Further to my last update regarding inquests, the Chief Coroner for England and Wales has issued further guidance in relation to the COVID-19 situation. This article summarises the main points from the guidance.
Chief Coroner Guidance No.34 (dated 26 March 2020)
This guidance note acknowledges that the COVID-19 emergency presents a number of challenges for coroners.
In light of the pandemic, the Chief Coroner’s position is that no physical hearing should take place unless it is urgent and essential business and that it is safe for those involved for the hearing to take place. Hearings which must continue should be those considered essential business.
Coroners are reminded that such hearings must in law take place in public and therefore coroners should conduct telephone hearings from a court, not their homes or their office.
When dealing with medical professionals in their work generally (including matters of evidence in inquests generally), coroners should recognise their primary clinical commitments, especially at times of high pressure on health services. This also applies to pathologists who will be under significant pressure as well. This may mean avoiding or deferring requests for lengthy reports / statements and accommodating clinical commitments if calling clinicians as witnesses.
COVID-19 is a natural cause of death
In the guidance note, the Chief Coroner reminds coroners of the Ministry of Justice Guidance on the Notification of Deaths Regulations 2019, which provides: “A death is typically considered to be unnatural if it has not resulted entirely from a naturally occurring disease process running its natural course, where nothing else is implicated.” COVID-19 is a naturally occurring disease and is therefore capable of being a natural cause of death. There may of course be additional factors around the death which mean a report of death to the coroner is necessary – for example where the cause is not clear, or where there are other relevant factors.
The Chief Coroner supports NHS England and the Chief Medical Officer’s advice to medical practitioners in England, that:
- COVID-19 is an acceptable direct or underlying cause of death for the purposes of completing the Medical Certificate of Cause of Death (MCCD)
- COVID-19 as cause of death (or contributory cause) is not a reason on its own to refer a death to a coroner under the CJA 2009
- That COVID-19 is now a notifiable disease under the Health Protection (Notification) Regulations 2010 does not mean referral to a coroner is required by virtue of its notifiable status (the notification is to Public Health England), and there will often be no reason for deaths caused by this disease to be referred to a coroner;
- For registration: where next of kin/informant are following self-isolation procedures, the arrangement for relatives should be for an alternative informant who has not been in contact with the patient to collect the MCCD and deliver to the registrar for registration purposes. The provisions in the Coronavirus Act will enable this to be done electronically as directed by the Registrar General.
Medical Certificate of Cause of Death (MCCD)
The guidance addresses hospital death and community death scenarios.
In a hospital death scenario, establishing COVID-19 as cause of death and following the MCCD process is a relatively straightforward matter because of diagnosis and treatment in life.
In community deaths it may become more complex. This is because with the pandemic pressures, there may be insufficient capacity within the health service to diagnose COVID-19 as an illness in life and to produce an MCCD after death without any report to the coroner.
Once the clauses relating to death certification and cremation are commenced, the Coronavirus Act 2020 will expand the MCCD ‘window’ from 14 to 28 days and allows a doctor who was not the attending doctor to sign the MCCD (this will reduce the risk of the scenario above happening). However, there may remain a proportion of suspected COVID-19 deaths where report of death is likely to be made to the coroner because a doctor is unable to sign a MCCD.
Personal Protective Equipment (PPE)
With regards to PPE, the Chief Coroner has advised that the issue of PPE for those attending the scene of a community death or for mortuary staff and other related issues (such as the safe transport of the deceased) is not an issue the coroner should seek to manage or direct on their own. It is likely to be the product of an agreed multi-agency response for community deaths in a local area of which the coroner should play a full part.
Coroners should not issue their own local Guidance to the police, ambulance service, funeral directors or any other organisation in respect of PPE or infection control for attendance at community deaths. Instead, a collective multi-agency response, involving the senior coroner and following national guidance will be required to ensure that a consistent process for dealing with the detailed logistics of all deaths, but particularly community deaths during the COVID-19 emergency can be achieved.
The Chief Coroner Guidance No. 34 (dated 26 March 2020) can be accessed at the following link:
Chief Coroner Guidance No.35 – hearings during the pandemic (dated 27 March 2020)
The Chief Coroner guidance No.35 addresses hearings during the pandemic and reminds coroners that inquests and pre-inquest hearings must be held in public but that the only hearings that should be taking place in a coroner’s court during the pandemic emergency are those which are urgent and essential business.
The guidance states that inquest hearings must take place with the coroner physically present because ‘absent a coroner, it is not a court’. Although all parties who need to be present may do so by phone or any other link, the Chief Coroner’s guidance is that, as the law currently stands, a coroner should be present at the hearing and can therefore not be present by Skype or phone.
Guidance No. 35 (dated 27 March 2020) can be accessed at the following link:
Ultimately whether a hearing can continue or not, and in what form, is a matter for the senior coroner in terms of the jurisdiction as a whole, and the coroner dealing with the case, for that case.
The issues raised in the guidance will be kept under constant review by the Chief Coroner.