DEATHS REPORTABLE TO THE CORONER

This should be done by the doctor looking after the child.

Full details of which cases should be reported to the Coroner are written on the cover of the Medical Certificate of Death book.

Some examples are:

  • Any sudden or unexpected death
  • Death at operation or procedure, or before full recovery from anaesthetic
  • Death occurring within a year and a day of an accident considered to be the direct cause of death
  • Any suspicious circumstances, e.g. violence, neglect, poisoning of any kind.

Each Coroner has their own particular cases they like to be informed of eg. Death within 24 hours of admission to hospital. These are not always written down anywhere. If there is any doubt about whether a death should be reported, it should be discussed with the Coroner’s officer.

The Coroner is often sympathetic to special circumstances and these should be discussed with the Coroner's officer.

Where it is known that a death is going to be reported to the Coroner, all tubes and lines should be left in situ on the child's body, although these can be made an unobtrusive as possible.

The Coroner has several courses of action:

  • He may decide the death was natural and the doctor can issue the death certificate
  • He may ask a pathologist to perform a post-mortem. If this shows the cause of death, the Coroner can then issue the death certificate, which the family can collect from the Registrar’s in Shakespeare Street.

An appointment must be made and this will ensure all the paper work is ready.

  • If the death is not from natural causes then the Coroner will hold an inquest to find out who has died and how, when and where. The inquest may be opened and adjourned to allow burial to take place, however the Coroner may decide not to allow burial to take place until all investigations are completed.

A Doctor should explain to the family what a Coroners post mortem examination would entail. The Pathologist or the Pathology Nurse Specialist may be involved to help explain.

The Pathology Specialist Nurse will usually contact the family, if not already involved, once she has discussed the child’s case with the Coroner, to ensure they understand what is happening and to obtain consent for what will happen to any tissue samples taken during the examination.

The Coroner or Coroners officer will keep in regular contact with the family until the case has been closed.

Coroners Telephone Number: 0115 9412322
POST MORTEM EXAMINATIONS

A post-mortem examination is the final stage in the investigation of a child’s illness. It is a careful, detailed medical examination, which takes place after the child has died.

A post mortem examination is carried out in a respectful manner and may be compared with an operation. Although there are extensive suture lines the examination is always carried out in such a way that it leaves virtually no obvious signs when the child is fully dressed afterwards.

There are 2 different reasons for a post mortem examination to be carried out:

Coroners Post Mortem – This is legally required to establish the cause of death.

Permission/ consent from the next of kin is not necessary in this situation. However, families need support and information as to why the procedure is required and how the findings may help them to understand why their child has died.

The tissues samples and very occasionally whole organs may need to be retained for further examination and parents should be informed and consent obtained as to what happens to the tissue samples afterwards.

The options available to the family are:

  • Keeping the tissue/organ as part of the child’s medical records.
  • Donating the tissue/organ for furthering medical knowledge
  • Having the tissue/organ collected by the undertaker for burial in the child’s grave at a later date
  • Having the tissue/organ collected by the undertaker for cremation at the crematorium
  • Having the tissue/organ disposed of by the hospital
  • Delaying the funeral until the tissue/organ has been reunited with the body, which could take several weeks

Hospital Post Mortem(consented post mortem)–This is when the cause of death is known, but either the family or medical staff request a post mortem to find out more about the child’s illness and/or death.

Post mortem examinations can provide lots of information about an illness and cause of death. They can help to:

  • Identify the cause of death
  • Confirm the nature of illness if this was not previously known
  • Reveal any condition which had not been diagnosed
  • Show up the effects of any treatment

The information gained can often help parents better understand and begin to come to terms with their loss and may help them make decisions about future pregnancies.

Sometimes questions families ask can only be answered with information gained from a post mortem examination. It is also possible that the information gained may sometime in the future benefit other children who suffer from a similar illness, something parents may gain comfort from.

Consent for a hospital post mortem has to be given and obtained in writing from the next of kin.

This type of post mortem can be ‘limited’ by the parents to examine certain organs only.

The family will also be asked whether they agree to any organs being retained for more detailed examination, if thought to be helpful.

The same options as above are given to the family regarding the disposal of any organs or tissue if they have agreed to them being retained.

What Happens In A Post Mortem Examination

The external examination

Before the Pathologist begins the post mortem he or she will examine the body extensively from the outside.

This will include:

Visually examining the child.

Weighing and measuring the child.

It may also include:

Taking photographs and x-rays.

Possibly CT scan

The Internal Examination

An incision is made from the sternum to the pubis and a detailed internal examination carried out. After the organs have been examined, they are generally removed from the body one by one, weighed and an incision made to examine them inside.

A small piece of tissue (about 1cubic centimetre) is then taken from each organ for examination under the microscope. Unless it has not been possible to complete an examination of an organ (usually the brain) the organs are then returned to the body. After suturing the wound, the child’s body is washed and dressed ready for transfer to the funeral directors or for viewing by the family in the Chapel of Rest.

To enable examination of the brain, an incision is made from ear to ear in the hair at the back of the head, the skull is opened and the brain removed. If the brain needs to be examined in detail it will require preparation (“fixation”) before the examination can take place. In paediatric cases, the brain can usually be examined after about 2-4 weeks, small pieces are then taken for microscopy and the brain can then be ‘disposed’ of according to family’s wishes or returned to the body. If the family choose to return the brain to their child’s body, it will mean the body has to stay in the hospital mortuary until the brain has been returned, which will require the funeral to be delayed.

For more detailed information please see the post mortem consent sheet and explanatory booklet.

Discussing The Post Mortem With Families

Coroners Post Mortem

A doctor usually the Paediatric Consultant will discuss the need for referral to the Coroner and the need for a post mortem examination with the family at the time of the child’s death. The Coroner or his officer will then usually speak to the family prior to the examination taking place. The Coroner will then often ask the Pathology Specialist Nurse to discuss the options for ‘disposal’ of tissue and samples with the family. The Pathology Specialist nurse will usually speak to the family on the phone and will send out a consent form for the family to complete and return.

Hospital Post Mortem

It is usually the Paediatric Consultant who discusses the need for a post mortem examination with the family. If the family wish the Consultant Pathologist is also often willing to discuss the procedure with the parents in person or by phone and will discuss the procedure in detail with the Consultant.

The Pathology Specialist Nurse is also trained to take consent and is available for further information, explanation or support and will discuss with the family their options following the post mortem examination.

When explaining to families what a post mortem examination entails, factual information needs to be given sensitively, referring to organs by name and reassuring the family that they will be able to see and hold their child again after the post mortem examination if they wish. Written information should also be given to the family to supplement any verbal information.

Where possible a member of staff should also be present as an advocate for the family.

Families should be given a named contact, usually the Consultant or Pathology Specialist Nurse.

A follow-up appointment will be offered to the family in 6-8 weeks with the Consultant to discuss the post mortem examination findings.

The Pathology Specialist Nurse is available Monday - Friday and can be contacted on telephone extension: 61726.

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