- An inquest is a fact-finding inquiry, not a trial.
- It is held by a coroner when they decide a death may not be due to natural causes, or where the cause of death is not known.
- You might be asked to give statements about the care and treatment you provided to patients who have died and, if required, attend inquests as a witness.
Types of cases to refer
You are not legally obliged to report a death to the coroner, though in practice you should if there's any doubt or suspicion about the cause of death. You should also be aware of the circumstances in which the registrar has to refer to the coroner (see below).
Many coroners publish local guidelines advising doctors in their jurisdiction of the types of cases which they expect to be referred. These usually include:
- deaths which may be due to an accident, suicide, violence or neglect
- deaths which may be due to an industrial disease
- deaths in, or shortly after, release from prison or police custody
- deaths during, or shortly after, an operation or anaesthetic
- drug abuse
- non-therapeutic abortion
- still births where there is a possibility that the child may have been born alive, or there is cause for suspicion
- cases where the cause of death is unknown or uncertain.
Some coroners require notification of all deaths which occurred within 24 hours of admission to hospital.
You should be familiar with the requirements for completing medical certificates of the cause of death (MCCD) and only sign statements you believe to be true. If you can't complete the MCCD, you should refer the matter to the coroner and tell the deceased's family.
Referring a death to the coroner
The coroner receives notifications from a number of sources, including doctors, the police, medical referees and the registrar of births, deaths and marriages.
In any of the following circumstances, only the registrar is obliged to refer a death to the coroner:
- if it appears that the deceased wasn't seen during their last illness by a registered medical practitioner
- if the registrar has been unable to obtain a completed certificate of cause of death
- if it appears from the certificate that the deceased was not seen by the certifying medical practitioner either after death or within 14 days before death
- if it appears that the cause of death is unknown
- if the death appears to have been unnatural, violent or suspicious
- if the death occurred during an operation or before recovery from anaesthesia
- if the death appears to have been due to industrial disease or industrial poisoning.
The coroner's investigations
Once a death has been referred, the coroner will investigate the circumstances in which it occurred. This can involve ordering a post-mortem as part of the investigations.
Inquiries are usually conducted by the coroner's officer, who is often also a police officer. You should cooperate fully by providing medical records and information if you're asked to.
Coroners and confidentiality
Although the duty of confidentiality still applies after the death of a patient, there is an exception when giving information to the coroner (or procurator fiscal in Scotland).
The Coroners and Justice Act 2009 introduced the power to require the production of documents. Not doing so could result in a fine and may also constitute a criminal offence.
If the coroner asks for information about living patients as part of the inquiry, you normally shouldn't hand this over before the inquest without the patient's consent. However, the coroner can order you to do so during the inquest. In this situation, it could well be prudent to contact the MDU for advice.
In the case of a suspected murder or manslaughter, the coroner will pass the investigation to the police, to whom you can then disclose the medical notes directly.
Scotland – Fatal Accident Inquiries (FAIs)
All sudden, suspicious, accidental, unexpected and unexplained deaths in Scotland are investigated by the procurator fiscal, rather than a coroner's office.
Under Section 1 of the Fatal Accidents and Sudden Deaths Inquiry (Scotland) Act 1976, the procurator fiscal may hold a public inquiry before a sheriff into any death which is sudden, suspicious or unexplained, or gives rise to serious public concern.
At the conclusion of the FAI, the sheriff issues a final report – the determination – which includes:
- details of the time, place and cause of death
- any reasonable precautions which could have prevented the death
- defects in any system that contributed to the death
- any other relevant facts.
Some other key points of FAIs include:
- there is no automatic right to a public inquiry unless the death occurred in custody or in the course of the deceased's employment
- doctors can be ordered to give evidence and answer any questions put to them at the inquiry, although no witness is obliged to answer questions which could result in an incriminating answer
- any party who can show a relevant interest in the proceedings may attend the FAI, be legally represented, present evidence and question witnesses.
There are some differences in the way the coronial system operates in Northern Ireland. If you need details, speak to the MDU's medico-legal advisers.
I am a GP. The relatives of my deceased patient are to be legally represented at a forthcoming inquest and their solicitors have asked for copies of the records. I have retained a copy set as the originals are with the coroner. Am I obliged to disclose the records?
The coroner should be informed of this request. The Access to Health Records Act 1990 entitles the patient's representative to have copies of any medical records made on or after 1 November 1991. Access to the records of a dead patient can, however, be withheld if you believe the information was provided by the patient in the expectation that it would not be disclosed to the applicant. This caveat should be noted on the records.
My patient, a woman in her 60s, died recently. She had only been on my list for six months and I saw her on one occasion three months before her death. I was aware from her notes of a problem with alcohol abuse and her relatives now tell me that she was neglecting herself. In short, I do not know whether I could sign a death certificate. Should I ask the coroner's permission?
The coroner cannot give you authority to sign a death certificate. A doctor attending the deceased patient in her last illness is required by statute to complete a death certificate, giving the cause of death to the best of their knowledge and belief. If, as it appears, you feel you are without the knowledge and belief to complete the certificate, then it can be completed to show that the death has been reported to the coroner. The registrar cannot register the death until the coroner has finished their inquiries.
Doctors may wish to avoid delay by reporting a death informally to the coroner and seeking reassurance to issue a death certificate. However, on receiving this reassurance, the doctor should not initial the certificate to indicate that the coroner has been informed. If it is initialled, the death cannot be registered without the coroner's authority, which produces the very delay that the doctor sought to avoid.
This guidance was correct at publication 18/03/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.