Coroners Act and HTA

Question 1

How do you verify death in the hospital (8)

Answer 1

No response to verbal or painful stimulus
No palpable carotid pulse
No heart sounds (2 minutes)
No breaths sounds (2 minutes)
Pupils fixed and dilated (non-responsive to light)

DOCUMENT in medical notes (date and time)
Notify Consultant, discuss cause of death for certificate, arrange for family to be notified etc.
DO NOT add messages/drawings/R.I.P.

Question 2

What does MCCD stand for

Answer 2

Medical Certificate of Cause of Death

Question 3

How do you document the cause of death (4)

Answer 3

1a is the ultimate cause of death
1b causes 1a
1c causes 1b

Part 2 - other diseases related to cause of death, but not related to 1a-c

Question 4

What should you avoid when documenting the cause of death (4)

Answer 4

Abbreviations
Question marks
Vague terms
Modes of death

Question 5

What was the result of the Shipman enquiry regarding documentation of cause of death

Answer 5

The inquiry found major flaws in the systems that govern death registration, the prescription of drugs and the monitoring of doctors

Question 6

What are you essentially stating when completing a cremation certificate

Answer 6

That further examination of the body is not required

Question 7

What are the three types of autopsy

Answer 7

Consented (hospital) autopsy.
Forensic autopsy.
Coroner’s autopsy.

Question 8

Why are hospital autopsies carried out (5)

Answer 8

To determine: extent of disease, response to treatment, occult disease.
To support: teaching/training, research/audit.

Question 9

Why is a forensic autopsy carries out (2)

Answer 9

Coroner’s rules.

Police involvement.

Question 10

Why is a Coroner’s autopsy carried out

Answer 10

Coroner’s rules

Question 11

Who conducts a forensic autopsy

Answer 11

Forensic pathologist

Question 12

Who conducts a coroner’s autopsy

Answer 12

General pathologist.

Question 13

What does the coroner do?

Answer 13

A coroner is an independent judicial office holder, appointed by a local council. Coroners usually have a legal background but will also be familiar with medical terminology. Coroners investigate deaths that have been reported to them if it appears that:
The death was violent or unnatural
The cause of death is unknown, or
The person died in prison, police custody, or another type of state detention.

Question 14

What is the coroner concerned with? (4)

Answer 14

Who died.
When did they die.
Where did they die.
How did they die.

Question 15

What deaths should be referred to the coroner (6)

Answer 15

Unknown cause of death
Not seen by a Dr during last illness or last 14 days
During or within 12 months of pregnancy
Death in custody
While detained under Mental Health Act

Death due to:
Suicide
Accident/trauma
Industrial disease
Medical/surgical treatment
Abortion 
Anaesthetic care
Lack of medical care
murder
Self-neglect

Question 16

What are some key laws regarding the Coroner (4)

Answer 16

Coroners Rules 1984
Coroners Act 1988
Coroners and Justice Act 2009
Coroners (investigations) Regulations 2013

Question 17

What is required in order to conduct a hospital autopsy

Answer 17

Patient/Family member’s consent

Question 18

What is essential with regards to consent

Answer 18

Capacity to consent

Question 19

Who does the Mental Capacity act protect

Answer 19

Protects people who cannot make decisions for themselves

Question 20

What does the mental capacity act presume

Answer 20

That people have capacity - you have determine incapacity

Question 21

What is required for a patient to be deemed to lack capacity (4)

Answer 21

They cannot:
Understand the information relevant to the decision.
Retain the information.
Use or weigh that information as part of the process of making the decision
Communicate the decision

Question 22

What was the Alder Hey organ scandal

Answer 22

Involved the unauthorised removal, retention, and disposal of human tissue, including children’s organs, during the period 1988 to 1995

Question 23

What resulted from the Alder Hey organ scandal?

Answer 23

Redfern Report led to the Human Tissue Act 2004

New law on informed consent.
Review of coroner’s system.
Trusts had to employ bereavement counsellors

Question 24

What did the Human Tissue Act 2004 create

Answer 24

Human Tissue Authority

Question 25

What is the Human Tissue Authority

Answer 25

The Human Tissue Authority (HTA) is a watchdog that supports public confidence by licensing organisations that store and use human tissue for purposes such as research, patient treatment, post-mortem examination, teaching, and public exhibitions.

Question 26

What does the Human Tissue Act deal with

Answer 26

Deals with consent, performance of autopsies and storage of material retained, as well as the collection and retention of material taken from the living.
You need consent for examination, removal, storage and ANY type of use – teaching, research, audit, clinical governance etc…

Question 27

What are the three key clauses of the Human Tissue Act (3)

Answer 27

16 (2) b –a post mortem examination

16 (2) c – The removal from the body of a deceased person of relevant material of which the body consists or which it contains for a scheduled purpose other than transplantation

16 (2) e – The storage of the body of a deceased person or relevant material which has come from a human body for use for a scheduled purpose.

Question 28

What activities require consent to use biological material from a decreased person (5)

Answer 28

Clinical audit. 
Education or training related to human health 
Performance assessment 
Public health monitoring 
Quality assurance

Question 29

Who is required to consent for pathology specimens for the coroner’s autopsy

Answer 29

The coroner, but can also gain consent from family