Dr Gerard Panting advises on aspects of GPs’ involvement after a patient’s death has been referred to the Coroner
Q I am due to attend an inquest next week. The patient died of an overdose but there is a complex social and family background, which although relevant is highly sensitive. The rest of the family, who would not want any of this information to come out, are my patients. I do not want to offend them but at the same time do not wish to be accused of withholding relevant information.
A The purpose of a Coroner’s inquest is to determine who has died, when they died, where they died and by what means they died. Although there may be family background behind your patient’s suicide, the Coroner will not wish to delve into issues that have no direct bearing on the circumstances surrounding death, particularly if forewarned of their sensitivity.
You will probably be asked for a report by the Coroner. If so, you can indicate in that report that you believe, from information obtained when the patient was alive or from relatives, or both, that there are delicate background issues which you have not set out in detail as they are not directly relevant to the patient’s death.
In most inquests, the Coroner will use the witness’s statement as a basis for taking evidence. If the Coroner decides that he needs to know more about these matters, they can at least be approached discreetly. If direct questions are asked, you may say that you would prefer not to answer them in open court, giving the Coroner a further opportunity to limit the information required or to pursue the point in camera.
Ultimately, the only grounds for refusing to answer the Coroner’s questions would be if to do so would incriminate you, which hardly seems likely here.
Q I am due to attend an inquest in the next couple of weeks and although I do not think I did anything wrong in managing the patient – whom I had known and got along with for years – the family, especially the daughter, are highly critical of my treatment, and I have been warned by the Coroner’s officer to expect a rough ride.
A A Coroner’s inquiry is unlike most other forms of court proceedings. Here there is no prosecution or defence, just the Coroner elucidating facts so that a proper conclusion to the investigation may be made. Having said that, any interested party can be legally represented at a Coroner’s inquest. And where there is any realistic prospect of criticism, it is advisable for doctors to consider the pros and cons of being legally represented.
Criticism may come from a number of quarters including relatives, as in this instance, the Coroner, other healthcare professionals involved in the patient’s care and the press. In addition, the doctor may have reservations about the clinical management.
Legal representation has several advantages. First, you don’t have to go on your own. Second, moral support from someone who knows how inquests are run is a real boon. Third, if necessary your solicitor can intervene, stopping the inquest straying into areas that lie beyond the Coroner’s jurisdiction. Fourth, when you have finished giving your evidence to the Coroner and answering questions from others represented at the inquest, your own solicitor can pose questions to clarify your evidence, mitigating any damage done during cross-examination.
Against legal representation is simply the question it will raise in everyone’s mind – why does he or she require legal representation? It amounts to a signal that you have got something to worry about and consequently it pays to consider carefully the merits of legal representation before jumping to the conclusion that the advantages will always outweigh the disadvantages.
Q An elderly patient of mine recently died of bronchopneumonia and I duly signed the death certificate. However, it has been rejected by the Registrar because the patient had fractured her neck of femur three weeks previously. The Registrar has referred the matter to the Coroner. Should I be concerned about it, and why would the Registrar want to make a referral to the Coroner when the cause of death is so obvious?
A There are several circumstances in which a death should be reported to the Coroner, but the statutory duty to report deaths rests with the Registrar of Births and Deaths. By convention, however, doctors do make reports direct to the Coroner.
In general, deaths should be reported when:
- No doctor has been in attendance during the final illness;
- No doctor saw the patient either after death or at any time during the 14 days before death;
- The death occurred during an operation, before or during recovery from an anaesthetic;
- The death is sudden and unexplained;
- The death occurred in suspicious circumstances;
- The death occurred in custody;
- The death might be due to industrial injury or disease, accident, violence, neglect, abortion or poisoning.
Once the Registrar of Births and Deaths has received notification and is satisfied that no further inquiry is necessary, a certificate is issued which permits the undertaker to proceed with burial or cremation.
What appears to have happened here is that the Registrar of Births and Deaths has been alerted to the fractured neck of femur, realised that the accident that caused it was material to the death and therefore referred the matter to the Coroner.