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The Coroner's Court and the Psychiatrist

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The Coroner's Court and the Psychiatrist Calthorpe & Choong Advances in Psychiatric Treatment (2004), vol. 10, 146–152 The coroner’s court and the psychiatrist Bill Calthorpe & Steve Choong Abstract In psychiatry we are perhaps fortunate that the death of our patients is not such a regular occurrence as for our colleagues in other specialties or in primary care. However, when death does occur it is more likely to result from some unnatural cause such as suicide. Consequently, the prospect of being involved in a coroner’s inquest is a very real and anxiety-provoking possibility for many psychiatrists. This article considers the role of the coroner in England and Wales and the process of investigation of sudden and unexplained deaths, and offers some practical advice regarding such proceedings. It illustrates a number of issues that have been highlighted in coroners’ verdicts and have implications for the process of clinical governance. It also considers possible changes to the coroner system that have been proposed recently in several high-profile reports. Historical aspects would take the confession of a criminal who had ‘turned approver’ or decided to turn King’s The origins of the role of coroner are obscure (Levine, evidence. 1995; Levine & Pike, 1999). In England the office Following the medieval period the coroner’s may date back to Saxon times and the reign of Alfred power was in decline. By 1500 he was no longer the Great (Knight, 1999). There is evidence, though, involved in collecting revenues and began to be that as early as the 7th century AD there were concerned with sudden death where there was coroners in existence in China (Knapman, 1993). a suspicion that the cause was either unnatural During the reign of Henry II, a time when many were or violent. Whenever such a death occurred the dissatisfied with the corruption of the sheriffs, the coroner would summon a jury to make ‘an in- other legal representative of the King was the Seviens quisition’. After viewing the body, the jury decided Regis Corinarius. However, in September 1194, with on a verdict of homicide, suicide or misadventure. Richard I on the throne, Article 20 of the Articles of In the case of murder, the coroner would be involved the Eyre stated that each county should elect Keepers in bringing the accused to trial, but this criminal of the Pleas of the Crown, and the ‘crowners’ or aspect of the coroners’ work has gradually dim- ‘coroners’ officially came into being. inished. The coroner was also obliged to hold an Since then the role of the coroner has changed inquest whenever a prisoner died in jail to determine considerably. In those early times the coroner was whether the prisoner had died ‘by the ill usage of an important and feared official (perhaps that is still the gaoler’. the case today!) who had a responsibility for keeping For the next 200 years there was little change, but a record of revenues that were due to the king. These an attempt to improve the status of the office in 1751 often arose from criminal proceedings – for example led to arguments that persisted for another century. a levy known as the ‘murdrum’ was payable to the A formal system of inquiry into deaths was king by the community whenever a Norman was established in the first half of the 19th century by murdered – but the coroner played little part in the the Birth and Death Registration Act and several judicial process. Another source of revenue was the other pieces of legislation. The first medically trained ‘deodand’, which was any item involved in a violent coroner was appointed in 1839 and recommend- death that was forfeited to the king. Later, coroners ations from a select committee in 1860 resulted in were involved in negotiations with criminals who the Coroners Act of 1887. This defined a structure of had taken sanctuary and they would offer fugitives duties and rules and marked the beginning of the the alternatives of surrender or exile. Similarly, they modern era. Bill Calthorpe is a specialist registrar in adult psychiatry at the Queen Elizabeth Psychiatric Hospital (Mindelsohn Way, off Vincent Drive, Edgbaston, Birmingham B15 2TZ, UK) and an honorary clinical lecturer in the University of Birmingham Medical School’s Department of Neurosciences and Psychiatry. Steve Choong is a consultant psychiatrist and a clinical director of the South Birmingham and Solihull Mental Health Trust, also at the Queen Elizabeth Psychiatric Hospital. He was formerly chairman of the Clinical Risk Management Group of the South Birmingham Mental Health Trust and is currently chairman of the Management Special Interest Group of the Royal College of Psychiatrists. 146 Advances in Psychiatric Treatment (2004), vol. 10. http://apt.rcpsych.org/ The coroner’s court and the psychiatrist Latterly the practice and procedures relating to assistant deputies, who are appointed by the coroner inquests and post-mortem examinations were to assist them. regulated by the Coroners Rules 1953. A review of In addition to the deputies, every coroner has on the coroner system by the Brodrick Committee average three coroner’s officers. They are usually between 1966 and 1971 made a number of recom- employed by the police and are serving or retired mendations (including that coroners should not be police officers. An increasing number of civilians doctors), but did not result in any significant are found in this position. Their roles vary, but they changes. With the current Coroners Rules being do much of the detailed investigation and prepar- introduced in 1984 and the Coroners Act 1988 ation for inquests as well as liaison with bereaved consolidating existing legislation, today the need families. for an inquest is well defined. The coroner’s duties are defined by Levine & Pike Although a ‘Continental’ system exists which only (1999) as follows: investigates deaths that have aroused the suspicions • to investigate all deaths where the cause is of the police, the coroner system was exported unknown or there is reason to believe that the throughout the British Empire and has been adopted cause was violent or unnatural; in many countries around the world. • to decide whether a post-mortem examination is required and to instruct an appropriate The coroner today (Box 1) medical practitioner to undertake it if necessary; • According to the Coroner Review Group (2003) there to hold an inquest, with or without a jury, are 123 coroners in England and Wales, who are where there is reason to suspect that the appointed and paid by local authorities in each deceased has died a violent, unnatural or district. The coroner is an independent judicial sudden death of unknown cause or has official who holds office until retirement. Responsi- died in prison or in any circumstances that bility for the operation of the coroner system falls to require an inquest according to other Acts of the Home Office, which deals with issues of Parliament (although deaths in psychiatric legislation, the Home Secretary, who sets fees, hospitals are not subject to a mandatory collects statistics and acts as an arbitrator, and the inquest, the Home Office has asked that all Lord Chancellor, who for the moment regulates deaths in legal custody, including those of practice and procedures and is the only person patients detained under the Mental Health able to dismiss a coroner. Apart from the basic Act, be investigated as if they were deaths in requirement of being medically or legally qualified prison); • for at least 5 years there is no obligatory training for to pay the relevant fees to witnesses and jurors; • coroners, although the Home Office provides some to notify the Registrar of Deaths of the induction courses and two or three weekend courses findings of the inquest or that no inquest a year. needed to be held; • In a survey of coroners by the Home Office (Tarling, to keep a register of all the deaths reported 1998) the vast majority (98%) were male with and retain documents in connection with an average age of 58 years (range 39–75 years). inquests and post-mortems; • The majority of coroners were part-time, but there to make annual returns to the Home Office in were 23 full-time posts in the busiest districts. The connection with the inquests held and the number of medically qualified coroners was small deaths investigated; • (15%), a situation reflected among deputies and to appoint a deputy coroner and an assistant deputy coroner if needed. The inquest Box 1 The coroner Purpose (Box 2) • An independent judicial officer • Responsible only to the Crown The inquest, held in the coroner’s court (Box 3), • Usually a lawyer, some are medically has a very limited remit. It is intended to establish qualified certain facts: namely, the identity of the deceased • Funded by the local authority and how, when and where they met their death. The • Responsible for investigating the cause and proceedings and evidence must be directed solely circumstances of sudden, violent or un- at this purpose and no comments from the coroner, natural death jury or any verdict can determine either blame or criminal or civil liability. Advances in Psychiatric Treatment (2004), vol. 10. http://apt.rcpsych.org/ 147 Calthorpe & Choong affect the health and safety of the public if they Box 2 Purpose of the inquest were allowed to continue. • To provide independent scrutiny of the events According to Home Office figures, a jury sat in surrounding a death only 3% of inquests in 2000, so it is an infrequent occurrence. A jury is made up of a maximum of 11 • To establish the facts jurors and a minimum of 7, who qualify for jury • To allow properly interested persons an service if they are aged between 18 and 64, are opportunity to question witnesses registered on the electoral roll and have lived in the • To draw attention to circumstances that UK for at least 5 years after the age of 13.
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