Perinatal pathology and the coroner/fiscal systems: consultant views

Perinatal pathology and the coroner/fiscal systems: consultant views

Daniel Nuzum (1), Brendan Fitzgerald (3), Keelin O’Donoghue (1,4), Margaret Jane Evans (2)

(1) Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland; (2) Department of Pathology, Edinburgh Royal Infirmary, Edinburgh, Scotland; (3) Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland; (4) Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.

Introduction:
During the past year (2018) it has been suggested that that all stillbirths and neonatal deaths should be referred to the Coroner/Fiscal for investigation. Objectives: This study was designed to examine the views and current practice of consultant perinatal pathologists.

Methods:
Voluntary, anonymised online questionnaire-based study of consultant paediatric/perinatal pathologists (UK and Ireland).

Results:
Thirty consultants responded (44% of total registered with EQA scheme). Six consultants (20%) gave an incorrect answer regarding the frequency of stillbirth within the UK/Ireland Demographics:
73% had been working for 10 years or more and one had retired but continued locum work. Nineteen (63%) were trained in the UK/Ireland, five (17%) within the EU and 5 (17%) outside the EU.
Coroners’/Fiscal Work: 18(60%) felt that the Coroner/Fiscal should be notified of all intrapartum stillbirths, 15 (50%) early neonatal deaths, 16 (53%) late neonatal deaths and only 1 all cases of stillbirth. 15(50%) felt the Coroner/Fiscal should investigate all intrapartum deaths and early neonatal deaths and 16(53%) late neonatal deaths. 9 (30%) expressed the view that the decision to report to the coroner/fiscal should be done on a case by case basis rather than being mandated by type.7 (23%) expressed dissatisfaction at the coronial system with one stating that the burden of the coronial work had caused them to leave their post. 3 (10%) felt that coronial /fiscal involvement was inappropriate in this type of work where issues were often of a medical nature and may contribute to delays in issuing the reports.

Discussion:
The study indicated that coronial/fiscal work was an area of controversy with the majority appearing to favour a flexible approach to cases rather than a mandated approach to investigate all cases. The concerns expressed included financing the system, insufficient consultant time, communication difficulties during the process and prolonged reporting times.

Ethics Statement:
Ethical approval for this study was granted by the Clinical Research Ethics Committee of the Cork Teaching Hospitals (Ref No: ECM4(a) 07/03/18)

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