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The role of the coroner and the legal requirements of autopsy
Recent Level 3 Diploma graduate Anita Hardy MAAPT gives a report of a recent lecture evening on role of the coroner and the legal requirements of autopsy
On a rainy and rather bleak Wednesday afternoon with four colleagues, I braved the rain to attend a two part lecture in the post graduate centre located on our hospital campus. The lecture was given by assistant coroner and paediatric consultant for the Trust, Dr Liz Didcock and our own Neuropathologist Dr Ian Scott.
The lecture topics to be covered were the role of the coroner and the legal requirements of autopsy.
Whilst those of us in the mortuary are already well versed in the coroners role and the processes around investigations and inquests it was interesting to hear the coroners side of things and have an honest discussion on the complexities around autopsy.
Dr Didcock began by discussing who the coroner is in Nottingham and how the coroner works. I was fascinated to learn that although Nottingham has a huge jurisdictional area that the percentage of post mortems performed was well below the national average (23% in Nottingham compared to the national average of 37%).
It was surprising to learn that of the 6709 deaths that were referred to the coroner in 2017 only 537 (8%) were taken to inquest.
Dr Didcock believes this is due to the fact that as a medically trained assistant coroner (one of the last few employed before the law changed requiring all coroners to be legally qualified) she is able to assist in filtering out unnecessary post mortems and investigations.
By having a medically trained coroner they are able to understand complex conditions and circumstances and help encourage GPs and clinicians to issue an MCCD whereas in other jurisdictions who have no medically trained coroners they may have gone for post mortem.
Dr Didcock also stressed the importance of the need for change in the referral process. Currently in Nottingham referrals are made through electronic means. This means that the information is clear, concise and leaves little error for miscommunication.
She believes that referrals that are taken in other ways i.e. verbally leave the potential for miscommunication and a lack clarity which can cause confusion and upset to the bereaved.
The talk detailed what steps are taken when a death is referred to the coroner, how the family are approached and managed and then also what options were available to the coroner when they have gathered their information.
Although I was familiar with the forms that are issued depending on whether the investigation would continue, I was interested to learn more about the inquest process.
I have attended and inquest on only one occasion and that was just as a visitor. I was intrigued at the process and what circumstances call for a jury to be present. I was not aware that in a death in custody, where the death is unnatural, required a jury and that it would be the jury’s responsibility to give a conclusion on the death.
I had previously thought that the coroner took this responsibility in all circumstances and was surprised to learn that the verdicts given at the end of the inquest are on a balance of probabilities and that suicide (now referred to as self-harm deaths) can now be given a verdict on a balance of probabilities instead of beyond reason of a doubt.
In Nottingham the average time of death to inquest is again below the national average, 19 weeks as opposed to 21 weeks which again is believed to be through the influence of having a medical assistant coroner. Dr Didcock takes part in a Friday Review for what could be considered ‘grey cases' where the death is natural but the family have concerns regarding their relatives care.
These reviews ask further questions of the clinicians and the family in order to build a fuller picture and many families can have their concerns alleviated and prevent the need for inquest.
Finally Dr Didcock discussed the role of the coroner in preventing future deaths. This was an area I was unfamiliar with and it seems silly now that I did not consider that the coroner would have a duty to prevent future deaths.
By evoking Regulation 28 the coroner has the power to demand a system of work or practise change in order to prevent a death happening in the same manner again.
For the end of the first session we were able to have some time to ask questions and hear her views on other aspects of the coroners proceedings such as still births requiring no coronial investigation which many believe should change and the difficulties that will be faced in the future with no new appointments of medically trained coroners unless they are legally trained.
The second part of the lecture given by Dr Scott discussed the legal ramifications faced by pathologists who perform post mortems for the coroner. I was not surprised by his frustration at certain aspects of his role when pathologists are often pulled in different directions.
We are all aware of the shortage of pathologists willing to perform post mortems and it is something that needs addressing sooner rather than later. Dr Scott explained that the coroner’s regulations often conflict that of the Royal College of Pathologists and it becomes a balancing act as to which regulations/ standards that are followed.
There is becoming an ever increasing need for digital autopsy and coroners are required to offer it as a option for families (at their own expense of course) however many hospitals do not have access to a CT scanner. Pathologists are left trying to read radiological reports and take responsibility for a case that they may not have even seen the radiological report on.
The Coroners Act also removed the remuneration for special cases such as maternal deaths. This has left some pathologists performing these cases (which can take 10-12 hours from examination to reporting) for a somewhat meagre sum.
Dr Scott also discussed the inevitable implementation of the Medical Examiner and how it may not actually improve the service provided to families currently. It is believed that the funding for this will come from the fee payable for a cremation form.
He believes this is unsustainable as for somewhere as large as Nottingham with its 1.1 million residents there will be a requirement for at least 10 MEs to cover the workload that is currently occurring and that the funding simply will not cover that.
At the lecture there were a lot of trainee pathologists in attendance and whilst not trying to scare them off from a potential future career performing post mortems he talked them through the challenges of the inquest procedure.
He explained about the need for them to be able to give evidence that is clear and concise but does not over step their area of expertise.
Dr Scott explained that they can be quite intimidating especially when the family or hospital has legal representation but that their sole purpose would be to give a true account of their findings. We were encouraged to attend an inquest in order to see how the system works.
Finally he rounded off his lecture by stating that his purpose was not to scare people away from pathology as he loves his work, he loves the complexities and the challenges that each case can bring.
Instead he wanted to make them more aware of what the service is currently facing and how change is needed for a future that works for both the coroner’s service and pathologists.