Posted by Ali Cloak, Partner
What you need to know about the new medical examiners helping bereaved families
From April 2019, a new system of medical examiners will be rolled out in medical settings to provide scrutiny and better recording of deaths across the country. A pilot scheme with medical examiners has taken place since 2008 so many hospitals, medical professionals or families may have already come across them.
The below was written as the new medical examiner system was due to be rolled out in April 2019 but it has since been announced that this has been delayed until 2020. You may still have a medical examiner in your Trust if it is a part of the pilot programme or your Trust has decided to implement the system at an earlier date than the national rollout.
A medical examiner is a medical professional – normally a consultant or senior doctor, or a GP – who is appointed to verify the death certificate and cause of death of any person that has died in their allocated hospital or Trust.
Under the new system, a death would not be able to be registered with the Registrar unless the cause of death has been reviewed by either a medical examiner or a coroner.
Some concern has been raised that medical examiners will be employed by the NHS Trust where they work as opposed to what was contemplated in the Coroners and Justice Act 2009, which suggested that they should be employed by the local authority (as coroners are) to add a greater level of independence to the role.
This concern has attempted to be addressed by ensuring that the medical examiner will report to someone in an external NHS structure, in other words, outside of the Trust they work in. However, both their actual and perceived independence will be an important factor in ensuring that families feel that their concerns about treatment or a loved one’s cause of death is taken seriously and is being appropriately investigated.
The requirement to have a medical examiner is not yet mandatory and so we will have to wait and see how many Trusts are able to appoint and fund an examiner.
Why the change?
This new role has been introduced to try and better analyse and record deaths, particularly in the light of some large-scale failings in medical care such as the Harold Shipman case and deaths that occurred at the Gosport War Memorial Hospital, where greater scrutiny may have led to investigating the pattern of deaths sooner.
The change is intended to ensure that death certificates are more accurate. Often death certificates can be completed incorrectly meaning that when they are sent to the Registrar to record the death, they can be returned which can cause delays to families as a funeral or cremation cannot take place before the death is registered.
The medical examiners are also meant to speak with bereaved families and discuss the cause of death. This could be beneficial for families as could allow them to ask questions at an early stage where they may have concerns about their loved one’s death or medical treatment.
Medical examiners will also be responsible for referring cases to the local coroner where they feel the coroner may wish to hold an inquest into the death. Medical examiners therefore could provide families with a point of contact and an opportunity to suggest that a , death be referred to the coroner and an inquest held where they have concerns about how their loved one died.
Will it affect whether there is an inquest?
The medical examiner system is meant to add an additional level of scrutiny to deaths and is not intended to take over any of a coroner’s role or duties.
The intention is that the medical examiner will review death certificates and consider additional cases that may need to be referred to the coroner for an inquest. It is hoped that the medical examiner will have a greater knowledge of which cases to refer compared to junior doctors or treating physicians who currently have this responsibility, yet are often unsure whether or not to refer to a coroner. It is envisioned that further regulations will clarify and provide more detail to medical professionals for when a death should be referred to the coroner and it is thought that the number of deaths being referred is likely to increase.
Once the case is referred to the coroner, he or she will decide whether or not to order a post mortem and whether an inquest needs to be held.
Overall, it appears that the medical examiner system could be a positive step for scrutinising deaths that occur in a medical setting and ensuring that those deaths that need further investigation are referred to a coroner. However, much will depend on the effectiveness of the system when it is implemented and we will be keeping our eyes open to see whether they fulfill the role as expected.
If you have any questions for our specialist fatal claims & inquests team, please contact us today.
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