During a recent five-year period, we had approximately 274 calls from foundation year doctors seeking help after receiving a request to prepare a report for the coroner in England and Wales or for a death investigation by a procurator fiscal (PF) in Scotland.
This was usually a request for a statement, although far less commonly, a request for the member to attend court to give evidence.
Being informed that a patient you've cared for has died can be upsetting and stressful, and even more so when the circumstances surrounding the death are the subject of an investigation by a coroner or procurator fiscal.
Coroners
As part of their inquests, coroners will often need written reports from those involved in the care of a deceased patient. These types of requests can make an already distressing time even more stressful for the clinicians involved. You may be contacted directly by the coroner's office or, more usually, by your hospital's inquest coordinator or legal department.
The purpose of an inquest is to establish the circumstances surrounding the death. They are inquisitorial rather than adversarial and the coroner will want you to provide a comprehensive, factually accurate report that is easy to read by everyone, not just other medics.
Read more in our guide to coroners' inquiries.
Fatal accident inquiry
A procurator fiscal investigation into a death can lead to a fatal accident inquiry (FAI) in the Sheriff Court. FAIs are far less common than coroners' inquest hearings - there were only 61 in 2020-21, compared to 32,000 inquests in England and Wales in 2020.
FAIs are organised by and held in front of sheriffs with investigations carried out by the procurators fiscal and often assisted by the police.
Read more in our guide to fatal accident inquiries.
The following steps can help guide you through responding to a request from the coroner or PF for a statement.
Don't panic
The coroner or PF needs your help in understanding what happened and what your role was. Their request does not necessarily mean there is any specific concern about your involvement in the case, just that you may be best placed to describe an episode during the patient's care.
Make sure you're fully informed
In order to write an accurate statement, you'll need the relevant records to make sure they are consistent with what you submit. Don't just rely on your recollections; they may be incomplete or inaccurate by the time you're asked for your account.
It's important that your statement is in line with the GMC's expectation of doctors when they provide evidence for legal processes, namely that you are honest and trustworthy when writing reports, and when completing or signing forms, reports and other documents.
Seek help
Discuss the case with your clinical or educational supervisor to obtain feedback and support. Even if you don't feel vulnerable to criticism, they can help reassure you and offer guidance on your statement.
They may also identify learning points that you hadn't considered, and the earlier you're made aware of these, the better. If it's found that you should have done something differently, they can help you reflect on this and advise you on how best to remediate.
Your hospital may also undertake its own internal investigation into the incident and you should take on board any learning points that come out of this.
Cooperate with the request
Whether the request has come straight from the coroner or a PF, as often happens in primary care, or via the trust or health board legal team, it's important to note any deadline and respond to the request as promptly as possible.
If you're an employee of a hospital trust or a health board, you will be indemnified by them. They, or their appointed solicitors, will usually support and guide you through the processes too, so we'll often advise you to liaise closely with the legal team.
Read the request carefully in case there are any specific issues you have been asked to address.
Before you write
It's in your best interests to include all information requested and by doing so, it may be possible to avoid attending the inquest or FAI to give evidence.
The more comprehensive and clear your statement, the less likely it is that you will be asked for a supplementary statement or to attend the inquest or FAI just to clarify any information that is unclear from your statement.
Points to cover
- Include your full name and qualifications (Bachelor of Medicine rather than MB).
- State the nature of the contact with the patient; for example, that you were the junior doctor on call for medicine overnight.
- Include a brief sentence indicating that you have prepared your statement at the request of whoever wrote you the letter, be it the coroner, the PF or one of their officers. You should also state the sources of information that you have relied upon for your statement; this is likely to be the clinical records that you have a copy of, any recollections you may have of this case and your normal practice in a certain situation.
- Outline the history that you obtained from the patient. The history should be written in full sentences and should include negative as well as positive findings. For example, rather than say 'Ptnt been SOB for 1/52' you should write 'Mr X gave a one-week history of shortness of breath.'
- Approach the examination findings, if you did examine the patient, in a systematic way in your report, followed by a paragraph on the management plan at the time of your involvement. Again, do this in full sentences, avoiding any medical jargon and abbreviations or explaining it in lay terms afterwards.
- Explain how your involvement with the patient's care ceased.
- Address any particular issue the coroner or PF may have raised in their request.
- Use the patient's name rather than referring to them as 'the patient'. The report may be seen by the family and using their name gives the report a more personal tone.
Other points in style
- When mentioning any drug, include the name and dosage as a minimum.
- Do not paste sections of the notes into the report or rely on the reader having access to supporting documents. Assume the reader is a lay person with no prior knowledge of the case and no access to the records. In other words, your statement should be able to stand alone.
- When referring to other staff, include their name and job title if possible - the coroner or PF may wish to contact them also as the investigation progresses.
- Write in the first person using an active voice. For example say, 'I reviewed the chest X-ray and it was normal' rather than 'The patient had a normal chest X-ray.'
Seek advice on your report
As your medical defence organisation, we can advise you not only on what information it might be helpful to include, but also on the style and formatting of the report.
When a member contacts us about writing a statement for the coroner or procurator fiscal, we usually suggest that they send their draft report to our advisory department as a Word document, along with the relevant entries in the medical records and the request for the statement.
We would request that all these documents are anonymised, in keeping with data protection law.
If you work within a hospital trust or health board, they should see your draft before it is submitted to the coroner or procurator fiscal. Generally, the trust or health board legal team will submit your finalised statement on your behalf. Don't submit your finalised statement directly to the coroner or procurator fiscal's office yourself. It's important to attend any meetings arranged by your trust or health board to discuss the investigation into the death.
If you're asked to attend an inquest hearing or an FAI as a witness to give oral evidence or if you have any concerns, remember you can contact us for support throughout the process.
Further advice
For detailed advice about your duties surrounding coroners' inquiries and FAIs, read our guides on:
There are some differences in the way the coronial system operates in Northern Ireland. If you need details, speak to our medico-legal advisers.
This page was correct at publication on 09/05/2022. Any guidance 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.