Inquests can be tough on doctors. In our modern technological world, where there is an unreaslistic expectation that doctors can overcome most ills, there is belief that doctors will prolong and preserve all human life, if they act correctly. Regrettably, some grieving families and bereaved spouses find it difficult to accept that their loved one has died a natural death and instead seek to blame doctors and other clinical staff for not doing enough. Many families look to blame doctors for the ‘premature’ or unexpected death of their loved one.
Where a death is not easily explained (at least in layman’s terms) criticism of the treating or responsible doctors is likely to follow. “Surely they would have lived longer if the doctor had acted promptly,” is an accusation often made against doctors, by grieving family members. Sometimes such allegations are made in more pejorative terms by local newspapers who get tipped off by families about the “cover ups” they fear are occurring. Coroners have a duty to investigate deaths that appear unnatural, or where the deceased met a violent death, or where the cause of death is otherwise unknown. A Coroner must hold an inquest in such circumstances.
Many doctors are called to give evidence at inquests and many find it a gruelling experience. Doctors are entitled to representation at inquests, if they are deemed to be an interested party. Many doctors, when giving evidence, find themselves responding to allegations that they have neglected a patient, or caused or contributed to a patient’s death through an inappropriate act or omission. A doctor is obliged to answer all reasonable questions, except where they might self-incriminate – an individual is not required under English and Welsh law to make admissions that could constitute an admission to a criminal offence.
Being well-prepared for an inquest is to a doctor’s advantage. A doctor should make sure that they have read the patient notes thoroughly before attending an inquest to give evidence. Many families will instruct experienced barristers to represent them at inquests and doctors attending as witnesses should consider having the support of a barrister themselves, to ensure “equality of arms” during the inquisitorial proceedings. It may be the case that due to grief a family automatically blames a doctor for the death of a relative, where there is little or no basis to make such a claim. However, most families have legitimate concerns about acts and omissions that have contributed to the early demise of their relative.
To Challenge judicial remarks that are not central to the verdict a doctor can apply to the High Court for permission to bring judicial review proceedings, and asking the court to quash the unlawful remarks made by the coroner. For more details on this subject, see our article: How to Challenge a Coroner’s Unlawful Remarks
(Note: Within coronial law a person can be found to have caused or contributed to the deceased’s death, even when the person’s contribution is not the main cause of death. All that is needed is proof that the causation or contribution to death was more than minimal or trivial or de minimus. This is separate from unfair or unlawful criticism which is open to challenge, and on some occasions there may be outright unfair and unlawful criticism of doctors that must be challenged.)
In law, a Coroner must answer four questions when recording a verdict (now referred to as a conclusion) and completing the coronial Inquisition Form: (1) the name of the deceased; (2) when the deceased met their death; (3) where the deceased met their death; and (4) how and in what circumstances the deceased met their death. It is the fourth question that is the most complicated to answer and which takes up most of the coronial court time. Many families will obtain expert evidence or ask that the Coroner does. A doctor who is called to give evidence would be wise to obtain their own independent expert report to be adduced at an inquest, where the Coroner or another interested party has obtained one. Medical and surgical approaches can be varied and a doctor may need to prove that their act or omission fell within a reasonable body of opinion. A finding that a doctor has caused or contributed to death or that a doctor has neglected a patient can have very serious ramifications for a doctor’s reputation. Such a verdict may also increase the likelihood that there will be a civil claim in tort or under the Fatal Accidents Acts for damages (compensation). On occasions Coroners will sit with a jury. Juries assist coroners by returning a verdict, after hearing the evidence. Jury members may ask questions themselves. Bereaved families are likely to receive State funding for legal representation where a Coroner sits with a jury and doctors would be wise to have representation of their own at such inquests. Many families also pay privately for representation. Doctors who are not represented may fail to put all of their case forward and DDS would recommend that doctors have legal representation at inquests, in order to ensure that their case is properly put.
There will be occasions where the criticism made by a coroner is unjust or unfounded such that it is unlawful and open to challenge. There will be a good reason to challenge a coroner’s judicial comments on occasions, because a doctor who is criticised by a coroner has a duty under the GMC Code of Conduct to self-report to the GMC. The Code of Conduct, Good Medical Practice, (Paragraph 75) states:
75: You must tell us without delay if, anywhere in the world:
1. … you have … been criticised by an official inquiry.
A coroner can also publish recommendations about a doctor, to prevent the risk of future deaths. To avoid such a publication, a doctor must take active steps to show that they have undertaken remediation and shown insight into the areas of concern. See our article: Doctors, Inquests and the Prevention of Future Deaths
Case Study: A GP Practice was found to have contributed to the death of an adult asthmatic for having not proactively done enough to control their client’s asthma symptoms. The GPs argued that the client had not attended for more prescriptions and had not attended the practice over a long period of time, so suggesting that she had low level or no symptoms requiring GP input. The GP practice’s paperwork showed a variable and inadequate response by the GPs to historic asthmatic episodes and no follow-up when the client failed to attend an appointment. The Coroner, sitting without a jury, found that the GPS on the balance of probabilities had contributed to the death of the client. The deceased’s family thereafter sought to sue the GP Practice for compensation after the inquest verdict was recorded.
Doctors Defence Service lawyers represent doctors at inquests and can advise doctors on the steps that need to be taken in preparation for an inquest. Medical notes and investigations reports, as well as statements, may need to be obtained and compiled into hearing bundles, with an index. Doctors Defence Service lawyers can undertake preparatory work in order to assist a doctor to put their historic contact with the patient or client in proper context.
If you would like to speak to a Doctors Defence Service lawyer in confidence and without obligation about an inquest or matter related to a patient’s death, call us on 0800 10 88 739
How to Challenge a Coroner’s Unlawful Remarks
Inquest Case Law
Inquests and the Prevention of Early Deaths – A Doctor’s Duty to Remediate
Doctor’s Mandatory Duty to Inform Coroner of Deaths