Medical Examiners

Given that the medical examiner (ME) role is a recent addition to the CDR landscape. It is important we explore opportunities to raise awareness of ME work, and learn from and work with MEs in our local areas.

What is a medical examiner, and what do they do?

The NHS provides us with a number of key outlines and resources in support of the ME role and their crucial role in local systems.

An NHS medical examiner is an independent senior doctor who scrutinises “non-coronial deaths”. An ME ensures that causes of death are recorded accurately, and helps identify and learn from care quality concerns. They are not involved in the deceased patient's clinical care. Given their independence, medical examiners can give the bereaved a voice, ensuring their views are given due consideration. Medical examiners have a statutory right to access patient health records for their review and are trained in the legal and clinical elements of death certification processes.

Increasingly, more MEs have a background in or deep understanding of paediatrics, though this is not always the case. Therefore, local CDR systems have a key role in supporting a collegiate response to child deaths with local MEs, as they would with the Coronial systems.

MEs:

■ provide greater safeguards for the public through independent scrutiny of all non-coronial deaths

■ ensure the appropriate direction of deaths to the coroner

■ provide bereaved people with an opportunity to ask questions and raise concerns to someone not involved in the care of the deceased

■ improve the quality of death certification and mortality data

Medical examiners seek to answer 3 questions:

1. What caused the death of the deceased?

2. Does the coroner need to be notified of the death?

3. Was the care before death appropriate?

Medical examiners answer these by providing independent scrutiny, with 3 elements:

1. a proportionate review of relevant medical records

2. interaction with the doctor completing the Medical Certificate of Cause of Death (MCCD)

3. interaction with a bereaved person, providing an opportunity to ask questions and to raise concerns

Medical examiners’ conclusions can inform learning to improve care for future patients, and in a minority of cases are referred to established clinical governance processes for further action. In addition, the medical examiner office can help and support clinical teams in raising and escalating concerns to other agencies.

Medical examiners help establish as accurately as possible causes of death for the Medical Certificate of Cause of Death (MCCD), which improves national data for health research, and advise if a death should in fact be notified to the coroner. Bereaved parents value having a better understanding of the cause of death and knowing that the recorded cause of death is as accurate as possible with the available information.

What is a medical examiner’s office, and what do medical examiner officers do?

Medical examiner offices are where MEs and ME officers work, and where their services are based. Medical examiner offices will generally be hosted at acute hospital sites in England and Wales, with medical examiners and officers employed by acute trusts in England and NHS Wales Shared Services Partnership (NWSSP) in Wales.

Medical examiner officers manage cases from initial notification through to completion and communication with the registrar. They obtain and carry out a preliminary review of all relevant medical records (and additional details where required) to develop a death case file for the medical examiner.

Medical examiners and medical examiner officers are advised to collaborate with neighbouring medical examiner offices, sharing experiences and expertise to support peer learning. Regional medical examiners and the Lead Medical Examiner for Wales will work with medical examiner offices to facilitate this. They also need to develop a good working relationship with the local coroner, registration services and other stakeholders, such as faith groups and funeral directors.

ME work overview

As soon as possible after a child’s death (on average within 24 hours) the next of kin will receive a phone call from the medical examiner’s service. This service provides an independent review of the cause of death and gives the next of kin time to ask questions.

Interpreting services will be available to support bereaved relatives who need them. The medical examiner’s office is sensitive to religious needs surrounding burial, and will make sure they call next of kin as soon as possible within 24 hours of the death. This call is designed to support the next of kin; the medical examiner’s office wants to check if the bereaved have any concerns about the death before the death certificate is issued. They provide an opportunity for families and carers to raise any concerns, such as unsatisfactory interactions with health services.

The medical examiner’s office will be able to:

■ confirm a loved one’s cause of death

■ discuss the care they received

■ answer the next of kin’s questions, and concerns

■ explain the wording on the death certificate agreed by the doctor and medical examiner.

If the cause of death is unknown, they will also be able to talk the next of kin through the referral process to the coroner (if required).

Following the call with the medical examiner’s office the medical certificate of cause of death will then be electronically sent to the registrar in the borough the death was recorded. The next of kin will then be able to book an appointment to register the death. To read more on a local London guide to medical examiner services, click here.

Further information

National leadership and guidance

The ME system is overseen by a National Medical Examiner, currently Dr. Alan Fletcher. Supported by the Royal College of Pathologists, Dr Fletcher leads the Good Practice Series, a collection of topical summary documents on best practice for front-line staff. The series highlights how medical examiners and medical examiner officers can better meet the needs of local communities, and work effectively with colleagues and partners.

The Good Practice Series on child and neonate deaths highlights that “the process of expertly reviewing all deaths of children is grounded in respect for the rights of children and their families”. It is stressed that MEs’ work must be coordinated and transparent, and that they should support families in a consistent and sensitive manner. Further, it is advised that bereaved people are put at the centre of the process.

The Series also encourages MEs to engage with local communities in a sustainable way, to ensure that their work methods are culturally relevant and meet the specific needs of local communities. Medical examiners should be sensitive to the cultural and religious expectations and needs of all those who have suffered loss, alongside thorough considerations for those with disabilities and accessibility requirements.

National medical examiner reports and updates

The National Medical Examiner publishes an annual report on implementation progress with the medical examiner system, milestones achieved, examples of the ME impact, and details of key activity details during the period covered by each report. These reports can be accessed here.

Additionally, the National Medical Examiner issues updates, providing useful information and news to support medical examiner offices, which can be found here.

Video resources:

https://gps.cityandhackneyccg.nhs.uk/education/video/introducing-the-medical-examiner-service

https://youtu.be/rVXACayZWQw?si=RReBh9ImtcFZBDqG

https://youtu.be/8ZQh8xiCcfc?si=Bnd2pVb7Gmeve7_W

Text resources:

NHS England » Medical examiners

NHS England » The national medical examiner system