Originally published March 2013 / Revised June 2016
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.
The difference between a coroner and a medical examiner
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, coroners in some provinces and territories need not be physicians. The majority of provinces and territories use the coroner system to investigate deaths. Irrespective of the system, the objective remains to determine the cause and circumstances surrounding certain deaths and to identify the deceased and the time of death.
Each province and territory has legislation governing the circumstances that require the reporting of a death to the coroner. Typically any person, including a physician, has the duty to report a death that they have reason to believe occurred under a circumstance listed in the legislation. These circumstances include violence or homicide, death during pregnancy, negligence, misconduct or malpractice, or when a death is unexplained or unexpected. The specific legislation in each jurisdiction might require physicians to report information about a death to the coroner in other circumstances.
Death certificates and medical assistance in dying
Medical assistance in dying (MAID) has been legal in Québec since December 10, 2015, and federal legislation now authorizes MAID across Canada in accordance with eligibility criteria and safeguards. It is expected that provincial and territorial legislation may be adopted to address the legislative and regulatory requirements regarding completion of death certificates in the context of MAID, and in particular the classification of the cause of death and reporting the death to the coroner or medical examiner. Physicians should be aware of any legislative and regulatory requirements regarding the reporting of the death to the coroner or medical examiner in that context.
Since the legislation usually requires that the person reporting has "reason to believe" the death occurred under one of the circumstances listed, when determining whether a death requires reporting to the coroner, physicians should consider 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.
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 the Yukon, Northwest Territories, and 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 the Territories 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
- The office of the coroner or medical examiner is mandated by legislation and plays an important societal role, one which should be respected and facilitated when possible.
- Statutory provisions 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, members should consider their duty of confidentiality to the deceased patient. 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. In the absence of a search warrant or summons, a physician is under no obligation to respond to questions posed by a coroner.
- 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.
The CMPA is pleased to assist members and provide advice when dealing with requests by coroners or medical examiners.