GP INVOLVEMENT IN
Most GPs will be called upon to produce at least one written report for a coroner during their professional career and may even be called as a witness if the coroner decides an inquest is required
Dr Catriona James advises on procedure
Nearly 211,000 deaths were reported to coroners in England and Wales in 2003 a rise of nearly 10,000 on figures for the previous four years1. Inquests were held into just under 13 per cent of these deaths, which is consistent with previous years.
Last year the MDU opened 342 new case files related to coroner's courts or inquests and its 24-hour medicolegal advice line took nearly three calls a day from doctors with questions about coroner's inquiries and inquests. In February, the Department for Constitutional Affairs announced that the coronial system would be reviewed2. A coroner's reform bill will be published next month and new criteria for deaths to be reported to and investigated by coroners are expected.
In the meantime, the MDU has produced a new booklet setting out the basics of good practice when writing a coroner's report or appearing as a witness. Here, we summarise that advice.
Writing a report for the coroner
Writing a good coroner's report requires skills that differ substantially from those needed to produce a good report for clinical purposes.
·The report should be a detailed factual account based on the medical records and your knowledge of the deceased. It should be typed on headed paper where possible.
·You should identify yourself with your full name and professional medical qualifications written in full, eg Bachelor of Medicine rather than MB. Describe your status GP registrar or GP principal for 10 years.
·Specify the nature of your contact with the patient: for instance if you saw the patient on the NHS (or privately) for clinical, or forensic purposes, or a combination of reasons. State if you saw the patient alone or accompanied by another person and give the name and status of the other person.
·The report should be capable of standing on its own. Do not assume the reader has any background knowledge of the case or medical training. Several people may have to read the report apart from the coroner.
·Give a factual chronology of events as you saw them, referring to the clinical notes whenever you can. Describe each and every relevant consultation or telephone contact in turn and include your working diagnosis or your differential diagnoses.
·Avoid jargon or medical abbreviations.
·Specify which details of your account are based on memory, contemporaneous notes you or others wrote, and 'usual' or 'normal' practice.
·Say not only what you found but also what you looked for and failed to find.
·Be aware of the GMC guidance in Good Medical Practice that doctors must be honest and trustworthy when writing reports and must take reasonable steps to verify any statement before signing documents. It adds: 'You must not write or sign documents which are false or misleading because they omit relevant information.'
If the report at the outset clearly demonstrates your history and examination were thorough, you are less likely to be called to have your evidence tested at an inquest.
An inquest is a fact-finding inquiry and not a trial. It is held by the coroner when he decides that a death may not be due to natural causes. The coroner usually sits alone but in some circumstances the case is heard before a jury. The role of an inquest is to determine the answers to four questions: who was the deceased, and how, when and where did the death come about?
In most cases where GPs are called to give evidence, legal representation is not necessary. But where there may be some criticism of your medical care you should discuss the case with your defence body.
Prepare for the inquest by re-reading your report and the records and take a copy of your report with you. Giving evidence may be a stressful experience but try to follow these guidelines:
·Listen to the question carefully and keep your responses short, clear and honest.
·If the question is unclear, do not hesitate to ask for clarification.
·Don't be afraid to say that you do not know the answer. Ask to refer to the records if you need to.
·Avoid medical jargon if at all possible; the inquest is an opportunity to provide the family of the deceased with a clear, factual account of the care and treatment given to their relative.
·Sometimes the questioning may seem to be repetitive, but you are expected to respond to each question and to retain a professional composure
A coroner will summarise and record findings and conclusions. A wide range of verdicts can be delivered, such as natural causes and death by accident or misadventure. In addition the words 'and the cause of death was aggravated by neglect/lack of care' can be added. This could include instances where there is a finding that inadequate medical care was provided.
These terms do not equate to a finding of negligence as the Coroners Rules 1984 state that no verdict should be framed in such a way as to appear to determine the criminal or civil liability of an individual.
Producing a statement and giving evidence at an inquest is usually straightforward, but you should seek advice from your defence body if you have any concerns.
The MDU's new guide contains a section dealing specifically with fatal accident inquiries and the role of the Procurator Fiscal in Scotland. The coronial system in Northern Ireland is a separate legal jurisdiction. The principles of writing a good report and giving evidence at an inquiry however, are equally applicable to all UK GPs.
The MDU's new guide to coroner's inquiries is available free to members from www.the-mdu.com or by contacting 020 7202 1500.
Catriona James is an MDU medicolegal adviser
I am due to go on holiday in three weeks, but have been asked to attend an inquest during the period I will be abroad. Can the coroner compel me to attend?
Yes. The coroner has power to compel the attendance of witnesses under pain of fine or imprisonment for contempt. Depending on how crucial your evidence is, or how central to the case, the coroner may well look sympathetically at receiving your evidence simply in the form of a statement. Alternatively, he may consider postponing the inquest. He has the authority to compel you to attend, regardless of any inconvenience, but this is