Interacting with the Coroner (5 Dec 2024)

SPEAKER_01 0:14

Welcome to Consultant Conversations by the recently appointed Consultants Committee of the Royal College of Physicians of Edinburgh. I am Kevin Conroy. I'm a recently appointed Consultants Committee member, and I'm a general and respiratory medicine consultant at the University Hospitals of North Tees and Hartlepool. I'm joined by my colleague Dr. Katie Elmer, who is not only a respiratory and general medicine consultant, but is also a medical examiner and has provided me with a lot of fantastic support and insight in my interactions with the coroner, both providing a written witness statement and attending in person to an inquest, both of which were interesting but fairly daunting experiences to have as a new consultant. I'm grateful for Katie for joining me today. Today we're going to be talking about interactions with the coroner or the procurator fiscal. So, Katie, I'm really grateful for the help that you've provided to me over the years that I've been a consultant in what can actually be quite a daunting process. As we've said many a time, having that first message that you've got to provide a witness statement to the coroner, or indeed that first time they get called in person as a witness can be pretty daunting to say the least. And I'm very grateful for the help that you've provided to me over the years. Even just handling and slowing down that new and inexperienced consultant to tell them, actually, this doesn't mean you've done anything wrong. This just means some more information might be required. Or even it's got nothing to do at all with what you've done, and it's an industrial cause of death that the coroner's opened an inquest for. I was hoping to see if we could share your expertise with the wider consultants group out there that hopefully are tuning in regularly to these podcasts that we're doing. A few questions then, Kate, if you don't mind, just as a start of 10. Could you just tell us what is the coroner? What's their role? Who are they?

SPEAKER_00 2:16

I am very happy to share what knowledge I've got and what experience I've got. And I think you're absolutely right. The first time it happens and you're asked to either give a statement or attend, it can be quite a stressful and scary experience. So having some knowledge beforehand is a good idea. So to your first question, what is the coroner? So the coroner is someone who investigates causes and circumstances of death. So there are certain situations where a death has to be investigated, and that's done via the coroner's court. So overall, I would say it's if there is an unnatural or violent death. So the violent death is straightforward. A death secondary to violence needs to be investigated, and that's done initially by the coroner, or indeed sometimes by the police as well. Then we also have an unnatural death, and that's actually a more broad category. So any unnatural death, as you said before, could be occupational related. So it could be due to exposures, or it could be due to an accident. Maybe sometimes an accident that happens 20 years or 30 years or in childhood. So for instance, a road traffic accident that leads to a paraplegia, and that paraplegia is related to your death, would then still be an unnatural death many, many years later. So that one is a fairly straightforward one. You then have deaths to do with alcohol or substance misuse. Neglect can be part of that. Neglect tends to not be specifically all by itself, but it contributes to a patient who has other conditions, maybe. And then I guess if you carry on with that, there's a whole other group of deaths that always have to be investigated if a death occurs in custody. So custody would include involved with the police, prison service.

SPEAKER_01 4:04

What actually is an inquest? We know what the coroner is. What is the inquest precisely?

SPEAKER_00 4:10

The inquest procedure, they often break it down to four questions. And you can understand why we would be involved. Who? So they'd have to confirm the person, how a person died, when they died, and then the most important question, and the one we tend to answer, is why they died. And that's often why further information is needed from the medical team. It's not about blame, but it is inquisitorial. So they will be questioning and trying to seek the answers to those questions.

SPEAKER_01 4:40

You said it's inquisitorial and it's about establishing why that person's died, but is there any legal power that the coroner has?

SPEAKER_00 4:48

It's a court, and so the inquest process is a judicial one. So there's not a jury there, there's the coroner and the family members usually and anyone who's giving evidence, but it's a judicial process. So the coroner has the right to call you to coroner's court or to call you for a statement, and you are obliged to give that statement and attend as necessary if they wish you to do so. And they do have the right to summons you and they do have the right to imprison you if you refuse to do so. They very, very rarely do that. But they do have that right.

SPEAKER_01 5:23

Okay. Do they have any powers to compel something to change after the inquest or anything like that?

SPEAKER_00 5:30

Yeah, so they do. So depending on the outcome of the inquest, they'll give various results if they feel that there is something that needs to change, and in your statement and explanation, that change has not already been put in place, or there's maybe barriers for that change to be put in place, then they can issue section 28. And I know that the Scottish procurator fiscal can also do that as well. They can enforce it. And for instance, in the acute setting, because I am a hospital doctor, they can issue that enforcement, and the hospital trust is obliged to respond.

SPEAKER_01 6:05

Right. I already feel myself getting nervous just thinking about all of this. My heart goes out to anyone who's having to deal with writing a statement for the first time. But my hope is that the rest of this podcast will give you the power to focus your mind, calm your nerves, and come out with a good witness statement. I guess the first question, just to nip this in the bud, Katie, if we could. Do I need to tell the GMC if I've been called as a witness?

SPEAKER_00 6:32

So the answer to that is no. You don't need to call the GMC. The investigation of someone's death is exploring things. It's not you on trial, it's you representing as the senior member of the medical team. The situation and the trust. So the GMC encourages you strongly to be involved in this process. And it's part of your duty as a doctor to do so. But you don't need to inform them, and there isn't a necessity to do that just because you've been called as a witness or to give a statement. If as an outcome of the investigation there is a concern about a specific thing that you personally may have done, then at that point you should inform the DMC. But that's a very, very rare outcome of this type of investigation.

SPEAKER_01 7:24

Okay, so I don't have to tell them unless I'm specifically criticized during the inquest, but I do have a legal obligation to execute my involvement. So if I'm called as a witness, I have to be part of that. And I also have a duty as a doctor to do that. Remembering all those years ago, the first time I was asked to write a witness statement, where do I start?

SPEAKER_00 7:48

Well, this is the important bit. The way you write the statement and how much you include in the statement affects the quality of that statement, the understanding of the participants, and actually affects things like whether you'll be called to speak as well. So the statement needs to be an overview of the care of that patient and the issues. When the coroner first asks for statements, it's usually just one from the supervising consultant, whether that be a newly appointed junior consultant or someone who's been there for a while. So what you would then do is review the case. The majority will be taken from the documentation. You'll often find that statements are about deaths that may have happened over a year ago. So your recollection will be hazy. So you should try and base the majority of this statement on your factual knowledge that you've taken from the documentation. You may have some recollection, but you must ensure that you state that that's from your memory because the way we remember things can change quite a lot. So the statement is in review of the care. You have to remember that that statement is being given to the coroner who's not medically trained. No coroners now in England, I'm not sure about Scotland, but none in England now are appointed from a medical educational background. They're nearly all from lawyers and solicitors' backgrounds or police backgrounds. There are maybe a few still in service, but it's now all from that different perspective. So they do not know medical jargon and they may not understand. So when you make the statement, you need to be clear and concise. You need to be descriptive. There needs to be as little opinion-based or speculation as possible. There will be occasions where you'll need to use medical terminology or jargon. And if you do so, you should clearly explain what that means. And then you should include names, I'm afraid, of particular people's involvements if that's relevant. Because it may be that the coroner would wish to call them for further information later. So if there is something quite relevant, then you might need to do that. What I would say is you write it out and you read it through, you can then discuss it with a colleague, and you can discuss it with the support service in the hospital. But essentially, the more information you put in it, the clearer you answer the questions. The better that statement will be, the better the statement is, the less likely you will be called to speak. If you are called to speak, if the statements will be clear and concise, you may just be asked to read that statement, and there may be only just a few specific questions that they'll ask you if you've already done most of it.

SPEAKER_01 10:23

The other thing that was helpful for me was obviously having the chance to speak to experienced consultants like yourself. Apart from the things you've said, is there any like a template or anything that we could use?

SPEAKER_00 10:35

So it will be different from trust to trust, but the majority of trusts have a coroner's liaison who will be the person who passes on the need for the statement to you. And they will introduce themselves to you. They will let you know what the questions are because the coroner, when they request statements, will request either an overview or request very specific areas that they want answers to. So they will share that with you. The coroners also give a bundle, so they'll give other information that they've got that will be available to you. So most trusts have a pro forma that you would then fill in that's quite clear and you can go through it. They will also guide you as to exactly what you should say and how you say it. And then once you've completed it, they'll have a conversation with you again.

SPEAKER_01 11:24

That's really helpful. So just to summarise, most trusts have a pro forma that you can follow. You've always got New York colleagues to chatting. But the first thing I was going to say is, as you said earlier, being asked to provide a witness statement does not equate with wrongdoing. Inquests can be held for all kinds of reasons. It might have nothing to do with the care that you've provided. It might simply be because of a potential industrial cause or industrial-related cause to this person's death. And even on the times when something has gone wrong, it might not be you personally who's done anything wrong, and you're simply there as the senior consultant providing that overview of the care. Just to summarise further, take time, as you said, because it can take up quite a lot of time reading through the notes and writing the statement. Don't speculate. Use the notes, and if you're using any personal recollections or memories, make it clear that you're doing so. And also avoid medical jargon. I think that's much of what you said, isn't it?

SPEAKER_00 12:24

The other thing here is that you're writing a statement for them to try and work out what happened, why it happened. And if something went wrong in the care and that does happen, the statement is also to show what we thought went wrong and often what we've put in place to ensure that that doesn't happen again. So it's an answer to questions. Now, some of those questions might be if you have to attend, but if you've answered them in the statement, then you might not have to. Have to be aware that these statements are shared completely with the family. So they have a copy of your statement as well. So it's really, really important to have also had a view of the questions that the family might have and ensure that you've answered those questions very specifically.

SPEAKER_01 13:12

Okay, let's move up a notch. I've been summoned in person to an inquest. Again, this is the first time I've done it. Where do you start?

SPEAKER_00 13:23

Well, you will have already preferred it, hopefully, a really clear and concise statement. So I would say we looked down numbers here just to try and answer this a bit. Maybe about a third of the time that you're asked to produce a statement will you actually have to attend? So if you've provided one, you won't always have to go, but occasionally you will. Before you go, you will be met again by the liaison. If it's a complicated or difficult problem that's happened, then they'll also arrange for you to speak to the legal service that's linked to the hospital. So they'll either have a face-to-face or a team's conversation. They'll go through the statement with you. Now, if the trust doesn't think that's going to be a concern, then they may not offer that. But if you're really worried, you can request it and they'll arrange it regardless. And you can have a conversation with a legal representative and they can go through things with you. So it's really, really important for you to have gone through it all, to be happy with what you're saying, why you're saying it, and have those questions all available. So preparing is the most important thing. And the more you prepare, the more comfortable you will be. Having said that, it's still quite a distressing thing and it can be very scary. So you have to be aware that the liaison from the hospital will go with you and will stay with you the entire time. They will often have a break with you and support you through it, then they will often meet up with you afterwards to make sure that you are okay. So you'll have someone there who is there for you essentially, because they are not going to be talking or speaking at the court.

SPEAKER_01 14:59

Is it worth getting advice from Personal Indemnity Service?

SPEAKER_00 15:04

So you can do that. So the trust is there to support you and will support you. But you're right, if you feel unsure about the process or you want an external opinion, then we've all got legal representatives through our indemnity. So you can speak to them and they'd be happy to speak to you about it, and they can go through things with you and support you if you feel you need that. You won't always need that, but maybe the first time you want to have a chat with them, that's the way to do it.

SPEAKER_01 15:28

How do the legal, what can you expect when you get there?

SPEAKER_00 15:32

So it is a court and it's set out like a court. There isn't a jury, there is just the coroner. The coroner will direct the whole situation. They will ask you to either swear on the Bible or affirm. They usually then ask you just to read your statement out. In some cases, they'll read it out for you. Then they will have specific questions based on that statement, if they want you to elaborate or if they want you to say what's happened now, they will ask some specific questions, or they may not if they're happy with your statement. They will then ask the family if they have specific questions, which you should have an idea of beforehand, as does the coroner. And then the coroner will guide that process and keep the family on track. So if the family start to ask questions that are not relevant to the investigation, the coroner will ask them to not. So the coroner will guide that and won't allow you to be harangued in any way. Once the coroner's spoken and the family have had that questions answered, the only other people who could ask questions would be other people who attend. So, for instance, if there was an issue with a care home or the ambulance service, they can attend, but they are not allowed to ask questions unless they attend with legal representative. And then it's the legal representative that will ask the questions. And the coroner will invite them and uninvite them as necessary.

SPEAKER_01 17:00

Inquests are recorded. Can anything you say in the inquest be used as evidence elsewhere?

SPEAKER_00 17:06

Yes, it can. It's an open court, and so it is recorded, and that recording is available to all. Anyone can enter or attend or sit in a gallery of the court, including the press. So anything you say can be used as evidence. That would only be possible if the family brought a legal representative with them. So if they attended without a legal representative, that would not necessarily be the case. So you just have to share what's happened and your opinion of what's happened and answer the questions clearly. If you do not know the answer to a question, or it's outside your realm of experience to speculate on an answer, then you shouldn't answer that question.

SPEAKER_01 17:49

Just to summarise, a lot of the same points for writing the statement are true, aren't they? It's about using the notes, not speculating, avoiding jargon and trying to just provide your evidence or answer any particular questions. You could expect to get support from the liaison service within the trust and perhaps the trust solicitor. You can speak to your own medical protection society if you're part of one, and they can provide independent advice with you as the client rather than the trust as the client. Because I understand, you can correct me if I'm wrong, your interest and the trust interests usually align, but there is the potential that there could be a conflict of interest or things simply not quite aligning.

SPEAKER_00 18:30

Very rare, but potentially.

SPEAKER_01 18:33

And then the actual process, you would affirm or swear on a holy book, it would be recorded. You would read your statement into the evidence. You could be asked questions by the coroner, the family, or any other parties if they have legal representation. And then your evidence can be used as evidence in civil court. And also, because it's a public event, the press can attend if they think it's newsworthy and report on it. Is that right?

SPEAKER_00 19:04

That is correct. They can use your name as well. That's a quite scary element of it. The majority of these cases have no interest to the press at all. Sometimes they attend these just to see what's going on. But to be honest, they are so procedure-driven and the majority of them, the statements are already available. You're very aware if that's going to be a risk or not.

SPEAKER_01 19:27

Thank you very much, Katie. We're going to wrap up, but just to say the processes in England and Wales are very, very similar to the deal with the Procurator Fiscal. In Scotland, they're both inquisitorial processes. The main difference, as we were discussing earlier before the podcast, was that in England and Wales you have the medical examiner service, and in Scotland the doctors have to liaise directly with the procurator fiscal. I hope this is useful to someone out there. I'm really grateful for your time and for your support. Thank you, Dr. Elmer.

SPEAKER_00 19:58

You're very welcome.