The scene

A GP phoned the MDU following a request from the coroner for a statement after the unexpected death of a 65-year old man.

The patient initially presented to ED with palpitations. He was diagnosed with atrial fibrillation and advised to follow up with his GP. The discharge summary, received by the practice a few days later, asked the GP to start anticoagulant medication. No details of medication or dose were provided and no discussion of the relative risks and benefits with the patient were recorded.

Over the next few days, the GP tried unsuccessfully to contact the hospital and asked the patient to book an urgent appointment to discuss appropriate treatment. The patient booked, but later rescheduled the appointment for another six days later. Sadly, he was admitted to hospital after an embolic stroke 11 days after his initial presentation and died two days after admission.

MDU advice

The GP contacted the MDU to discuss how to present the interactions between primary and secondary care with respect to prescribing anticoagulants. An MDU adviser helped the doctor draft a clear factual account of events, avoiding criticism of other clinicians while highlighting important factors. A month later, the GP came back to the MDU saying he had been called to the inquest, but that he had not been identified as an interested person (IP).

Interested persons have the right to legal representation at an inquest and can seek disclosure of documents relevant to the inquest. By contrast, clinicians not identified as IPs should not expect to be criticised by a coroner and therefore do not have access to witness statements or representation - their role is normally simply to give witness evidence. The MDU adviser established that in this case, the hospital had been identified as an IP and was to be represented by solicitors at the inquest.

The adviser suggested that the hospital doctor's perspective on initiating anticoagulant medication could conflict with the GP's. They would have the advantage of their position being represented by a solicitor at the inquest, whereas the GP could not be legally represented if not identified as an IP.

After discussion, the GP agreed that a request be made to the coroner that he be given IP status, to which the coroner agreed. With the expertise of an MDU solicitor, he was then able to review statements provided by the hospital doctor and family, identify any points of contention and prepare clear responses.

Outcome

It might seem counter-productive for doctors to consider requesting IP status, as the position is associated with the possibility of criticism by the coroner. However, where a potential issue is identified, seeking IP status affords the opportunity to prepare, and in this GP's case, reviewing witness statements with an experienced solicitor made it clear that the family were not critical of the GP.

The MDU solicitor was able to help the doctor anticipate the possibility that communication between the hospital and general practice could be criticised, and the GP was very well prepared for the inquest and gave a clear account of his decision-making regarding appropriate prescribing of anticoagulants. His position was entirely appreciated by the coroner and no adverse conclusions were drawn about any clinicians involved in the patient's care.

Coroner's case

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