Inconsistent coroner interpretations of cardiac death in the presence of cannabis in urine

Abstract

In Ireland, the Coroners Act 1962 is still in place and coroners are relatively autonomous. Coroners may be medical practitioners or lawyers. The Coroners Bill 2007 was never passed into law but did include the office of Chief Coroner whose job entails the provision of leadership and direction in all coronial matters. In England and Wales, the Coroners and Justice Act 2009 introduced a system of checks and balances with a Chief Coroner who must be a lawyer backed by Medical Examiners. The National Medical Examiner must issue guidance to District Medical Examiners to insure that they carry out their functions in an effective manner. Northern Ireland still operates with the Coroners Act (Northern Ireland) 1959. Scottish Law is based in large part on Roman law, and death investigations are carried out by the local public prosecutor called the Procurator Fiscal. In the era of continuing professional development and accreditation of professional standards and procedures, coroner’s law does not explicitly deal with the issue of quality assurance and professional audit in the common law jurisdictions of England, Wales, Northern Ireland, and the Republic of Ireland. In Ireland, the intention of Section 45 of the new 2007 Coroners Bill, is to allow the Attorney General to order a new inquest after consultation with the Chief Coroner when a problem arises. The only other appeal mechanism is a Judicial Review under Section 62 of the Bill. This is intended to modify a similar section of the Coroners Act 1962, Section 24. In Northern Ireland, the 1959 Coroners Act, Section 14, allows the Attorney General to order an inquest even where a coroner has already held an inquest. The Lord Chief Justice has a role in the regulation of practice and procedure. In England and Wales, under Section 40 (8) of the Coroners and Justice Act 2009, an appeal to the Chief Coroner may be made to amend a determination or finding. An appeal to the Court of Appeal against a decision of the Chief Coroner may only be made on a point of law under Section 40 (9). Consistency of interpretation of the same data is important in medical diagnosis. Coroners rely on the accuracy and competence of interpretations by expert witnesses who play an important role in the coronial system. The expert witness has a primary duty to the court rather than the client [1]. The Law Commission Report recommends that the court should rule on the experts’ areas of expertise before they give evidence [2]. This is particularly pertinent in evidence from pathologists. Can an expert in histopathology give definitive evidence in biochemical toxicology? The following cases illustrate the need for quality assurance in relation to coroners court proceedings. These cases involve the finding of cannabinoids in the urine in cases where the decedents died from acute myocardial infarction. The key article linking the triggering of acute myocardial infarction with cannabis smoking is the report that smoking cannabis increased the risk of myocardial infarction 4.8 times over baseline in the hour following the initiation of smoking. The relative risk for the second hour was 1.7 but the 95% confidence interval was 0.6–5.1 [3]. Cannabis declines to about 10% of peak levels in blood within 1–2 h [4]. Positive urine cannabinoids with zero W. Tormey (&) T. Moore School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland e-mail: billtormey@gmail.com