In this article...

• The Purpose of an Inquest
• Preparing for an Inquest
• The Inquest
• Juries
• The Verdict
• Conclusion

In 2005 a total of 29, 271 Inquests were held in England and Wales, representing 13% of all deaths. Doctors and nurses are frequently called to give evidence as part of the team caring for a patient that died in hospital and Trust Legal Services Managers will generally be called on to support them. This article aims to demystify the process for clinical staff.

The Purpose of an Inquest

The purpose of the Inquest is to ascertain the medical cause of death and the circumstances surrounding the death, in order to establish who the deceased was and when, where and how they came to their death. Under Rule 42 of the Coroner’s rules the verdict cannot ascribe civil or criminal liability to any individual, however recent events (the Shipman Inquiry, the introduction of the Human Rights Act) have encouraged Coroners to examine hospital systems and to criticise where failings have contributed to a death. In cases where a patient has died in hospital or whilst under the care of community health teams, the Coroner will wish to ascertain whether there were any opportunities to prevent the death which the state (the NHS) failed to address. Witnesses need to be thoroughly prepared for such detailed questioning.

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Preparing for an Inquest

Following a reportable hospital death, the Coroner will decide if statements are required from members of staff and may request these from the clinician, the Trust’s Legal Services Manager or ask his Officer to take a statement. If you are contacted directly by the Coroner’s Officer, ensure you tell the Trust’s Legal Services Manager, who can support you through the process.

Your NHS Trust will decide whether there are potential problems which require legal representation at the Inquest. In many cases clinicians may not be represented, or if they are, this may not be until after witness statements have been submitted to the Coroner. If you are drafting a statement without legal advice, it should be an honest, chronological account of your involvement in events and include details of your background and experience. You should refer to important entries in the medical records, but should stick to the facts and not comment on the actions of others involved.

A thorough statement that addresses all relevant issues, may avoid the need to give oral evidence at the Inquest. If the evidence is not questioned by the family or any other interested person or the Coroner considers the evidence to be peripheral to the central issues for the Inquest, your statement, may be admitted under Rule 37, which means that your statement is simply read out at the Inquest and there is no need for you to attend. In this situation, it is best not to attend the hearing as if the Coroner knows you are present he may ask for you to give evidence orally.

Having seen the statements the Coroner will decide who will give evidence at the Inquest. If summonsed to give evidence by the Coroner it is compulsory to attend. Failure to do so can result in contempt of court. It is daunting to be asked to give evidence and explaining the rationale behind care that you have given in good faith can be very stressful, but remember that the purpose of the Inquest is not to apportion blame.

If you are anxious, make sure that you talk to your Trust’s Legal Services Manager, especially if you are concerned about the care that was provided, so your Legal Manager can consider whether you require legal representation at the Inquest. Even if the Trust is not being represented, it is usual practice for a Trust representative to accompany witnesses and you can take a friend for support.

When preparing to give evidence, remember to re-read your statement so it is fresh in your mind and, if it will help you, flag up relevant passages in the medical records.

The Inquest

The Coroner’s Officer will advise you where to sit in the court. Coroners rarely have their own dedicated courts and you may give evidence around a boardroom table, or from the witness box of a Magistrate’s court.

The Coroner will usually hear evidence chronologically, starting with the GP and finishing with the witness who last saw the person alive. The pathologist is usually first or last.

The press are frequently in attendance. They can report anything that is said in court and it unwise to speak to them. The Trusts press officer or communication department will normally prepare a press statement and most journalists know who to contact at the Trust.

Giving evidence

Witnesses are asked to take the oath or affirm. You will then normally be invited to read through your statement after which the Coroner will ask questions. You should call the Coroner “Sir” or “Ma’am”. The Coroner will then invite questions from any other “interested person”. The deceased’s family or their legal representatives will ask questions first and the Trust’s legal representative, last. Questions should not be confrontational and the Coroner will refuse to allow questions which are bullying or seek to apportion blame. Where represented, the Trust’s solicitor will interject when questioning is inappropriate.

It is helpful to bear in mind the following about giving evidence: -

		Speak clearly and slowly.
		The Coroner will take hand-written notes, so watch him/her and check that he can keep up with you, if not, slow down or pause.
		Do not say more than is necessary to answer the question. If the answer is “yes” or “no” then that is enough.
		Flag up the relevant passages in the medical records.
		If you do not understand a question, say so.
		“I do not know” and “I cannot remember” are entirely appropriate responses, where that is the reality.
		If you think that someone else would be better placed to answer a question, say so.
		You are not required to answer any question that may incriminate you.

Juries

There are most commonly held where the Coroner has identified potential systems failures which contributed to the death and which, if they go unchecked, could put future patients at risk. Juries are also empanelled where a patient has died whilst detained under the Mental Health Act 1983.

Unlike criminal trials, jurors can also ask questions of witnesses. In complex medical cases, the circumstances can be hard for jurors to fully comprehend and you are advised to bear this in mind when answering jury questions and again seek clarification if you have not understood the question.

The Verdict

Short Form Verdicts Once all the evidence has been heard, the Coroner will summarise the circumstances surrounding the death and present his conclusions in open court. There is a range of verdicts available. The following are examples of short form verdicts:

		Natural causes (e.g. Myocardial Infarction, bronchopneumonia)
		Accidental Death / Misadventure (e.g. death resulting from complications of surgery)
		Suicide

Narrative Verdicts

Where hospital systems have been investigated and where problems have been discovered which may have contributed to the death, the Coroner will favour a narrative verdict which more fully describes the circumstances surrounding the death.

Neglect Rider

These days neglect is rarely returned as a verdict on its own and is more often a rider to another verdict where the Coroner finds that there has been a gross failure to provide basic medical attention which has a direct causal link to the death. This is an exacting test, but where there is a real possibility that the Coroner will make a finding of neglect, the Trust should instruct solicitors.

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Conclusion

Most Inquests are routine. The key to reducing the stress associated with an Inquest is preparation. Never feel awkward asking for support. Your Trust’s legal advisors should be available to answer your questions and it may be useful to speak to other doctors or nurses that have been involved in the process before. Consider visiting a court to watch another Inquest or attend a training session. At Bevan Brittan we offer an interactive seminar entitled “Doctors in Court” about giving evidence at Inquests and in civil and criminal courts. If you would like to attend, please e-mail us. There is also a DVD available to your Trust from Bevan Brittan which will show you a mock inquest in progress.