Process of certifying death, role of HM coroner and inquest process Flashcards
According to the Births & Deaths Registration Act 1953 (S.22), who can sign a death certificate, and what piece of info must they include?
Registered medical practitioner
Fulfil to the best of their knowledge and belief: CAUSE OF DEATH
Give 2 reasons why the Medical Certificate as to Cause of Death (MCCD) helpful for family members?
Allows them to register death
Provides explanation of how/why patient died
Why is the Medical Certificate as to Cause of Death (MCCD) helpful in research?
Informs research into health effects of exposure to risk factors
Give 3 criteria that must be completed by the doctor with the statutory duty to complete the Medical Certificate as to Cause of Death (MCCD)?
Saw patient in last 14 days and saw body after death
Cared for patient in the illness that led to death
Knows past medical history, investigations and treatments
After the attending doctor with the statutory duty (fulfils 3 criteria) diagnoses death, who investigates the case to help certify it?
Medical Examiner Office
What is the role of the Medical Examiner Office in helping the statutory attending doctor, regarding the MCCD?
Agree proposed cause of death with MCCD statutory doctor
eg. what did this person die from?
Where are Medical Examiner Officers based, and what are their 2 main roles to aid MCCD completion?
Senior doctors in Acute Trusts that extend support to hospital to complete MCCD by:
improving communication with family
appropriately referring to HM coroner
Why does the Medical Examiners Office discuss the cause of death with the next of kin?
To establish any questions, concerns with care before death
Who informs local mortality arrangements of deceased patients eg. funeral care?
Medical Examiners Office
If the statutory attending doctor doesn’t fulfil the 3 criteria to complete the MCCD and the proposed cause of death isn’t agreed on, who must the patient case be referred to by the Medical Examiner Office?
HM coroner
All deaths undergo MEs or HM coroners investigation
How is section 1 of the cause of death section on the MCCD completed?
Immediate, direct cause on line 1a
On each line below go through prior sequence of events/conditions that led to death
Lowest line has event/condition that caused all conditions above i
Give examples of vague terms that should be avoided when completing the cause of death section of the MCCD?
‘old age’, ‘natural causes’, ‘organ failure’, ‘cardiovascular event’
Which 2 guidance frameworks are used to determine if a post mortem/autopsy can be performed?
Human Tissue Act 2004
Code of Practice
What are the 2 situations in which a post mortem is done?
Coroner orders it to determine cause of unknown, unnatural, suspicious, violent death
Agreed upon by hospital and family to understand deceased illness/cause of death and/or enhance future healthcare
If a post mortem is ordered by a coroner, do they need the family’s consent to proceed?
No
How soon after the death must the coroner perform the post mortem?
Done by suitable practitioner as soon as reasonably possible
When a coroner performs a post mortem, what standards must they comply with?
Human Tissue Authority standards
How soon after the post mortem must the coroner release the body for burial/cremation?
As soon as possible (usually within 28 days)
After what finding must the coroner hold an inquest?
post mortem doesn’t confirm natural cause of death
According to Coroners & Justice Act 2009 (S.1), in which 3 situations does the coroner have a duty to investigate a death?
body is within coroner’s area
has reason to suspect violent/unnatural/unknown cause of death
patient died in state detention/custody
Who are HM coroners employed by?
Independent Judicial Officer of the Crown (employed by the Local Authority), all new coroners are lawyers
What is a coroner inquest hearing, and is anyone blamed?
A fact-finding, public hearing (no blame) that states who deceased person was, how, when, where death occurred
At a coroner inquest hearing, who decides who will attend and give evidence?
Coroner
At a coroner inquest hearing, can relatives attend?
Yes
Relatives can attend, ask questions and be legally represented
At a coroner inquest hearing, why would a Trust solicitor/barrister attend?
requested by staff to provide written statement/oral evidence
At a coroner inquest hearing, give examples of the verdict that a coroner can come to?
natural causes, accident/misadventure, killed himself, narrative verdict (brief description of factual events)
At a coroner inquest hearing, who can challenge the coroner’s verdict?
Judicial review
At a coroner inquest hearing, why would the coroner refer the doctor to their regulatory body?
Refers doctor to their regulatory body (eg. GMC, NHS England) if they think it would prevent recurrence of incident that caused death
Give 2 examples of common adverse findings/verdicts in a coroner inquest hearing?
Neglect: Gross failure over period of time to provide basic care and nourishment that overlooks clinical judgement
Regulation 28 Report: Coroner’s duty to issue report to public authorities about circumstances which pose risk of more deaths, copy sent to chief coroner to be published
Does a body have to be buried in an authorised place eg. graveyard?
No
In order to bury a body in a garden, what 3 requirements are there?
Consent from burial register
Consent from Local Authority
Certainty that body (clinical waste) won’t poison water supply
According to the Cremation (England and Wales) Regulations 2008, what is the role of the Cremation 4 and 5 doctors, and the medical referee?
Cremation 4 form: Statutory attending doctor who cared for patient in last illness before death
Cremation 5 form: Confirmation certificate mostly by ME after discussing with Crem 4 doctor
medical referee at crematoria approves medical documentation before consenting to cremation
Is it lawful to cremate a body in a garden?
No
