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.
Given this remit it is not surprising that most doctors will at some point be asked to provide information to assist the coroner. In 2013 and 2014, the MDU was asked to support more than 2,200 members with written queries relating in some way to coroners' inquests or fatal accident inquiries.
While inquests are fairly common, a request from a coroner can 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 the production of a statement to appearance at an inquest.
Some doctors will submit a statement and not be required to attend the inquest in person, while others will receive a summons to attend as a witness. 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.
Pros and cons
A common question for doctors asked to attend an inquest is whether it would be advisable to have legal representation.
For the vast majority of doctors, legal representation at an inquest is not required. Although the inquest relates to a patient who has died there is usually no criticism of the doctor's clinical care.
However, the coroner and the deceased's family may have questions about the circumstances of the death and it can be unnerving to answer questions in a court setting. Thankfully most doctors are experienced in explaining medical care to their patients. If asked to do so, you should answer questions honestly and clearly, avoiding jargon.
If you have legal representation, your representative would not be allowed to answer any questions on your behalf. Unless you have been named as an interested party, your legal representative wouldn't be allowed to ask questions of the witnesses.
While it may be reassuring to have a friend or colleague present for support, it can appear overly defensive to attend with a solicitor and might make the doctor more prominent at the inquest than they need be.
However, there are some circumstances where being supported by a solicitor is advisable.
When advising members attending inquests, the things we consider include:
- whether there is there any known or anticipated criticism of the care provided by the doctor, either from the coroner or family
- whether the family or other parties are to be legally represented
- whether the doctor has been named as an 'interested party' by the coroner
- inquests in special circumstances, such as detained patients, or when the coroner sits with a jury.
The coroner has a wide scope to name interested parties. These would automatically include family members, but the coroner can also name a person as an interested party if there is the possibility that by act or omission they may have caused or contributed to the person's death. Interested parties have more involvement in the process and they, or their legal representatives, can ask questions of other witnesses.
Because of our extensive experience supporting members with this type of enquiry, the MDU does not underestimate the emotional impact that an inquest can have on a doctor. In the current climate many doctors are understandably worried about claims and complaints following the death of a patient. As insightful professionals, doctors may also look back at the care provided with the benefit of hindsight and question their actions at the time - it is easy to make different decisions in retrospect.
We must also be mindful of the requirement of paragraph 75a of the GMC's guidance in 'Good medical practice', which requires doctors to advise the GMC if they have been criticised by the coroner.
It may therefore be reassuring for members to know that in a recent audit on MDU inquest files in 2013 and 2014 that had a solicitor instructed, fewer than 1% were associated with any form of criminal investigation. Likewise, fewer than 1% of those members who required legal representation were criticised by the coroner to the extent that they needed to inform the GMC.
Claims were initiated by the estate in approximately 14% of cases while a complaint was raised with the GMC in 8%. Given that these were inquest cases where legal representation had been thought prudent, the statistics for all inquest cases in total are likely to be even lower.
Involvement in an inquest can be very worrying, but we are here to assist MDU members through the process. Members can contact us at any stage, but you may like to consider doing so at an early stage as we can often advise on the preparation of a written statement.
A well-considered, clear statement which addresses many possible questions in advance can reduce the likelihood of a member being invited to attend the inquest at all, and make the giving of evidence more straightforward if this is required.