Death Certification, and the Coroner Pam Martin David Snead September 2007

Death Certification 1a immediate cause(s) of death 1b disease or condition(s) leading to 1a 1c disease or condition(s) leading to 1b 2 Other diseases present not directly related to the cause of death If doubt discuss with coroners officer or colleague

Notifiable Diseases Acute encephalitis Acute poliomyelitis Anthrax Cholera Diphtheria Dysentery Food poisoning Leptospirosis Malaria Measles Meningitis meningococcal pneumococcal haemophilus influenzae viral other specified unspecified Meningococcal septicaemia (without meningitis) Mumps Ophthalmia neonatorum Paratyphoid fever Plague Rabies Relapsing fever Rubella Scarlet fever Smallpox Tetanus Tuberculosis Typhoid fever Typhus fever Viral haemorrhagic fever Viral hepatitis Hepatitis A Hepatitis B Hepatitis C other Whooping cough Yellow fever Leprosy is also notifiable, but to the Director, CDSC Notify the Public Health Officer

Coroner Is an ancient and powerful legal office Appointed by the Crown Investigates unnatural deaths Holds inquests Establishes the facts Who died Where they died How they died

Statements and reports for the coroner Brief Prompt Accurate Clear Typed signed and dated on headed paper DO NOT USE ABBREVIATIONS WITHOUT DEFINING THEM JTA, SOP,CFA, HTA, PDA, ROM

Giving evidence Speak up Use lay language Answer the questions clearly Restrict yourself to your area of expertise, and the facts as known to you

Autopsies Coroner (consent not required) Registrar or procurator fiscal (consent not required) Medical practitioner (Hospital request autopsies – consent required)

Requesting hospital autopsies Brief clinical summary Consent relatives fully Be confident they know what will happen Be clear what the purpose is Be clear of time scale Be clear on tissue retention »Routine histology »Teaching »Research Offer debrief on findings Attend to see findings and discuss case

Consent Give the relatives have time to reflect before they decide. Make sure the person giving consent is the correct person a)spouse or partner (including civil or same sex partner 3 ) –3 Section 54 (9) states for these purposes a person is another persons partner if the two of them (whether of different sexes or the same sex) live as partners in an enduring family relationship. b)parent or child (in this context a ‘child’ can be any age) c)brother or sister d)grandparent or grandchild e)niece or nephew f)stepfather or stepmother g)half-brother or half-sister h)friend of long standing. Review the HTA code of practice on consent (

Case 1 A patient is admitted to hospital with a chest infection, which over the next few days develops into pneumonia and they subsequently die. Whilst taking care of this patient, the family inform you that on the day of admission the patient had fallen although they had not hurt themselves, do you report this to H M Coroner?

Case 1 Cont. Death certificate issued Request made for hospital autopsy Pathologist informs coroner of head injury Asked to proceed with Hospital Autopsy

Case 1 cont

Case 2 Elderly women admitted as emergency with breathing difficulties History COPD Initially though to have a chest infection Collapsed and dies suddenly Possibility of cardiac cause considered Cause of death not definite, and the team refer the case to coroner for PM.

Case 2 outcome Corner’s officer speaks to GP Case written up as –1a Chest infection –1b COPD –2 Hypertension

Case3 A doctor issues a cause of death certificate the day before going on holiday abroad. The patient had been admitted as an emergency and was only seen by 2 doctors and only 1 documented their name into the patient case notes. The death was registered and the funeral arranged which was to be a cremation. Nobody traceable to fill in Cremation form. Funeral cancelled. Think ahead when planning leave, and avoid if possible signing death certificates the day before you leave the country.

Case 4 Elderly man dies of peritoneal mesothelioma Should this be referred to the coroner? Yes Linked to asbestos exposure Case needs inquest and is compensatable

Case 5 46 yr old man arrested for armed robbery Long history of non-hodgkins lymphoma Diagnosed on node biopsy 8 months previously Nodule noted in arm pit Duty doctor informed Widespread lymphadenopathy Admitted Dies 2 weeks later of chest infection Refer to coroner?