Guidance for registered medical practitioners on the Notification of Deaths Regs 2019
The government has now published regulations on the notification of deaths to HM Coroners. Hitherto, I was surprised to learn, there were only informal arrangements. Although little has changed from our custom and practice, based on the rubric in the books of Medical Certificates of Cause of Death (MCCD or “death certificate”) there are some new emphases. For example, even if a medical practitioner is aware that someone other than a medical practitioner has reported a death to the coroner, the registered medical practitioner should still make a notification under the regulations to make sure that all the right information is available. There is also reference to discussing cases with one of the new medical examiners (“where one is available” – there are none in Somerset for GPs to refer, yet) if a doctor has questions about the cause of death, or about completing the MCCD.
The list of situations where a death must be notified is familiar and largely self-evident, like violent deaths, deaths in any sort of custody, when the cause is unknown or those related to employment. The death of a patient subject to a Deprivation of Liberty Order per se does not need to be reported. The regulations go on to list poisoning but including by any substance normally harmless, like salt, smoking and alcohol (but only acute poisoning, not long term conditions caused by either), toxicity including that caused by radioactivity, and any medicinal product whether prescribed or illicit. If any psycho-active substance has caused death it must be notified and this now specifically includes “legal highs…designer drugs. Herbal highs, such a salvia.” Deaths due to neglect where the deceased was “in a dependent position” must be reported as must self-neglect. “However, this does not include circumstances where there has been a documented, reasonable and informed decision by the deceased not to act in a way that would have preserved their own life. This may include a decision not to take a certain course of treatment. There may be cases where people fail to take adequate nourishment or proper personal care due to the natural progression of an underlying illness, such as dementia. Although this may hasten their death, this death should not be notified to the coroner unless there was neglect by others.”
Self-neglect does not extend to lifestyle choices “for example, to smoke, eat excessively, or to have a chronic alcohol condition.
Deaths that “ may be related to surgical, diagnostic or therapeutic procedures and investigations, anaesthetics, nursing or any other kind of medical care” should be reported but, “It is only in circumstances where the medical practitioner believes that the death was due to this procedure that the death should be notified.” If “the original diagnosis of a disease or condition was delayed or erroneous, leading to either the death or the acceleration of the death” then that should be notified.
Paragraph 28 has caused some controversy with one commentator speculating that it cancels the “14 day rule” but I cannot agree. “Only an attending medical practitioner – a registered medical practitioner who attended the deceased during his/her last illness before his or her death – can complete an MCCD without reference to a senior coroner. Under the Registration of Births and Deaths Regulations 1987, any MCCD that has not been completed by an attending medical practitioner who has seen the deceased either in the 14 days prior to the date of death, or after death, must be reported to the coroner by the Registrar.” So the onus is on the Registrar to make the referral. I do not see how that helps as contact with the GP is bound to follow?
There is a section about the attending medical practitioner not being available to complete (it says “sign” as if someone else would fill it in!) within a “reasonable period” which not defined other than being “as soon as possible” and not exceeding the five days within which a death must be registered by law.
How the coroner is informed should normally be in writing but IT systems to help electronic transfer of information is expected with oral notification in “exceptional circumstances.” The information to be provided under the regulations is set out in the Somerset Electronic Death Referral Form.
