The Medical Examiner (ME) is an independent review system, developed following several high-profile investigations into patient deaths. It’s aims are:
• Provide greater safeguards for the public.
• Ensure independent scrutiny of all non-coronial deaths.
• Appropriate direction of deaths to the coroner.
• Provide a better service for the bereaved and an opportunity for them to raise any concerns to a doctor not involved in the care of the deceased.
• Improve the quality of death certification.
• Improve the quality of mortality data.
The ME will provide scrutiny of all non-coronial deaths at the East Lancashire Teaching Hospital NHS Trust (ELHT). This includes all associated sites: Royal Blackburn Teaching Hospital, Burnley General Hospital, Pendle Community Hospital and Clitheroe Community Hospital.
The service also scrutinises and reviews non-acute deaths in the community. The service covers over seventy GP practices within Pennine Lancashire.
The Medical Examiner is:
• Independent, has no prior knowledge of the patient.
• Experienced, senior doctor.
• Able to review clinical records including any diagnostic information.
• Able to communicate effectively and interact with the bereaved.
• Trained by the Royal College of Pathologists.
They also ensure:
• Appropriate referrals to the coroner.
• Accuracy and consistency of the Medical Certificate of Cause of Death (MCCD).
• Early detection of clinical governance concerns.
The ME service is not accountable to the hospital trust but is accountable to their professional regulatory body and the regional and national ME service.
There are eleven appointed Medical Examiners within East Lancashire. All are senior medical practitioners.
Lead Medical Examiner: Mr Andrew Sloan
Medical Examiners:
Dr Emma Davies Dr Nicholas Roberts
Dr Paul Fourie Dr Justine Nugent
Mr Aamir Zubairy Dr Rose Kogie-Henshall
Dr Justine Nugent Dr Mohammed Moosa
Dr Adarsh Bhulani Dr Khurram Hassan
The Medical Examiners are also supported by six Medical Examiner Officers (MEO’s).
Mrs Angela O’Malley Miss Stephanie Walton
Mrs Deborah Perry Mr David Wallace
Mr Darren Wingrove Mrs Susan Hambley
The Medical Examiner service is located within the bereavement services office at the Royal Blackburn Hospital, Haslingden Road, Blackburn.
Office hours are 8:30am – 4:30pm Mon to Fri. Tel: 01254 735673 or 01254 734696. Email: elht.elme@nhs.net
The Medical Examiner operates a limited out of hours service for medical practitioners: 10:00 am –12:00 noon at the weekend.
Practitioners should call the hospital switch board to contact the ME.
The ME service will:
• Discuss the circumstances and cause of death with certifying medical practitioner.
• Review clinical records, diagnostic reports and any other any other information which may be pertinent to the patient and their death.
• Direct the certifying doctor to make an appropriate referral to the coroner where it is clearly required.
• Clear communication with coroner’s office regarding complex deaths.
• Raise concerns through the clinical governance processes at the Trust
With all reportable deaths the ME will speak with bereaved regarding the circumstances of the death and ensure they understand the information included on the MCCD and address any issues or concerns.
The ‘Care after Death' booklet has been developed by the hospital trust to assist the bereaved providing information and advice when someone dies. Further information regarding the Medical Examiner service can be found in this booklet.
Faith Deaths
The ME service is sensitive to the requirements of all faiths and religions. The ME works closely with faith leaders to ensure they can provide a service for all patients.
The service will endeavour to complete timely scrutiny of all faith deaths, allowing when possible, the early release of the deceased thus facilitating death registration. In addition to this, the ME provides an out of hours service at the weekend. This allows the treating medical practitioner the opportunity to discuss the circumstances and the cause of death with the on-call ME who will support the issue of the MCCD and release in all non-coronial deaths.
HM Coroner:
A standard operating procedure has been developed by Dr James Adeley (Senior Coroner for Blackburn with Darwen and Lancashire) and Dr Huw Twamley (Regional Lead Medical Examiner) for hospital and community deaths, this also includes referrals to the coroner. The ME continues to work closely with the coroner along with both the regional and national medical examiner services.
Why is this role important?
The benefits of this new service for the bereaved are likely to be the most dramatic. In current practice, relatives of deceased patients rarely get to speak to the clinical team after a patient has died. In the new system, relatives are given a chance to ask a doctor questions, and often, they want to hear, in simple terms, what really happened.
They fully explain specifically what has been documented on the Medical Certificate of Cause of Death and discuss any issues that arise. This often brings clarity, dissipates doubts, and helps to alleviate negative thoughts and experiences. Providing a voice to the bereaved at this most difficult of times is important and rewarding. It allows them to make significant improvements in what happens after death, including spotting concerns sooner.
Medical Practitioners
On a clinical note, the ME service offers greater safeguarding to the public, and uses the independent review of deaths for learning, education, and improvement or the services the Trust provides.
They work closely with the Foundation year doctors to improve the quality and consistency of death certification and, in turn, the accuracy of mortality data. The ME service has also designed guidance packages for the completion of paperwork, and assists with terminology, structure, and sequence. This can help to alleviate worries or concerns of the qualified attending medical practitioner, especially if the case needs a coronial referral.
Currently, the ME is a non-statutory role, but it is expected that legislation will be passed and become statutory later this year.