Whilst many Coroners publish local guidelines on the circumstances in which they expect a death to be reported, central guidance has been lacking which has led to uncertainty. Draft guidance has long been in circulation but help is now at hand in the shape of regulations with accompanying guidance published by the Ministry of Justice ‘Guidance for registered medical practitioners on Notification of Deaths Regulations 2019’. The Regulations themselves come into force on 1st October 2019.
When to notify a death?
The new Regulations impose a duty on registered medical practitioners to notify the relevant Senior Coroner of a death if one or more of the circumstances set out in Regulation 3(1) applies. In considering the applicability of Regulation 3 (1) the accompanying guidance is invaluable.
The list of circumstances requiring notification include where the medical practitioner ‘suspects’ that a death was due to (i.e. more than minimally/trivially caused or contributed to by) any of the following:
- Poisoning including by an otherwise benign substance – deaths due to chronic conditions e.g. alcoholism are not captured.
- Exposure to or contact with toxic substances - including radioactive material.
- Medicinal products, controlled drugs or psychoactive substances - e.g. deliberate or accidental intake of recreational drugs, including ‘legal highs’ or medications.
- Violence/trauma/injury - g. inflicted by someone else or sustained by the deceased.
- Self-harm - e.g. if reasonable to suspect the deceased died as a result of poisoning, trauma or injuries inflicted by him/herself.
- Neglect, including self-neglect – here the accompanying guidance importantly provides detail relevant to hospital inquests and explains that: “This also includes a death, albeit from natural causes, where it is reasonable to suspect that the death results from some human failure, including any acts/omissions”. This is likely to be one of the most difficult categories in the regulations for medical practitioners to consider as it relates to a judgement about the care provided.
- Undergoing any treatment or procedure of a medical or similar nature - g. encompassing surgical, nursing, diagnostic, investigatory or therapeutic procedures where the medical practitioner has considered and believes there is some relationship between the treatment/care and the death. Some helpful examples emerge from the guidance and it is clear this subsection is intended to cover a recognised complication of treatment or treatment errors such as a delayed diagnosis or mediation error.
- Injury/disease attributable to the deceased’s employment - e.g. construction worker dies of mesothelioma.
- Other unnatural death – this provision mops up other deaths not due to a ‘natural’ cause not falling into the proceeding categories e.g. mesothelioma contracted by washing a partner’s overalls.
- Cause of death unknown - where the attending medical practitioner is unable to determine the cause of death despite suitable consultation with colleagues or a medical examiner.
- Person died in custody/’state detention’ – e.g. where the deceased was detained under the Mental Health Act at the time of their death. The guidance helpfully makes it clear that the fact someone died whilst subject to a Deprivation of Liberty Authorisation does not require notification under this category.
- No attending registered medical practitioner to sign a MCCD
- Identity of deceased unknown
How to notify?
The Regulations list the information that needs to be provided to the Senior Coroner by the medical practitioner which should include the applicable circumstance/s as set out in the Regulations that explain the need to notify. Such notification should be in writing save in exceptional circumstances e.g. IT infrastructure failure.
What is the significance?
It is to be hoped that the current uncertainties relating to when a death should be notified will be consigned to history. However, there is a shared concern with the imposition of a legal duty to notify relevant deaths, and whilst medical practitioners become used to the new Regulations, there may be a short-lived increase in the number of deaths notified. This is to perhaps particularly be expected as a failure to notify a death, which falls within the Regulations, may have repercussions for medical practitioners, such as being reported to their professional body. It will also be interesting to see how the New Medical Examiner systems will work alongside the Regulations. Time will tell.
In the meantime, if training on the Regulations would be helpful please contact our national inquest team and we will be happy to help.