The following case is fictitious but based on the types of calls we receive to the MDU advice line.

The scene

A 75-year-old patient of a GP practice had died at home. The death was expected and followed a period of palliative care and support from the community nursing team, as well as from the patient's regular carers.

The GP had been in attendance throughout and was well acquainted with the patient, who had paraplegia and had been largely bed bound, with recurrent bouts of pneumonia. The patient had made an informed decision, supported by his wife, not to be admitted for intravenous antibiotics, and had died peacefully at home.

The GP knew the cause of death and was willing to provide the medical certificate of cause of death (MCCD), proposing 1a bronchopneumonia, 1b immobility, 1c paraplegia. The GP notified the local medical examiner (ME) office accordingly and provided a summary of the recent medical records, as was usual practice.

Later that day, the medical examiner officer (MEO) called and asked for further medical records relating to the patient's paraplegia. The practice manager (PM) took the call but was concerned that the request was for medical information dating back over 25 years.

The attending GP was not on duty that afternoon, and the PM did not want to delay responding to the request, so she called the MDU.

The PM explained that the practice's usual procedure was to send a short summary of recent records to the ME Office. However, she was not sure about sending further information - and also asked if she should seek consent from the patient's wife.

MDU advice

The MDU adviser acknowledged that the medical examiner system is relatively new, explaining that medical examiners are senior doctors who conduct a proportionate and independent review of all deaths not referred to the coroner at the outset.

The MDU adviser clarified that the statutory medical examiner system will begin on 9 September 2024. From this date, the Access to Health Records Act 1990 will be amended to give medical examiners the statutory right to access the medical records of the deceased.

Until that date, NHS England have approval under Regulation 5 of the Health Service (Control of Patient Information) Regulations 2002 (commonly known as 'section 251 support') to process confidential information without consent for this purpose. The adviser reassured the PM that the information sought could be lawfully shared with the medical examiner without the need for consent.

Medical examiners provide support to bereaved relatives, allowing them the opportunity to discuss the cause of the death, ask questions and talk about any concerns. The MDU adviser suggested that it was therefore good practice for doctors involved in end-of-life care to explain the role of the ME to patients' relatives, and that they should expect the ME to make contact.

The MDU adviser explained that it was likely that the ME needed to further understand the cause of the paraplegia mentioned on the MCCD. If the paraplegia had resulted from an unnatural event (such as an injury or accident) and had contributed to the death, then the death should be referred to the coroner. This would remain the case no matter how long the intervening period between the event and the death.

The outcome

The PM was reassured that the request for further information was appropriate, and she shared the relevant parts of the record with the medical examiner. The medical examiner reviewed the records, discussed the death with the wife, and subsequently contacted the GP.

The medical examiner advised that the case be referred to the coroner, given that the paraplegia had been caused by a fall around twenty years ago. The PM also updated the practice policy about sharing records with the medical examiner office.