Death Certification and Coroners

Question 1

When to report death to the coroner

Answer 1

Unexpected, sudden death
-within 24hrs of admission where death was unexpected

Death from unnatural causes
-accidents, suicide, violence
-poisoning, ilicit substances

Deaths during or shortly after medical procedures
-during surgery, before recovery from anaesthetic

Disputed or unclear cause of death

Death related to neglect or self-neglect
-bedsores, malnutrition

Deaths in custody or state detention
-police custody, prison, MHA

Occupational or industrial disease
-asbestos, mesothelioma, silicosis

When the doctor attending the deceased did not see them within 28 days before death

No attending registered practitioner that could sign the MCCD

Identity of deceased is unknown

Question 2

Who is the Medical Examiner

Answer 2

Carry out independent reviews
-review clinical records of the deceased
-discuss circumstances of death with certifying doctor

Family engagement
-communicate with the bereaved family to explain cause of death and address concerns

Referral to coroners
-identify and refer cases to the coroner where further investigation is needed

Don’t get involved in cases where the coroner is already involved

Question 3

Process of certifying death

Answer 3

1 - Certifying doctor completes MCCD
-must be familiar with the patient and attended to them during their lifetime

2 - ME reviews MCCD, medical records and discusses case with certifying doctor

3 - ME can amend or confirm accuracy

4 - ME communicates with bereaved family for clarification and feedback

5 - ME decides if coroner referral is needed

Question 4

Completion of MCCD

Answer 4

Avoid abbreviations
Name, DOB, Age in numerals
NHS No

Date of death
Place of death - as precisely as possible

1a - disease or condition that led directly to death

Cannot be any
-failures
-learning disabilities, MH diagnoses, physical disability
-cardiac/resp arrest, syncope, shock

OLD AGE IS ONLY ACCEPTABLE IF 80+ and known to attending medical practitioner for several months where gradual decline has been noted and no other cause is suspected

1b - underlying cause that initiated the direct cause of death

2 - other conditions that likely played a role in hastening the death

Further info and demographics

Any implantable medical devices
-metalwork
-wires
-pacemakers
-defibrillators
-drug pumps

Attending practitioner details

Question 5

Who requires a post mortem

Answer 5

Carried out by pathologists to find out how and why someone died

Coroner referral - required by law to carry out post mortem, no consent needed
Inquest may be help afterwards
Samples of organs and tissues will be retained until this is all over

Hospital post mortem - requested by hospital doctors or by relatives
Needs consent from individual or person close to the deceased
Can only examine limited areas of the body

Question 6

How to refer to the coroner

Answer 6

Phone call to coroner’s office
Be able to discuss the circumstances and events leading to death
Rationale for discussing case with coroner