Regardless of what speciality a doctor is working in, they may face a coroner's inquest at some point during their career. It's therefore helpful to understand the process and what's expected for those providing statements at the coroner's request or attending inquest hearings to give oral evidence.
While inquests are fairly common, a request from a coroner can still be a source of stress and worry for individual doctors, particularly if they have little experience of the process. The MDU can support and advise members through the entire process, from producing a statement to appearing at an inquest.
The role of the coroner
The coroner holds an inquest if a death has been sudden and unexplained, or where the cause of death is unknown or unnatural. They will also consider deaths in custody, and those due to industrial disease. A coroner's inquest aims to answer specific questions; who was the deceased and how, when and where did they die.
Doctors of any grade can become involved in the coronial process, depending on their involvement in the deceased's care. Some may only need to submit a statement and won't be required to attend the inquest in person, while others will receive a summons to attend as a witness or interested person. Failing to attend when summonsed would be in breach of the GMC's guidance, and the coroner also might consider this a contempt of court.
Following the pandemic, many inquests are now being held remotely, which means less disruption to the doctor's working day. The coroner and deceased's family may be in court, but other witnesses are able to join from a remote location. Often witnesses are given the choice as to how they would prefer to attend.
MDU file analysis
An analysis of MDU files opened in 2019 relating to inquests found that 75% of members who were contacted by the coroner were working in general practice. The remainder were made up mainly of those working in anaesthetics, psychiatry, emergency medicine and surgery.
While those working in NHS hospital medicine will hopefully have the support of their employing trust and legal services department, the MDU can provide advice and assistance with writing a report for the coroner and preparing to give evidence. Because of our extensive experience in supporting members with this type of enquiry, we don't underestimate the emotional impact an inquest can have on a doctor. Even where there are no concerns about whether the trust legal team will also represent individual doctors, we know that members value the additional support we can provide.
There may be some incidences where conflict arises between an employing trust and a doctor, meaning it's not possible for the trust legal team to represent both parties. In this case, it's important to seek advice from the MDU as soon as possible so we can consider your position carefully and, if appropriate, arrange legal representation to protect your interests.
Interested person (IP)
An interested person, according to Section 47(2)(f) of the Coroners and Justice Act 2009 is, in addition to family members and others with a specific relationship to the deceased, "a person who may by any act or omission have caused or contributed to the death of the deceased, or whose employee or agent may have done so".
It is not unusual for a GP or their practice, or a hospital trust, to be awarded IP status by the coroner. Being an IP can understandably cause concern for doctors as it may suggest the coroner, or family, have concerns about their involvement in the patient's care.
However, it also has the advantage of ensuring the doctor receives a full copy of any documentation the coroner will be relying on, such as witness statements, and to have legal representation if necessary. A witness, on the other hand, does not.
It is unusual for a doctor working in an NHS trust to be made an IP in their own right, but if this was the case - as it was in 11% of the MDU cases analysed - it is likely that separate legal representation would be required. This can be very costly for those who don't have appropriate membership with a medical defence organisation.
According to our analysis, 69% of members we supported were an IP. Of those, 50% were given IP status by the coroner from the start of the process. The remainder were either made an IP later after the coroner had reviewed their witness statement, or at the request of the MDU's legal representative so they could better protect the member's position.
This may happen (for example) where the MDU's medico-legal adviser has identified potential vulnerability to criticism and has, with the member's permission, instructed a solicitor. The solicitor will only be able to represent the member at the hearing if they are an IP.
Legal representation isn't always necessary, and in some cases it can look overly defensive to arrive at an inquest hearing with a solicitor or barrister, if there is no clear evidence of likely criticism. It is also generally better for NHS hospital doctors to be represented with their colleagues by their employing trust.
However, having legal representation can be particularly important when there is a potential for criticism by the coroner because of the GMC's requirement for doctors to self-refer if they have been criticised by an official inquiry, which includes a coroner's inquest. In our analysis, after the inquest was completed and the coroner's conclusions had been received, 7% of doctors found themselves in a position where their GMC obligation was engaged, and they were advised to inform the GMC of the criticism they'd received.
In some cases, this could lead to an investigation into the doctor's fitness to practise and is another reason why personal medical indemnity is so important. Where a doctor doesn't appropriately inform the GMC about criticism and this comes to the GMC's attention from another source, there is a risk that the GMC could criticise the doctor for not having self-referred.
Where a doctor doesn't appropriately inform the GMC about criticism and this comes to their attention from another source, there is a risk that the GMC will also then be concerned about the doctor's probity.
Reflection and remediation
As with any clinical incident, reflecting on the care provided to the patient is essential. This allows areas of good practice to be identified as well as areas where, with hindsight, things could have been done differently. This might include potential problems with existing policies and protocols.
The coroner can issue a prevention of future deaths (PFD) report when they are concerned that a recurrence could occur and put other patients at risk. To avoid or reduce the risk of a PFD report being issued or a doctor being individually criticised, the coroner will - like the GMC - take into account what action has been taken to address any concerns. This can include reviewing and amending policies, and individual professional development and remediation.
Coroners' inquiries can be stressful. It's important to seek advice from your medical defence organisation early so you can ensure your report for the coroner is appropriate, and that you're prepared if you're asked to attend to give oral evidence.
At the MDU, we can assess whether you might need legal representation so your interests can be best protected, and whether you're obliged to inform the GMC of any criticism levelled at you by the coroner.