Inquests in Medical Negligence Cases

A coroner’s inquest is a public investigation to establish the facts relating to a death that is either unnatural or from an unknown cause.

The questions asked include:

• What was the identity of the person who died?
• Where did they die?
• When did they die?
• How did their death occur?

Where there is a death from medical negligence, for example, where the care received was inadequate or negligent, the case is likely to be referred to a coroner. This could also happen where there was no medical intervention, despite a request being made. For example, if a doctor failed to visit a patient or no ambulance was sent despite being called.

People sometimes use the term ‘medical inquest’ for a coroner’s inquest in these circumstances, but this is not an officially recognised term.

Whilst an inquest will ascertain how somebody died and the circumstances related to their death, it won’t apportion blame and the coroner will simply seek to establish the facts leading up to the death. However, the evidence established during a clinical negligence inquest can form part of a subsequent claim for compensation.

If you are a member of the deceased’s family, you can attend the inquest as an interested party or you can appoint an inquest lawyer to represent your views in relation to the death.

As specialists in inquests relating to medical negligence, our lawyers understand inquest procedures and can apply questions to witnesses on your behalf.

We can also advise you on whether a related medical negligence claim is likely to be successful after the inquest.

The inquest will generally be heard in public at the coroner’s court. This means that journalists can attend if they wish.

If you are a close relative of the deceased, such as a spouse, parent or child, or you are a personal representative of the deceased’s estate, you will be classed as an ‘interested person’. This gives you the right to participate in the hearing and any pre-hearing review if you wish.

You should be notified of the details of the hearing, including the location, time and date. You or your solicitor (if you have instructed one) can request that particular witnesses be asked to attend and also that the coroner ask independent experts to give evidence.

Your solicitor will go through all of the evidence in advance to establish which witnesses need to be examined and what questions need to be asked.

The coroner will run the proceedings and witness statements can be read out. In some circumstances, witnesses may be asked to attend and there will be the opportunity for your lawyer to question them. The coroner can also ask the witnesses questions.

If you ask us to represent you, we will obtain copies of the relevant documentation that the court will be considering in advance. This will allow us to prepare any questions and speak directly to the witnesses to try and establish exactly what happened and what their role was. This can be very useful in starting to put together evidence for a subsequent medical negligence claim for compensation.

As an interested person, you can put forward any questions you may have, which we can ask on your behalf. You may also have your own evidence that can be put before the coroner before the hearing.

You will be able to request a copy of the post-mortem report and other reports or documents submitted to the coroner as well as a transcript of the hearing. There may be fees payable for these.

If the coroner makes a report intended to prevent other deaths, you are entitled to see a copy of this and you can also request a copy of any responses to the report that are received.

It is also open to the coroner to refer the actions of a professional to their regulator, such as the General Medical Council or the Nursing and Midwifery Council.

While the coroner cannot make any decisions relating to civil liability, they can reach a range of verdicts or conclusions, including that the death was due to:

• Accident or misadventure
• Neglect
• Natural causes
• Industrial disease
• Unlawful killing (which is rare)
• Open conclusion (where there is insufficient evidence to reach any other conclusion)
• A narrative verdict (given as well as or instead of another verdict and where a longer written explanation is given setting out the key issues)

The coroner will usually need to be satisfied with their conclusion on the balance of probabilities.

There can be a wait of several months before an inquest. Where results are awaited, such as blood or other tests or a post-mortem report is necessary, the length of time will depend on how quickly these are provided. This could be upwards of four to six months after the date of death.

The coroner and court officers will check on the progress of the case internally in the meantime. There may also be one or more pre-inquest review hearings before the final hearing. This is so that administrative matters can be dealt with, such as agreeing on which witnesses will be called, what reports ordered and what evidence should be made available.

The length of a coroner’s hearing could be a few hours or longer, depending on how many witnesses are called and how long the questioning takes. The inquest itself can last for a number of weeks, depending on the complexity of the case.

If you believe that your loved one died because of medical negligence, you are advised to speak to a solicitor straight away. This will enable them to start putting together evidence of what happened while matters are fresh in everyone’s minds and witnesses are available to speak to.

While the documents from the inquest will be helpful in establishing what happened, an inquest verdict does not by itself prove medical negligence and it will be necessary to build a separate case to establish this.