The ME service is an independent review system, developed following a number of high-profile investigations into patient deaths to provide greater safeguarding to the public around certification of death. It’s aims are:
- Scrutiny of all non-coronial deaths
- Ensure appropriate referral to coroner
- Support Doctors completing Medical Certificate Cause of Death’s (MCCD) and therefore improve the quality of MCCD and mortality data
- Discussion with relatives/family – allowing any concerns to be raised / questions answered.
Currently the ME is a non-statutory role but it is expected that is will be passed and become statutory later this year.
The ME service is not accountable to the Trust – but is accountable to their professional regulatory body and the National ME. They have a close working relationship with the Coroner.
The Medical Examiner is:
- Independent (has no prior knowledge of the patient)
- Able to scrutinise documents and circumstances surrounding deaths (not investigated by the Coroner)
- Able to communicate with relatives
- Trained by the Royal College of Pathologists
They also ensure:
- Timely and appropriate referral of cases to the Coroner
- Accuracy and consistency of the MCCD
- Early detection of clinical governance concerns
ELHT has appointed seven Medical Examiners. They are all experienced clinicians and have a variety of clinical backgrounds. Our Medical Examiners are:
1) Mr Andrew Sloan. Lead Medical Examiner (Orthopaedic and Trauma Surgeon)
2) Dr Emma Davies (Medical Legal Consultant, former ED Consultant)
3) Mr Andrew Evans (General Surgery Consultant)
4) Dr Nicholas Roberts (Medicine for older People consultant)
5) Dr Paul Fourie (GP)
6) Dr Fiona Tyacke (ED Consultant and former GP)
7) Dr Justine Nugent (Obstetrics and Gynaecology Consultant
The ME’s are also supported by 2 Medical Examiner Officers (MEO’s). They are:
1) Ms Angela O’Malley (Previous higher clerical officer, 16yrs)
2) Miss Stephanie Walton (Previous Cardiology and Emergency Surgery Nurse)
The ME service is situated within the General Office on the Royal Blackburn Hospital site. The MEO’s are in the office during normal working hours (8-30am – 4-30pm) Monday – Friday. The ME’s are in the office during the afternoon session Monday – Friday and contactable at weekends (10-00am – 12-00pm) through switchboard.
- The ME service will:
- Discuss the cause of death with certifying doctor
- Review the hospital records and any other documents which might be pertinent to the patient and their death
Discuss with the family/relatives/next of kin of the deceased the circumstances around the death, ensure they understand the information included on the MCCD and address any issues that might come to light
- Direct the certifying Doctor to make an appropriate referral to the Coroner where it is clearly required
- Be able to discuss with Coroners officers / Coroner cases which are more complex
- Be able to directly refer to the Coroner
- Be able to raise through the clinical governance processes of ELHT any concerns that come to light
The Bereavement Booklet ‘Care After Death’ leaflet given to bereaved relatives on the ward, now contains information around the ME service.
The ME service is sensitive to the requirements of different faiths following deaths and works closely with the various faith leaders to ensure they can provide a service for all patients.
The ME service will continue to complete the scrutiny of deaths as timely as possible allowing the death to be registered and the body released. Where possible, faith deaths will be prioritised by the ME service. The ME’s are available on a weekend between the hours of 10am – 12pm for discussion of any deaths which require registration that day.
The ME Service / HM Coroner:
A standard operating procedure has been produced by Dr James Adeley (Senior Coroner) and Dr Huw Twamley (Regional Lead Medical Examiner) for hospital deaths and referrals to the coroner. The East Lancashire ME service continues to work closely with the Coroner and both the regional and national ME to ensure all deaths are reported in a timely manner.
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 critically important and rewarding. It allows them to make significant improvements in what happens after death, including spotting concerns sooner.
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 completing qualified attending practitioner, especially if the case needs a coronial referral.