We have been working with care homes to update their contracts and advise on the risks of charging the resident a regular “top-up” or additional fee where a resident is funded through NHS CHC
In these unprecedented times, we find ourselves in, there has been the need for emergency legislation, and the Chief Coroner of England and Wales has published guidance on the impact of covid-19 on the Coronial Service.
Covid-19 is an acceptable direct or underlying cause of death for completing the medical certificate of cause of death (a certificate completed by the attending doctor). Therefore, covid-19 as a cause of death is not a reason on its own to refer a death to a Coroner. Covid-19 is a naturally occurring disease and is therefore capable of being a natural cause of death and will be stated as such on the death certificate.
There may be situations where covid-19 is only suspected as a cause of death, thus meaning the attending doctor cannot give a precise medical cause of death, and in those circumstances, the death must be reported to the Coroner.
Due to the unprecedented demands both the Coronial Service and the NHS currently face, it may not always be possible to carry out a post-mortem examination to confirm the cause of death. In this case, the Coroner may proceed to Inquest to allow the death to be registered with a post mortem. This will include the Coroner assembling all the relevant medical and other evidence, including witness statements, to include accurate information from the scene in a community death.
If there is no reliable, objective medical evidence establishing the cause of death, witness statements of those who knew the deceased in life and can describe symptoms, etc. may enable a conclusion to be reached.
The Coroner then has two options available. If it is possible to hold a short Inquest (documentary evidence only without the need to call witnesses if the facts are clear and uncontroversial) soon after the report of death to arrive at a conclusion (possibly of natural causes) with a medical cause of death either providing covid-19 as the cause or, if there is still uncertainty, an unknown cause.
However, a death caused by covid-19, may be in a category that requires a more detailed explanation, such as a death in prison or custody. In this situation, the Coroner can open an Inquest but adjourn to a later date to assemble all relevant evidence or release the body for burial or cremation and list the Inquest at a future date.
Inquests must be held in public. Therefore, a Coroner must sit in a Court and cannot conduct the hearing remotely, e.g. from home, although it is possible for witnesses to give evidence remotely, e.g. by Skype facility. Due to the need to exercise social distancing within the Court setting, and the availability of judiciary, staff and witnesses, the Chief Coroner has given guidance as to the adjournment/postponement of Inquests.
As from 31 March 2020, Inquests involving a jury are to be postponed to a date after 28 August 2020. Complex Inquests involving attendance of witnesses, particularly those involved in the health service and police service, again are to be considered for postponement until after 28 August 2020. This will inevitably lead to delays in concluding Inquests and registrations of death.
Coroners will consider inviting interested persons to agree to concluding Inquests on a documentary evidence basis (Rule 23). This is where the Coroner considers the cause of death is clear, and the evidence is uncontroversial, and that it calling a witness to give oral evidence is unlikely to bring further information. Families are entitled to refuse this but will have to accept there will be a delay.
Finally, whilst covid-19 is a notifiable disease, and must be reported to Public Health England, for the coronial service, and whilst a death involving a notifiable disease must always be dealt with as an Inquest with a jury, the emergency Coronavirus Bill provides that, in the case of a covid-19 death, an Inquest can be held without a jury. There may be other factors involved in the death that would require a jury Inquest, as mentioned above. This is we conclude in anticipation of an increased number of deaths.
For any questions relating to either death involving covid-19 or any death, please contact Sarah Huntbach.
Sarah Huntbach is a Senior Associate in the Clinical Negligence and Personal Injury department of Anthony Collins Solicitors and also sits as an Assistant Coroner for Derby and Derbyshire.
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