DOES anyone do their job diligently nowadays? It’s a question I have been asking myself more and more during the past five years. I suspect I am far from alone in this contemplation, particularly since the proliferation of people working from home.
I lost someone very dear to me on February 22 – my aunt, the subject of a number of TCW articles. She was just a few months shy of her 93rd birthday. Bedbound for almost two years, she had been slowly deteriorating, though her death was quite unexpected at the very end. She had simply given up.
I am pleased to say that her passing was peaceful and natural with no end-of-life medications given her (as could easily have happened during her hospitalisation in 2020). The following day I was informed by the funeral director that there is a wait of up to two weeks for families of deceased persons to be contacted by the Medical Examiner (ME).
Last September in England and Wales, changes to the death certification process came into force, partly to provide independent scrutiny to causes of death. The Harold Shipman inquiry and several other reports and inquiries highlighted the need for this change. The gov.uk webpage states: ‘Medical examiner scrutiny is not mandated in the non-statutory system. However, NHS England and NHS Wales Shared Services Partnership started implementing the medical examiner system on a non-statutory basis in 2019.
‘It has increasingly become standard practice for medical examiners to provide independent scrutiny of deaths not taken for investigation by a coroner. Medical examiners are now scrutinising almost all deaths in acute trusts and a growing proportion of deaths in all other healthcare settings (including the community).
‘The new death certification reforms require an independent review to be carried out for all deaths in England and Wales, without exception. This will either be provided by independent scrutiny by a medical examiner or by investigation by a coroner.’
According to the NHS website, medical examiners are senior medical doctors. Their role is to answer three questions:
- What caused the death of the deceased?
- Does the coroner need to be notified of the death?
- Was the care before death appropriate?
Medical examiners answer these by providing independent scrutiny, with three elements:
- A proportionate review of relevant medical records;
- Interaction with the doctor completing the Medical Certificate of Cause of Death (MCCD);
- Interaction with a bereaved person, providing an opportunity to ask questions and to raise concerns.
Until this scrutiny has taken place, families are unable to make appointments to register a death and obtain a death certificate. Without a death certificate, no funeral arrangements can be started and no application for probate can be set in motion.
At 1.30am on the seventeenth day following my aunt’s death, I awoke from an uneasy slumber and began to search online for information on medical examiners. The funeral directors had told me that they were unable to chase up the ME and I had begun to wonder what on earth the hold-up could be.
My search culminated in my completing an online form to the ME service in Wales, with a desperate request for advice. The following morning, I received a phone call from the ME service requesting further details. It transpired that the cause of death had indeed been finalised and scrutinised a whole week earlier, yet they had ‘no details of next of kin’.
The GP surgery had been contacted, but not replied. I even had lasting power of attorney for my aunt’s health and welfare, so this should have been straightforward! The ME representative was extremely apologetic, adding that their office should have chased up the GP surgery and mumbled something about teething problems, lessons learned and the usual excuses. I responded that they knew the place of death and couldn’t they have contacted the care home where the death took place?
I was told that the details would immediately be added to the system and that I should be able to make an appointment to register the death ‘by the end of the day’. I suggested that in view of the circumstances I ought to receive a telephone call back to inform me as soon as this was on the system, not merely wait and try at the end of the day.
The call back came 40 minutes later. It would appear that the gravity and indignity of this error had been acknowledged.
Goodness knows how long we would have had to wait had I not been proactive in the matter. When would they have realised that this had not been chased up and how long would my dear aunt had to languish in the mortuary refrigerator? The funeral director dealing with my relative told of a case where the family of a 103-year-old had waited five or six weeks due to the case being referred to the coroner. Funeral directors and registrars are fully aware of the flaws in the system, six months into its operation, and hope that changes will be made.
I previously wrote advising readers to ‘accept nothing the hospitals tell you’ regarding the anticipatory medications that my aunt managed to evade in 2020.
My advice now? Accept nothing, full stop. Chase up everything.
And do not believe that anyone will do their job conscientiously any more, no matter how ‘respectable’ or professional their position.
