This case is fictitious but based on the types of advice line calls we receive.
A doctor in England called the MDU's advice line after receiving an expert report from the coroner, who was asking for further comment about the care provided by the practice. The doctor was concerned that the report of the expert who had been instructed by the coroner included implied criticism of his part in the care and of the practice in general.
The doctor had already submitted his report to the coroner some months earlier, and had recently learned from the practice manager that an invitation to a pre-inquest review (PIR) had been received by the practice but no-one had attended.
Speaking to the MDU's medico-legal adviser, the doctor explained the background. He had been a locum and had only seen the patient once. The patient was in his thirties and the doctor could see from the records that he had presented several times over a few years with a variety of non-specific symptoms. On each occasion the symptoms had resolved, sometimes after treatment with antibiotics. The patient was well in himself and reported that he was already improving. The doctor had suggested some screening blood tests.
The results of the screening blood tests were reviewed by one of the partners; they were normal and were filed with no action. The doctor heard no more about the case until several months later, when the practice manager forwarded a request from the coroner for a report, and the doctor learned that the patient had been admitted 10 days after his consultation and had died after a long hospital admission.
Concerned that this was an unexpected death of a young person, a pre-inquest review had already been held and there sounded to be implied criticism from the coroner's expert, the adviser suggested the doctor send the documents and relevant correspondence to the MDU for further consideration.
From these it was clear that the practice as an organisation had been made an 'interested person' by the coroner, who was seeking comment on practice policies - the doctor, in his role as a locum, was not in a position to comment on this.
The documents also showed that the coroner's expert was a laboratory specialist, not a GP. The patient's family had raised concerns in their letter to the coroner, mainly about hospital care but with questions for the practice. The two hospital trusts had been represented by their legal teams at the PIR.
The adviser recommended that the MDU organise for the doctor to be legally represented at the inquest because of the complexity of the case and criticism in the expert report and the concerns of the family. One of the MDU's solicitors obtained an independent expert report from a GP expert.
This report was supportive of the doctor's management and clearly explained the limitations of the resources available to general practice. The solicitor submitted this to the coroner, and liaised with the coroner's office to explain that the doctor had been a locum and could not answer for the practice on matters of policy, and that such questions should be addressed to the partners. She also arranged for the locum to be named separately as an 'interested person' and assisted him with a supplementary report.
The coroner decided to also call one of the GP partners as a witness. The MDU solicitor supported the locum doctor at the inquest, where there were separate legal teams for each hospital trust and for the GP partners. The MDU solicitor was able to ask questions of the coroner's expert and the GP partner, which helped to clarify the locum GP's role. In her determination, the coroner made no criticism of the locum GP.
The risks for doctors
The purpose of a coroner's inquiry or FAI is to establish the facts of the death, not to apportion blame. However, criticism may result from the process and doctors have an obligation to self-report to the GMC if they are criticised by a coroner.
How can the MDU help?
There is guidance on coroners' on inquiries on our website, including on writing a report and on attending an inquest. Doctors may well be confident to submit their reports without further advice, especially if they have previous experience, but we are always pleased to review members' draft reports if needed.
If a doctor might be vulnerable to criticism we would want to instruct legal representation for them, and in these cases we would like to be involved as early as possible. So how do you recognise a case where you should seek help?
If you are named as 'an interested person' you are entitled to legal representation, but it may not always be necessary or helpful.
We try to assess any vulnerability to criticism and we would take into account:
- whether there are other legal teams representing other practitioners or organisations
- whether the family have complained or are legally represented
- whether there is criticism of the care you provided (for example by the family, an expert or an independent investigation)
Other factors that suggest a more complex case include:
- a longer inquest scheduled for several days or weeks
- an unexpected death where a diagnosis had not been recognised
- the coroner arranges a pre-inquest review
- independent experts are involved
- a case where there is previous media involvement.
If a coroner ever suggests that a doctor should seek legal representation, we suggest you take that advice seriously and call the MDU.
Doctors working in hospital
For hospital doctors, the trust legal team will usually assist and support the whole team but the MDU still offers a first review of a draft report and general advice about the process. The trust legal team is instructed to represent the trust's interests and occasionally that may conflict with an individual doctors interests.
If you have been criticised by an internal investigation or you feel unsupported by the hospital team or if you are advised to seek separate legal advice by that team, call the MDU promptly.
For more member dilemmas and to find out how we helped, read this year's Cautionary Tales on the MDU website.