After someone has died, at a time when people are least able to deal with it, there is a requirement by law to complete a number of legal formalities. Before a funeral can be arranged or before any administrative details can be tackled by the next of kin, it is necessary to have a copy of the death certificate. Obtaining a death certificate would seem like a simple formality, but it hasn’t always been. All too often unnecessary delays and mistakes in the system have caused distress to the surviving next of kin, which could so easily have been avoided.
Changes to the system had been long over-due. A detailed audit of practice by Swift and West (2002) showed that the notification of the cause of death provided by doctors was very often not to the expected standard.
What this meant in practice was that cases which required further investigation were not always passed onto a coroner. The law requires that some deaths are referred to the coroner, who will then decide whether or not to investigate (for example if there is any possibility that the death should have been avoidable). The coroner's role is mainly to investigate deaths that are not entirely due to 'natural causes', where something may have gone wrong or where the death might have been prevented. Mistakes like this can sometimes have serious consequences, as apart from missing important information that can be learned from, it also meant that some cases of potential malpractice, or a neglect of duty of care, or a criminal activity, could have gone unnoticed.
Leicestershire has taken the initiative in addressing the shortfalls of the existing process of death certification and to pilot an improved procedure, which requires the involvement of a Medical Examiner. The Medical Examiner is a qualified hospital consultant who has not been involved with the care of the deceased before their death, whose role it is to identify any shortfalls in care delivery or irregularities with regards to the cause of death. It will be the responsibility of a Medical Examiner to examine all the deceased’s case notes, agree the cause of death, or if necessary, refer the case to a Coroner for further investigation. The Medical Examiner has been specifically trained for this, which ensures that all death certificates are completed more accurately, with the right detail and to the same high standard. The Medical Examiner will also be available to speak to the next of kin, so that any questions or concerns they raise can be addressed through an independent agent. In order to make sure that the NHS learns from patients and families' experiences of care, a medical examiner will also ask about the care the deceased has received, good or bad. Opinions can then be passed back to the doctors concerned so that lessons can be learned. The law does not give anyone the right to reject the doctor’s opinion on the cause of death, but the views of the bereaved are an important part of this process and the outcomes from any subsequent review by the practice can be shared with the next of kin. Following the success of the pilot programme in Leicester, the improved procedures will now be rolled out throughout England and should mean that the process of obtaining a death certificate can be handled with much greater sensitivity and consideration for the next of kin. For more information about the role of a Medical Examiner and of a Coroner, visit the 'after loss' page on this website.
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