you or others wrote and 'normal' practice. Include what you looked for, but failed to find.
An inquest is a fact-finding investigation of a death held when a coroner decides that a death might not be due to natural causes. If your report is well written, you are less likely to have to give evidence. The coroner usually sits alone, but can sit with a jury.
Listen carefully to the questions put to you and answer them, rather than the questions you want or expect. If a question is unclear, ask for clarification. Keep your answers short and avoid medical jargon. Try to speak clearly and as honestly as you can.
The coroner summarises and records findings and conclusions. The range of possible verdicts is wide, and the words 'the cause of death was aggravated by neglect/lack of care' can be added if it appears medical care was inadequate.
Often, verdicts are narratives summarising the circumstances of a death.
A procurator fiscal (PF) investigates all sudden, suspicious, accidental, unexpected and unexplained deaths. PFs can compel doctors to see them in person and give a statement. A public inquiry is not automatic unless the death occurred in custody or in the course of the deceased's employment.
The PF decides whether to report the death to the Lord Advocate who, in the case of an accident, decides whether there will be a sheriff court 'fatal accident inquiry'.
The coroner's system in Northern Ireland is currently similar to England and Wales.
- Dr Devlin is a medico-legal adviser at the Medical Defence Union
- The MDU's 'Guide to Coroners' Inquiries' is free to members.
Tel: 0800 716376 or visit www.the-mdu.com
In England and Wales, a GP may decide to refer a death to the coroner if the deceased was not seen by the GP either after death or within the 14 days before death. Or, if the cause of death was, or might have been:
- Unknown, violent, unnatural or suspicious.
- Accidental (whenever it occurred).
- Due to self-neglect or neglect by others.
- Resulting from an industrial disease or related to the deceased's employment.
- Due to an abortion.
- The result of an operation or recovery from the effects of an anaesthetic.
- Due to or shortly after detention in police/prison custody.
(Local coroners might have guidelines for reporting cases.) Writing a report for the coroner
- Put together a detailed, factual, chronological account.
- Avoid jargon or medical abbreviations.
- Describe your status, for example GP partner for 10 years.
- Specify the nature of your contact with the deceased - NHS patient, clinical purpose, etc.
- Identify which details are based on memory, contemporaneous notes you or others wrote and 'normal' practice.
- Also state what you looked for and failed to find.
CORONER REFORMS IN ENGLAND AND WALES
- A new role of chief coroner and a number of deputy chief coroners responsible for hearing appeals against coroners' decisions and overseeing training and guidance.
- Coroners to have new powers to obtain evidence for investigating deaths and to impose reporting restrictions in certain cases, such as apparent suicides and child deaths.
- Coroners to be provided with 'significant new medical expertise' to help decision making. There will be a chief medical adviser and funding for medical support.
- The deceased's relatives will be able to ask the coroner for a second opinion on a death certificate.
Visit www.dca.gov.uk for the draft Coroners Bill.