The scene

An elderly male patient with a long history of bronchiectasis and deteriorating respiratory function was receiving regular out-patient follow-up under the ongoing care of the respiratory team at a large teaching hospital. He usually attended in person, but because of COVID, his appointment was changed to a remote format.

The consultation was done over the phone with a respiratory consultant during an extra ad hoc weekend clinic, which had been initiated to try to reduce waiting times. The patient was well known to the consultant, who immediately suspected he was not well - he had evident shortness of breath and reported feeling unwell in the preceding few days.

The consultant was aware that the patient frequently had infective exacerbations and often attended his GP or A&E to help with treatment. On the basis of the consultation, the consultant concluded that the patient likely had another infective episode.

As it was the weekend, it was unlikely that the patient would be able to access primary care, and because he lived alone, the consultant felt the best solution would be for him to immediately attend A&E. The patient agreed, and although the consultant suggested an ambulance, the patient was confident he could get a lift. He did arrive at the A&E later that morning, but when he was admitted his condition was very serious.

Sadly the patient died shortly after being admitted, and the consultant was contacted by the coroner for a statement the same week. This understandably made the consultant somewhat anxious, as it had been many years since he had written a statement for the coroner. He called the MDU advice line for assistance.

MDU advice

The MDU's medico-legal adviser reassured the consultant that it was a normal part of the coroner's remit to seek statements from those involved in providing care, and that the MDU could assist with the statement and offer guidance if he was subsequently called to be a witness at an inquest.

The adviser went through how to draft a statement for the coroner and gave a comprehensive overview of the coroner's processes. The initial advice was to provide a detailed, factual statement, as doing so (in the MDU's experience) potentially reduced the likelihood of being called to an inquest.

The doctor produced a thorough statement based upon the advice, which was refined with the MDU's assistance, to try to pre-empt any aspects the coroner might be particularly interested in. The consultant's statement ran to several pages and included information about the patient's diagnosis, why the clinic was being run remotely and the rationale for suggesting admission.

The consultant explained that based on personal knowledge of the patient over many years, he had been confident the patient would follow his advice to attend hospital, even though he had declined an ambulance, and felt the patient had capacity to make this decision.

The outcome

The coroner was satisfied with the consultant's comprehensive report and did not call on him to attend the inquest.

This dilemma is fictional but based on members' experiences and the types of calls we receive to our advice line.

Coroner's statement after remote consultation

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