Many doctors are not clear about when to notify a coroner of the death of a patient. This has often not been the fault of the doctors involved; after all, the law has been far from clear on this point. But that lack of understanding has led to real difficulties for doctors and coroners alike. Deaths that should have been reported get overlooked, meaning the state misses opportunities to investigate some deaths; and the converse is also true, leading to the clogging up of the bulging inboxes of local coroners, wholly unnecessarily.
Why have the new regulations been introduced?
The new regulations coming in to force on the 1st of October 2019 are designed to stop this happening. The intention of them is to standardise the situations when deaths must be reported. The aim is therefore to introduce consistency to the process and to remove any uncertainty which may have existed in the past.
When does the duty to notify arise?
Under the regulations, a registered medical practitioner’s (‘RMP’) duty to notify under S3 (1) arises in the following circumstances:
- Where the RMP suspects the death was due (more than minimally, negligibly or trivially)to:
- Poisoning, including by an otherwise benign substance
- Exposure to or contact with a toxic substance
- Use of a medicinal product, controlled drug or psychoactive substance
- Trauma or injury
- Self- harm
- Neglect including self- neglect
- Receipt of treatment or a medical procedure or procedure of a similar nature
- Injury or disease attributable to the person’s employment at any stage in their life
- The RMP suspects that the death was unnatural but not covered by the above.
- The RMP is an attending medical practitioner required to sign a certificate of cause of death but considers the cause of death is unknown having taken reasonable steps to determine cause of death.
- The RMP suspects the death occurred in custody/state detention (e.g. detention under the Mental Health Act).
- The RMP reasonably believes that there is no attending medical practitioner required to sign a certificate of cause of death.
- The RMP reasonably believes that an attending medical practitioner is required to sign a certificate of cause of death but is not available within a reasonable time of the person’s death to sign the certificate.
- The RMP is unable to identify the deceased person having taking reasonable steps to ascertain their identity.
How should a notification be made?
The regulations require the RMP (usually one of the attending medical practitioners) to notify a senior coroner of a death in writing as soon as is reasonably practicable. The guidance sets out the information which ought to be provided in the written notification.
The notification can be made orally in exceptional circumstances. However, this oral notification must be confirmed in writing as soon as reasonably practicable.
The RMP should still notify under these regulations even in circumstances where they are aware that someone else e.g. family /police have already reported the death to the Coroner.
Doctors need to be careful, because the regulations do not just formalise the obligations of the RMP – they also in broad terms set out the sanctions for non compliance.
If you are a medical practitioner you should consider the legislation and guidance thoroughly. Whilst the new regulations do not introduce specific sanctions for failure to comply, referral to the GMC, disciplinary action by employers and offences under coronial/ criminal law are potential consequences for failure to notify in the specified circumstances.
What is the likely impact of the regulations?
So what are is the likely impact of the new regulations? Will the number of referrals go down or increase? We shall wait and see. It is perhaps hoped by all involved that referrals go down, as ambiguity and confusion about when to refer will lessen. But the opposite may also happen. However, what it will lead to – in conjunction with the new Medical Examiner system – is an improvement to the quality and consistency of certification. And that can only be a good thing.
Regulatory offence lawyers
Written by Zita Spencer and Alex Preston. Zita is a criminal and regulatory solicitor who has considerable experience in this field having defended in some of the most high profile cases of recent years. She is known for meticulous preparation and exceptional attention to detail. Alex has used her experience in criminal litigation to build a considerable practice in the coroners courts, representing individuals who are involved in differing capacities in inquests. She has particular expertise in representing those who either have faced criminal investigation or who may face criminal investigation following an inquest.