THE RELATIONSHIP OF CORONER AND MEDICAL PROFESSION.

838

THE

RELATIONSHIP OF CORONER AND MEDICAL PROF

Special Articles. THE RELATIONSHIP OF

CORONER AND MEDICAL PROFESSION. Post-graduates, at the Manchester Royal Infirmary on Oct. 11th, 1929, BY C. W. W. SURRIDGE,

A Lecture delivered to

H.M. CORONER FOR THE CITY OF MANCHESTER.

like at the outset to point out that the is an independent official. He is not a police official, and within certain limitations he has a wide He is not discretion and a heavy responsibility. bound by the laws of evidence, although in criminal matters, in my opinion, he should strictly observe them. The practice and procedure varies amongst different coroners, and I am only speaking of my own I

SHOULD

coroner

practice

and

procedure.

act upon information. In all is concerned, or serious accident, he usually gets his information immediately from the police, but in a very large number of cases the police are not called in, and it is from the doctors that the coroner derives his information, or from the registrar, whose duty it is to scrutinise closely the doctor’s certificates, and to refer them to the coroner if he is unable to accept them. A

only

coroner can cases where a crime

Obligation

to

Inform.

There is no statutory obligation upon a doctor to inform the coroner, though it is said to be his common law duty, as one of those about the deceased, to inform the coroner or his officer, or the police, where he has any reason to suppose an inquest may be necessary.

But

although

there is

no

statutory duty

upon

a

which I adopt is not universal. For my part, Icannot see how such deaths under anaesthetics. the category of deaths from can come under natural causes, and I therefore always holdinquests in such cases. In most cases it is true that. the inquest is a pure formality, and I sympathise very sincerely with doctors who have to attend an inquest in cases where they have been called upon to give an anesthetic to a patient where the chances of his surviving the operation were very remote, but I can assure them that in such cases not the slightest reflection is cast upon their skill. I am convinced that the holding of an inquest is. a great public safeguard, and that it is a good thing tosatisfy people that everything has been properlycarried out, and that all proper precautions have been taken, and that all known means of resuscitation were at hand and employed. In some cases-fortunatelyvery few-I have found that my Inquiry has been fully justified, and it is only on such occasions that Ihave any adverse comment tó make. With regard to cases of accidents, I find that sometimes a doctor fails to report a death from a simpleaccident, and the excuse given for his omission is that he did not report it as no question of compensation was involved. Of course, that is an entirely erroneous. impression. The coroner has to hold an inquest in every case where death has been caused or accelerated by an accident, quite apart from any question of’ compensation. Another mistaken impression is that it is not necessary to inform the coroner where death. has occurred more than a year and a day after the accident. This impression springs from the fact that no person who has inflicted the injury can beconvicted of murder or manslaughter if death ensues after the lapse of a year and a day from the injury, but the coroner is solely concerned with the question as to whether the injury has or has not caused or accelerated death. Compensation Cases. Cases where compensation may be involved demand

doctor to inform the coroner, it is, in this city at any rate, an unwritten law of courtesy for the doctor to inform the coroner at the earliest possible moment of any case of his which calls for the coroner’s intervention. If he disregards this courteous procedure, he not only ruffles the coroner, who is a very autocratic individual and capable of being extremely unpleasant is of more immediate on the telephone, but what concern to the doctor, he runs the risk of alienating the regard and possibly the future patronage of the family of the deceased. If the doctor contents himself with posting his certificate to the registrar, who, upon receipt of it, posts the appropriate form to the coroner, it is three days after the death before the coroner knows anything at all about it. It is very inconvenient and

unpleasant

for the relatives

to

be

informed, perhaps on the eve of the funeral, that an inquest must be held. The majority of doctors in this city fully realise the position, and are anxious to work in harmony with the coroner, but difficulties do arise through a doubt to the circumstances under which a doctor should communicate with the coroner. This question is answered by reference to Section 3 (1) of the Coroners’ Act, 1887, which enacts : " Where there is reasonable cause to suspect that such person has died either a violent or unnatural death, or has died a sudden death of which the cause is unknown, or that such person has died in prison..... the coroner shall ....." in effect hold an inquest. Violent or unnatural deaths include all cases where death is due to an accident of any kind-however trivial the original accident may have been. They also include deaths from all forms of poisoning, including not only acids and alkalis, but alcoholic or food poisoning, or death from industrial disease, or deaths from suicide. as

.....

or to me that the deceased had an accident at his work some months ago, or has been working amongst lead or chemical fumes, and the question is raised whether the accident or the work upon which the deceased has been engaged has,* attributed to his 2 y I

In such cases I always hold an inquest if death. desired to do so by the relatives and order a postmortem examination. This does not mean that I distrust the diagnosis of the doctor, but the matter has to be fully investigated. If I were to refuse to hold an inquest and the case went for compensation, the county court judge might want to know why no inquest had been held. Very often the doctor has £ ’ never been informed of the accident or condition of work, and he should always make careful inquiries on these points, and where he has reason to believe that the relatives consider that the accident has contributed to the death, he should always report it to the coroner. Cases of sudden death do not necessarily demand an inquest. Where the doctor has attended a patient for heart disease, for example, and death occurs suddenly, a doctor is quite in order in giving a certificate if he is satisfied that no other cause, such as accident or poison, has contributed to the death, but under the regulations contained in the last Registration Act, 1927, the registrar has to refer to the coroner all cases where the deceased has not been seen by the doctor after death, or within 14 days of death, and in such cases it is a great convenience to all concerned if the doctor notifies the coroner at once. But informing the coroner does not relieve the doctor from his duty of issuing a certificate where the cause of death is diagnosed. ’

Deaths under Ancestheties. The Question of Fees. of death I should like to call your The only payment authorised by statute is a fee for attention, because I believe that the practicegiving evidence at an inquest, or for making a post-

To this

special

especial care. I very frequently get cases where the doctor gives a certificate of death from some natural cause, but where the relatives mention to the registrar

cause

THK

PRACTITIONER’,3

;mortem examination. No payment is made by me for any letter written to me by a doctor or any other ,communications. I want to emphasise the fact that I do not order a doctor to make a written report. The letters to which I allude are purely voluntary communications. In cases where I have to ask for information on the telephone, 1 am invariably assisted with the very greatest courtesy by the doctors in this city. If a doctor is in any doubt whatever about a case he should consult the coroner, for I am only too ready to -assist them as they assist me. Content yourselves with stating the facts, and leave the responsibility to the coroner. Never try to evade an inquest. I have two golden rules. In all cases where the relatives .desire an inquest I always hold one, and whenever any undue pressure is brought to bear upon me not to hold an inquest I always hold one. This practice I have found to be fully justified on many occasions. It has never been my practice to call doctors ’unnecessarily--e.g., in simple cases of fall down stairs or burns, where I get evidence of the injuries from other sources, but in cases where compensation is involved I generally call the doctor, as the employers our insurance companies may desire to cross-examine the doctor through their counsel.

839

BMPLOYEKS.

mechanics and apprentices, domestic servants, hallporters, and chauffeurs. The contributions for such persons must be paid for each during which they are employed ; and in any week they have been employed in an insurable capacity by

week when

than one employer, the first employer is responsible, These requirements are explained in detail in Pamphlet A, which may be had from the Health Insurance Departments of the Ministry of Health, Whitehall, S.W. 1. more

Rate of Remuneration.-In arriving at the rate of remuneration of employees (other than manual workers), account should be taken of the value to the employee of any emoluments in kind, such as board The or lodging, provided at the employer’s expense. cost to the employer, though often a useful guide, is not necessarily to be taken as the value of remunera" The employer and the employed tion in kind. person," says the memorandum, " will usually be in a position to agree as to what should be taken as a fair money equivalent of the value of such emoluments to the employed person, and it is only in cases of special difficulty that reference need be made to the Insurance Department. Ordinarily, the value of board and lodging is assessed at about 35s. a week. In the case of part-time employment the equivalent remuneration for normal whole-time employment should be taken."

Evidenee in Court. On the question of giving evidence in court, perhaps Manual Labour.-The question whether an employI may be permitted to give you some hints. ment is or is not by way of manual labour is only (1) Always speak up, so that everyone may hear material where the pay exceeds JE250 a year, as you. Do not act as if you were carrving on a private who receive less are insurable in any event. conversation with the coroner; remember that relatives persons The question arises principally in the case of dental have a right to hear what you say and an interest mechanics and chauffeurs. in your evidence. A dental mechanic is employed by way of manual labour, (2) Make your language as simple and as untechnical

notwithstanding that he supervises assistants in addition to engaging in the manipulative work involved in making as you can, but at the same time A decision of dentures, plates, artificial teeth, crowns, &c. he luminous. the Minister of Health to this effect has been upheld by Justice Roche in the High Court. On the other hand, (4) Formulate your opinion and conclusions with aMr.dentist’s assistant who is engaged in the ordinary duties care, and do not allow yourself to be shaken by cross- of a qualified dentist and who attends to patients in that examination. I do not mean by this that you can capacity is regarded as employed otherwise than by way of always be exact. Medicine is not an exact science, manual labour. But where such an assistant also takes --e.g., you may say death was undoubtedly, in my part in mechanical work, regard must be had to the main opinion, caused or accelerated by the accident, or, in and substantial nature of his duties. If he is substantially my opinion, the accident had no connexion with the employed as a dental mechanic he is a manual worker. as

possible. (3) Be as concise

you may say I

In

unable to say accelerated by the accident or not. But once you have made up ’your mind, hold your ground, and do not allow yourself to be shaken by cross-examination. ,(5) Do not show any resentment at being crossexamined. Remember, it may be counsel’s duty to ’try to weaken or negative your evidence. Content yourself with reiterating your conclusions or adding reasons for those conclusions. cause

of death,

or

,definitely whether death

was

am

caused

case

of doubt reference should be made to the Insurance

Department for a ruling. A chauffeur who is required to clean the

or

car

and to

effect

running repairs, besides driving, is normally regarded as employed by way of manual labour, and is, therefore, compulsorily insurable irrespective of

his remuneration.

Unemployment

Insurance.*

From the practitioner’s point of view there are three main classes in which liability to unemployment insurance does not coincide with liability to insurance under the Health Insurance and Pensions Acts-

THE PRACTITIONER’S EMPLOYEES.

viz., employment

as a

female

professional

nurse

for

sick, employment in domestic service, and employment in agriculture (including horticulture). Female nurses have been excepted from unemployment insurance since July, 1922. The exception does not, however, extend to dispensers, secretaries, or persons employed by doctors or dentists on such duties as to receive patients, make appointments, the

THEIR POSITION UNDER NATIONAL INSURANCE.

MEDICAL and dental practitioners are often in ’doubt about the position of their employees under the various Acts which regulate national health

-insurance, contributory pensions, and unemployment insurance. An explanatory memorandum answer telephone messages, clean and sterilise instruhas therefore been issued by the Ministry ments, clean and dust surgery fittings, mix cement, (317/X) to the dentist, or attend on of Health and other departments concerned. The hand instruments, &c., anaesthetic cases, unless the attendant is a duly ’main facts may’be summarised as follows :— qualified nurse and employed as such. Health and Pensions Insurance. Employment in domestic service is excepted from Under the National Health Insurance Acts and liability to insurance only where the employed person the Widows’, Orphans’, and Old Age Contributory is not employed in a trade or business carried on for Tensions Act contributions have in general to be the purposes of gain. It has been held by Mr. Justice in the High Court that a doctor is carrying paid for everyone over 16 who is earning not more than :15250 a year for whole-time service, and also on a business for the purpose of gain within the for everyone whose employment is by way of manual The requirements of the Unemployment Insurance Acts are, labour. Thus, subject to what is said below, health set out in detail in Leaflet U.I.L.4, which may be had from the -and pensions contributions are payable for nurses, Ministry of Labour or from any Employment Exchange or 4ipensers, secretaries and reception clerks, dental Branch Employment Office. ’

Roche *