Opinion Former Article

MRSA Action UK assess the Coroner's and Justice Bill

MRSA Action UK is a registered charity that supports people who have been affected by healthcare infections. Providing advice and information to people who enquire on the best way to prepare and reduce the risks of contracting an infection, the charity is well placed to help provide a patient voice to those who influence and regulate the delivery of high quality, safe patient care.

Working in partnership with healthcare providers, both in the public and private sector in the United Kingdom, MRSA Action UK are an independent organisation who advise and work with government, the public, patients and other professionals to promote awareness of healthcare infections and how to prevent them.

We welcome the Creation of a new system of secondary certification of deaths not referred to a coroner.

The role proposed for Medical Examiners in confirming the cause of death for all deaths not investigated by the coroner will mean that Registrars will no longer need to make judgements about the content of The Medical Certificate of Cause of Death - an activity for which they are often poorly qualified - and will need to report fewer incidence of questionable certifications to the coroner.

The Medical Examiners Officer will oversee the application for disposal of the body with relatives and The Medical Certificate of Cause of Death will be scrutinised by the Medical Examiner and discussed with relatives. At this stage relatives who believe the death may have been caused by a healthcare infection or was a significant contributory factor can raise concerns. We are hopeful that this will be a vehicle to be able to challenge poor practice and the non-recording of infections on death certificates. The true toll to deaths from healthcare infections will begin to evolve.

The need for transparency and independence

We are of the view that the Medical Examiners should be accountable to, and appointed by the Coroner's Office and not appointed by Primary Care Trusts. The governance is important for the Medical Examiners to be able to be completely independent. The Medical Examiner's role should be to scrutinise the death certificates and act as a source of medical expertise within the coroner's office.

We believe the reform of death certification should produce a significant improvement in the quality and consistency of information on death certificates. The Medical Certificate of Cause of Death provides a valuable source of information on diseases, which is important for the general public, clinicians and those responsible for planning health services.

It will greatly help Primary Care Trusts and Hospital Trusts to ensure they have consistent and robust arrangements in place to assist doctors in death certification.

The National Confidential Study of Deaths Following Meticillin-Resistant Staphylococcus aureas (MRSA) Infection identified significant anomalies with non-recording of MRSA or septicaemia.1 Together with our own experience from the public contacting us, we believe published figures are greatly underestimated and may be at least double the numbers reported by the ONS, an accurate picture is needed so that actions can be taken to avoid preventable deaths in the future.

The study identified that of the clinicians interviewed none were aware of whether their Trust had a policy or procedure regarding death certification. The majority stated that death certificates were usually completed by the most junior members of the team. Training for doctors completing death certificates varied and mainly consisted of a short training session during induction, with a few others stating that training was also provided during the final year of pre-registration training.2

The ONS recognise that death certification practices differ between doctors and establishments. This means that some establishments may be more likely to record MRSA and Clostridium difficile than others. Some establishments may undertake more comprehensive screening or testing for MRSA and Clostridium difficile, and may do this more often than others. The ONS in its publishing of causes of death in establishments also recognises a number of factors influencing recording of healthcare associated infections including as a result of varying standards of care.3

A charter for the bereaved

We welcome the charter for bereaved people who come into contact with a reformed coroner system and its revisions, and we welcome the guidance that will be provided to other interested parties. We believe organisations, including Hospital Trusts must have similar responsibilities to the bereaved placed upon them in dealing with the Medical Examiner and Coroner's Office, namely they should:

· have a statutory responsibility to provide all information to the Medical Examiner and the Coroner's Office that is relevant to the investigation

· when requested, should treat with confidence any information or documents they have disclosed to them

· should treat the bereaved, the Medical Examiner, the Coroner and his or her staff with courtesy and respect at all stages of the investigation

With the assistance of the Chief Coroner, coroners will maintain information on the main local and national voluntary bodies, support groups and faith groups which offer help or support to people who have been bereaved, including bereavement as a result of particular types of incidents or circumstances. They will make this information available to family members or their representatives unless they request otherwise.

MRSA Action UK believe this should include reference to the availability of support of the independent Medical Examiner to explain the processes and help relatives if they need help in understanding what is involved.

Interim arrangements have been made to enable relatives to draw the medical referee's attention to any concerns about unexpected symptoms or discrepancies in the cause of death, until the legislation has passed. The right of families to inspect medical forms of a deceased relative completed by doctors before cremation takes place was effective from 1 January 2009. MRSA Action UK believe this should be extended to burials.

It is in the public interest on the grounds of safety for deaths attributable to outbreaks of healthcare infections to be recorded so that recommendations made by Coroners and relevant agencies are acted upon. We believe that bereaved relatives will come forward where they have evidence to suggest that healthcare infections were a contributory factor or cause of death, and as such guidance and standards should be set out on how to deal with this matter sensitively and in a manner that is in the best interest of everyone involved.

MRSA Action UK ask that any relatives who believe their loved one either died from MRSA or another healthcare infection, or that it was a contributory factor in their death have the right for the death certificate to be amended. If bereaved people come forward the case notes should be reviewed, this will allow a true picture to be given and then there will be transparency for the public, and an assurance that everything is being done to reduce avoidable deaths from healthcare infections - without a baseline figure how will we know what improvement and saving lives looks like. It is also the final posthumous thing that the bereaved can do for their loved ones.

Derek Butler
Chair, MRSA Action UK
Registered Charity 1115672
20th July 2009
Contact: derek.butler@mrsaactionuk.net
Telephone: 07762 741114
Website: http://mrsaactionuk.net

References:

1 National Confidential Study of Deaths Following Meticillin-Resistant (MRSA) Infection, Page 7, Health Protection Agency - November 2007

2 National Confidential Study of Deaths Following Meticillin-Resistant (MRSA) Infection, Page 13, Health Protection Agency - November 2007

3 Deaths involving Clostridium difficile by communal establishment, England and Wales, 2001-07 - Office for National Statistics - 28 August 2008;

Deaths involving MRSA by communal establishment, England and Wales, 2001-07 - Office for National Statistics - 28 August 2008

MRSA Action UK response to the Ministry of Justice draft charter for bereaved people who come into contact with a reformed coroner system

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