The Coroner's Court investigates sudden, unexplained, or suspicious deaths to determine the cause of death. Healthcare professionals may be called to provide witness evidence, which can be a stressful experience. As a medical indemnity provider, we understand the emotional and professional pressures this process can bring, especially when it may lead to a General Medical Council (GMC) investigation or clinical negligence claim. Our medico-legal team is staffed with dual-qualified doctors and lawyers, so they also fully understand the emotional impact that a patient death can have on a healthcare professional. This article aims to provide you with a clear understanding of what to expect and how to prepare, and to ensure you feel supported and informed every step of the way.
This guidance note relates only to Coroner’s Courts in England, Wales and Northern Ireland, and not to Fatal Accident Enquiries in Scotland, although similar principles apply.
The Coroner’s Court aims to establish who the deceased was, and when, where, and how they died. The Coroner does not attribute blame or liability, but can criticise individuals involved the patient’s care. As a healthcare professional, you may be asked to provide a statement and potentially be called to give witness evidence if you were involved in the clinical care of the deceased.
The Coroner can request a factual statement about your involvement with the patient. This must be based on your personal knowledge and medical records. It's important not to let anyone influence your statement or attempt to influence others, as this could lead to professional misconduct investigations by the GMC.
Although patient confidentiality remains important, there is an exception when providing information to the Coroner. Your statement will be shared with the deceased’s family and other legal representatives, and you may be questioned on its content during the inquest.
If you are a pure witness, legal advice may not be required. However, it’s recommended to seek medico-legal guidance to ensure your statement is clear, accurate, and appropriate. On the other hand, if there’s a possibility you might be considered an Interested Person (i.e. someone potentially responsible for contributing to the death), it’s crucial to seek formal legal advice before submitting your statement. Interested Persons may be involved in future investigations or claims, so accuracy is vital.
To avoid any missteps, we advise contacting the Incision medico-legal team as soon as you're asked for a statement.
In most cases, if you're called as a witness, it means you’re not considered to have contributed to the death. You won't have the right to question other witnesses or make legal submissions. Even though this can be intimidating, you are simply expected to provide factual evidence about your involvement. Our medico-legal team can offer support and tips for preparing to give evidence.
An Interested Person is someone who may have contributed to the death. Under the Coroners and Justice Act 2009, these individuals have additional rights in the inquest process, such as receiving witness statements, cross-examining witnesses, and making submissions on evidence and legal points. If you are designated as an Interested Person, it’s crucial to have formal legal representation to ensure your rights are protected.
After the Inquest hearing, the Coroner delivers the 'findings of fact' and a conclusion (also known as the verdict), which answers how the deceased died. Conclusions can range from natural causes to neglect, unlawful killing, or gross negligence manslaughter. The Coroner may also give a narrative verdict to suggest ways to prevent future deaths. At this point, the Inquest ends.
Healthcare professionals must self-refer to the GMC if criticised in an official inquiry, which includes Inquests (see paragraph 75 of Good Medical Practice). If criticised, seek immediate medico-legal advice on whether and how to make this self-referral.
Incision provides indemnity for legal representation if you're an Interested Person (subject as always to the terms and conditions), whether the incident occurred in NHS or private practice.
Your Incision insurance requires you to promptly inform ("notify") your insurers of any issues, so do this as soon as you suspect you may be an Interested Person in an inquest. Timely notification ensures you avoid coverage problems and get the right medico-legal support when needed. Delaying offers no benefit. If in doubt, notify us early to avoid complications later. especially if the death was unexpected and you were involved in the patient's care. If someone at your hospital suggests you will be criticised for your care or that you need legal advice, notify Incision immediately.
If you contact Incision when first asked for a statement, they’ll handle any necessary notification for you. Early contact ensures the best support through the process, helping protect your reputation during what will be a stressful time following a patient's unexpected death.
Healthcare professionals acting as expert witnesses may be asked to provide reports for Coroners or Interested Parties and could be cross-examined at the Inquest. This can be prestigious and lucrative work.
Before accepting your first Inquest instruction, seek guidance from both the instructing party and the Incision medico-legal team. Additional training may be helpful, as Inquest procedures differ from Civil or Criminal courts.
Also, ensure your Incision professional indemnity cover extends to Inquest-related medico-legal work. If adjustments are needed, the Incision team can assist quickly to make sure you have the right scope of cover for your practice, at all times.
At Incision, we're here to support you through challenging times. Our services include:
Being called to a Coroner's Court to give witness evidence is a serious but manageable responsibility. By understanding the process, preparing thoroughly, and utilising the support available from your medical indemnity provider, you can navigate the inquest with confidence. Remember, our primary goal is to ensure you are well-supported and protected, allowing you to focus on providing the best possible care to your patients.
For further information or assistance, please contact our medico-legal helpline at medicolegal@incisionindemnity.com or 0333 010 2826. We are here to help you every step of the way.
As a healthcare professional, you strive to provide the best care to all patients. However, sometimes you may encounter a patient whose behaviour or demands are unreasonable, disruptive, or even abusive. In such cases, it is crucial to recognise when it is appropriate to terminate the patient-provider relationship before it escalates. This article provides guidance on identifying difficult patients early, handling these situations professionally, and ensuring the safety and well-being of both you and your staff.
Difficult patients can exhibit a range of behaviours that disrupt the clinical environment and compromise care quality. Some common indicators include:
Excessive Demands: Repeatedly demanding unnecessary tests, medications, or treatments.
Aggression: Verbal or physical aggression towards staff or other patients.
Non-Compliance: Consistently failing to follow medical advice or treatment plans.
Manipulative Behaviour: Attempting to manipulate staff to receive special treatment or prescriptions.
Frequent Complaints: Constantly complaining without reasonable cause or justification.
In rare circumstances, the breakdown of trust between you and a patient means you can’t continue to provide them with good clinical care. This might occur when a patient has, for example:
You should not end a professional relationship with a patient solely because of:
Initial Assessment: Pay attention during the first interaction. Look for signs of demanding behaviour or aggression.
History Check: Review the patient’s medical history for any red flags, such as frequent changes in healthcare providers or a history of non-compliance.
Staff Feedback: Listen to feedback from your team regarding their interactions with the patient.
Setting clear boundaries from the outset can prevent escalation and protect your practice. Here are some strategies:
Clear Communication: Clearly explain your practice policies, including appointment scheduling, treatment plans, and follow-up procedures.
Written Agreements: Consider using written agreements that outline the patient’s responsibilities and the consequences of non-compliance or disruptive behaviour.
Consistent Enforcement: Apply your policies consistently to all patients to avoid any perceptions of unfair treatment.
If it becomes necessary to end the patient-provider relationship, it must be done professionally and ethically. Here are steps to consider:
Before you end the relationship:
Immediate Termination:
It may be reasonable to end a relationship immediately in certain circumstances. For example, primary care regulations and contracts allow for the immediate removal of patients from practice lists if a patient has been violent or behaved in a way that has caused other people to fear for their safety. You must follow local or national guidance and regulations.
Restoring the Relationship:
Before you end a professional relationship with a patient, you should:
When you've made the decision to end the relationship:
Documentation:
Document all interactions with the patient, including any incidents of disruptive behaviour or non-compliance. This will support your decision if it is ever questioned.
Written Notice:
Provide a written notice to the patient, explaining the reasons for the termination of the relationship. Ensure that this notice is clear, respectful, and includes a reasonable notice period.
Alternative Care:
Where possible, offer to assist the patient in finding alternative care. Provide a list of other healthcare providers or refer them to a relevant service.
Emergency Care:
Inform the patient that you will continue to provide emergency care for a specified period until they find a new provider.
______________________________________________________________________________________________________________________
Here is a template for a professional termination letter:
[Your Practice’s Name]
[Your Address]
[City, Postcode]
[Date]
[Patient’s Name]
[Patient’s Address]
[City, Postcode]
Dear [Patient’s Name],
After careful consideration, I regret to inform you that I am no longer able to provide medical care for you at [Practice Name]. This decision has been made based on [specific reasons – e.g., repeated non-compliance with treatment plans, disruptive behaviour, etc.].
We understand the importance of continuous medical care and want to ensure you have adequate time to find another healthcare provider. Therefore, we will continue to provide emergency care for the next [30 days/appropriate period], until [date].
To assist you in this transition, I have enclosed a list of alternative healthcare providers in our area. Additionally, your medical records can be transferred to your new provider upon your request.
We wish you all the best in your future healthcare needs.
Sincerely,
[Your Name]
[Your Title]
[Practice Name]
__________________________________________________________________________________
Handling difficult patients can be challenging, but you are not alone. As your medical indemnity provider, we offer:
Legal Advice:
Guidance on the legal aspects of terminating a patient relationship.
Risk Management:
Resources and training on managing difficult patients and setting effective boundaries.
Emotional Support:
Our Medico-Legal Advisors are there to assist and listen to you, for you and your staff to cope with the stress of dealing with challenging situations.
Recognising and addressing difficult patient behaviour early is crucial for maintaining a safe and effective practice environment. By setting clear boundaries, documenting interactions, and terminating relationships professionally when necessary, you can protect yourself, your staff, and your other patients. Remember, we are here to support you with expert advice and resources to navigate these challenging situations.
For further information or assistance, please contact our dedicated support team. We are here to help you every step of the way.
Extending far beyond our comprehensive coverage, Incision provides all members with a wealth of risk management material, educational resources and 24/7 in-house medico-legal support.
Incision Indemnity
c/o Paragon International Insurance Brokers Ltd
140 Leadenhall Street London EC3V 4QT
Medico-legal Advice 0333 010 2826
Membership Information 0333 444 1515
Incision is a trading name of Paragon International Insurance Brokers Limited (Paragon) which is authorised and Regulated by the Financial Conduct Authority and is an Accredited Lloyd’s Broker. Registered in England. Company no. 03215272. Paragon International Insurance Brokers Limited, 140 Leadenhall Street, London, EC3V 4QT
