The Notification of Deaths Regulations 2019 come into force on 1 October 2019 and are made in exercise of the powers conferred by section 18(1) of the Coroners and Justice Act 2009.
These Regulations impose a duty on registered medical practitioners to notify a senior coroner of a person’s death under certain circumstances. The senior coroner to be notified is the senior coroner appointed for the area in which the body of the deceased person lies. The duty applies to all deaths on or after that date.
Regulation 2 provides that the duty applies where the registered medical practitioner comes to know of the death on or after these Regulations come into force and at least one of the circumstances set out in regulation 3 applies, unless the registered medical practitioner reasonably believes that the relevant senior coroner has already been notified of the death under these Regulations.
Circumstances in which the duty to notify arises
The duty to report arises when the registered medical practitioner suspects that that the person’s death was due to:
- poisoning, including by an otherwise benign substance
- exposure to or contact with a toxic substance
- the use of a medicinal product, controlled drug or psychoactive substance
- trauma or injury
- neglect, including self-neglect
- the person undergoing a treatment or procedure of a medical or similar nature; or
- an injury or disease attributable to any employment held by the person during the person’s lifetime.
The medical practitioner also has to report deaths:
- which they suspect were unnatural (even if they do not fall within the categories above)
- where they consider that the cause of death is unknown (despite taking reasonable steps to determine the cause of death)
- where they suspect that the person died while in custody or otherwise in state detention
- where, after taking reasonable steps to ascertain the identity of the deceased person, is unable to do so.
And the duty extends to deaths where the medical practitioner reasonably believes that:
- there is no attending medical practitioner required to sign a certificate of cause of death
- an attending medical practitioner is required to sign a certificate of cause of death but the attending medical practitioner is not available within a reasonable time of the person’s death to sign the certificate of cause of death.
Timescales, how to report and what information must be given to the Senior Coroner
Once the duty arises the medical practitioner must notify the Senior Coroner as soon as is reasonably practicable. Regulation 4 sets out the information that must be provided about the medical practitioner and the deceased. If the information is provided orally the medical practitioner must, as soon as reasonably practicable afterwards, confirm the information in writing.
The Ministry of Justice has provided helpful guidance which medical practitioners should refer to if they have any questions about the circumstances of the death, for example whether the death was due to neglect, or self-neglect or whether the person was undergoing any treatment or procedure of a medical or similar nature.
It is clear that any circumstances where the death may be due to psychoactive substance should be notified to the coroner, reflecting increased scrutiny of such deaths.
The guidance also helpfully sets out the definition of deaths in custody or otherwise in state detention.
Whilst the duty to report arises, it does not follow that all notifiable cases will result in the coroner opening an investigation. This duty to report reflects current practice and the coroner’s duty to consider and investigate certain deaths. The regulations help set out and clarify the process that has been followed by medical practitioners up until this point and hopefully this will lend clarity to the process.