Coroners, also known as medical examiners, play an important role in public safety. While physicians may be familiar with their obligation to report certain deaths to coroners, many may not know how best to respond to a coroner's request for information. And while physicians respect the mandate of coroners and medical examiners, they must also balance co-operation with their obligations to patients.
Coroners are responsible for determining the cause and circumstances surrounding unexpected, unnatural, or unexplained deaths. They are also responsible for identifying the deceased and the time of death. This is usually done by means of an investigation and in some cases an inquest, also known as an inquiry in some jurisdictions. As part of this investigation, the coroner may order an autopsy.
During an investigation, coroners may identify practices or conditions that could have led to the death and may make recommendations to prevent similar deaths. They may also identify mortality trends over time.
While the terms "coroner" and "medical examiner" are often used interchangeably, they represent different systems of investigating deaths. For example, although medical examiners are physicians, most jurisdictions use the coroner system to investigate deaths, and coroners do not need to be physicians.
Every Canadian jurisdiction has legislation requiring physicians to report a death they believe occurred under a listed circumstance. These circumstances include – but are not limited to – violence or homicide, death during pregnancy, negligence, misconduct or malpractice, or when a death is unexplained or unexpected.
Since the legislation usually requires that the physician have "reason to believe" the death occurred under a listed circumstance, physicians should assess whether they have sufficient and reliable information to draw conclusions about the circumstances of the death.
When notifying the coroner, physicians should be careful to respect their duty of confidentiality to the deceased and refrain from disclosing additional information other than what is necessary to comply with the reporting obligation. When a physician volunteers more information than is required to comply with the law, without obtaining the consent of the deceased patient's legal representative, the disclosure could be considered a breach of the physician's duty to protect the confidentiality of the patient's information.
Death certificates and medical assistance in dying
Physicians may need to notify the coroner or medical examiner when an individual receives medical assistance in dying (MAID). The obligation to report MAID deaths varies from one province/territory to the next. Physicians should be aware of any legislation or College policies regarding the reporting of MAID deaths in their jurisdiction.
Provincial and territorial legislation sets out the circumstances in which a coroner may obtain records about a deceased person for the purpose of conducting an investigation into the individual's death.
In most jurisdictions, the legislation provides broad investigative powers to the coroner (or the coroner's delegate) to inspect and copy records relating to the deceased. In these jurisdictions, the coroner may not need a warrant to gain access to records. Nonetheless, physicians who receive a coroner's request for patient records should ask the coroner to confirm the authority under which they are making the request. Once the coroner confirms his or her authority to review the records, physicians should co-operate with the investigation. It is an offence in many jurisdictions to hinder or interfere with a coroner's investigation.
In Nunavut, a coroner must obtain a warrant to compel the disclosure of information believed to be material to the investigation unless the matter proceeds to an inquest. It is reasonable and prudent for physicians in Nunavut to ask for a copy of the warrant before disclosing the requested information to the coroner or a delegate. It is also important that physicians disclose only those records listed in the warrant so as not to breach doctor-patient confidentiality.
While coroners have the power to inspect, seize, or make copies of medical records, there is no power granted in the legislation to question physicians as part of their investigation. Nonetheless, it may be reasonable for a physician to translate a shorthand notation in the patient's medical record. However, members should otherwise refrain from volunteering additional information without the consent of the deceased patient's legal representative (i.e. estate).
Following an investigation, the coroner can make recommendations to the chief coroner (or chief medical examiner) as to whether or not an inquest or an inquiry should be held. Inquests are usually presided over by a coroner or a judge. In some jurisdictions, a jury will make findings and issue a verdict. Hearings are usually public, unless an exception applies.
Coroners and judges presiding over inquests have extensive powers to govern the proceedings. They may summon anyone as a witness to give evidence or produce documents. They also can admit evidence that might not otherwise be admissible in judicial proceedings.
Physicians may be summoned to attend an inquest to give evidence under oath about a deceased patient and may be required to bring medical records with them. Some jurisdictions (i.e., British Columbia, Alberta, Ontario, and Newfoundland and Labrador) specify that evidence given by a witness at an inquest is not admissible in other proceedings. This ensures that, in those jurisdictions, testimony given by a physician at an inquest cannot be introduced as evidence against the physician in subsequent civil or regulatory proceedings. Most jurisdictions, with the exception of Manitoba and New Brunswick, specify that inquests cannot make determinations of liability or conclusions of law.
The bottom line
- Legislation may allow a coroner to access medical records, but generally do not require a physician to engage in a verbal or written dialogue with the coroner about a patient's care.
- When disclosing information at the request of a coroner, or when fulfilling the duty to notify the coroner about a reportable death, physicians should consider their duty of confidentiality to the deceased patient.
- Members should communicate with the CMPA if they are contacted by a coroner (or delegate) for medical information or if they receive a summons or warrant to disclose records or attend an inquest.