Coroner's Jurisdiction Research Articles

Systemic sclerosis (scleroderma): An insight into a rare condition and cause of death

Systemic sclerosis is a debilitating and rare autoimmune disease with only approximately 200 cases in Singapore (from 2008-2012). Cardiovascular and pulmonary involvement remain the leading causes of mortality in these patients. We present a 46-year-old Chinese male who was found dead in his home. He had presented to the emergency department with generalised weakness, dysphagia and skin thickening prior to his demise, prompting a presumptive diagnosis of scleroderma. He also had anaemia and mild transaminitis. Significant autopsy findings included thickened skin and extensive adhesions in the pleural cavity. Histological sections showed extensive subendocardial fibrosis with vasculopathy affecting the intramural myocardial vessels as well as pulmonary arterial hypertension. Fibrosis involving the wall of the oesophagus and the dermis was also present. An interesting finding was that of extensive hyalinisation of the lymph nodes in the deceased. Our findings concur with those described previously in literature and the likely cause of mortality in our case was due to extensive cardiac and pulmonary involvement. Most of the mortalities occurring from this condition are not subjected to the coroner's jurisdiction. However, the rare case that presents at the autopsy suite does provide an educational insight to the pathology behind the condition.

Local variations in reporting deaths to the coroner in England and Wales: a postcode lottery?

AimsIn England and Wales, doctors are charged with a responsibility either to report a death to the coroner or issue a medical certificate specifying cause of death. A lack of...

Toxicology: What is Routine for Medicolegal Death Investigation Purposes?

Drugs, whether illicit, prescription, or over-the-counter, cause or contribute to death in many cases falling under medical examiner or coroner jurisdiction. Thus, toxicological analysis often plays a critical role in the determination of the cause and manner of death. There is significant variability, however, between medicolegal death investigation systems with respect to standards of practice for the performance of “routine” toxicological analysis. Depending on a multitude of variables, including the size of the office, caseload, population base, budget, laboratory testing panel, pathologist philosophy, and personnel availability, routine toxicological analysis may range from no testing at all, to minimalistic urine screening, to complete quantification of all potential toxins identified on screening assays. As physicians, forensic pathologists are trained to search for the correct diagnosis in every case, every time. When establishing protocols and defining routine toxicological analyses, however, the pathologist is often forced to consider the pros of thoroughness and accuracy, versus the cons of cost and diminished timeliness of results. A rational approach to forensic toxicology is offered in an attempt to combine efficiency and frugality with acquisition of essential medicolegal data.

Essential Medicolegal Death Investigation Services: Standardization of a Survey Instrument Based on the Essential Public Health Services

The National Academy of Sciences recommends that states assess the performance of medicolegal death investigation agencies. To aid in performance assessment, we adapted an instrument based on the CDC's 10 Essential Public Health Services by translating the terminology to that of essential medicolegal death investigation services. This produced a survey that could be used to standardize reporting practices and services of agencies. To validate the instrument, a stratified random sample of 12 death investigation chiefs in 12 states was interviewed. This sample represented both medical examiner and coroner jurisdictions within the varying medicolegal structures. A cognitive testing process elicited how well participants could respond to and interpret the survey questions. The response was favorable in that the respondents agreed that given specific revisions toward question clarification, the instrument would be a useful and relevant tool for assessing system performance.

The coroner's jurisdiction 2: the current law in the UK

Ivy Smith was admitted to the accident and emergency (A&E) department following an overdose. The A&E staff attempted to ‘pump’ her out, but she died despite their efforts. The coroner was informed. Ivy's mother said that she did not feel that she could give evidence at an inquest and wondered if she could be excused. What is the law?

The coroner's jurisdiction 1: the current law in the UK

Ray Dobson fell downstairs during the night and was rushed to hospital by ambulance. He died shortly after his admission and his widow, Mary, was advised that the death was being reported to the coroner. She was concerned at the implications for herself and whether it would delay a funeral and cremation. What is the law?.

A study of suicides in Kildare, 1995–2002

This paper focuses on 109 cases of suicide that occurred in Kildare from 1995 to 2002. These statistics were obtained by examining the records of the Kildare County Coroner. There is no central national location for the records of the 48 coroner jurisdictions in Ireland and all coroners are required by law to retain the files on each inquest indefinitely. However, the actual record of verdict given at inquest is not the one used for determining the suicide rate in the country. This is achieved by the Central Statistics Office (CSO) Form 104, which asks for the investigating police officer to give his or her opinion as to the cause of death. This results in discrepancies between what the coroner records and what the official suicide rate is presumed to be. These figures are further influenced by some coroners choosing to return a verdict “death in accordance with the medical evidence” as opposed to a verdict of suicide. The files were also examined to find the high-risk groups or those groups which have a tendency towards suicide. Over 84% of suicides were male and 32 men were between the ages of 20 and 30. It is suggested that the standardisation of recording verdicts of suicide be implemented as soon as possible as the current situation leads to variances between coroner's records and those kept by the CSO.

Sudden, unexpected cardiac or unexplained death in England: a national survey

Post-mortem examinations of adults who were apparently healthy but died suddenly and unexpectedly sometimes reveal no morphological abnormalities to explain their deaths. The frequency of such unexplained deaths in relation to other causes of sudden cardiac death is not known. To estimate the frequency of sudden unexpected cardiac or unexplained death in England. Prospective survey using a stratified random sample of 83 of the 132 H.M. Coroner's jurisdictions in England. Consecutive White Caucasians, aged 16-64 years, with no medical history of cardiac disease, seen alive within 12 h of death, on whom autopsy found either a cardiac or no identifiable cause of death, were included. The coroner's officer sent a copy of the post-mortem report and a completed case registration form to the investigators, with tissue samples. Sixty-seven (81%) coroners participated, each maintaining prospective surveillance for 4 months. Of 692 ascertained cases, case registration forms were received for 650 (94%), post-mortem reports for 682 (99%), blood samples for 569 (82%), myocardial slices for 517 (75%) and whole hearts for 47 (7%). In cases with myocardial tissue, death was ascribed to ischaemic heart disease in 465 (82.4%). In 43.1% the ischaemia was acute, in 19.1% there was myocardial scarring but no acute ischaemia, and 20.2% had coronary atheroma only. Death was due to left ventricular hypertrophy in 32 (5.7%), to other cardiac causes in 30 (5.3%) and in 23 (4.1%) there was no clear cause. Those with cardiac causes were 81% male, median ages 55.9 (male) and 56.6 (female) years. The 23 unexplained deaths were 57% female, median ages 40.5 (male) and 54.9 (female) years. The estimated annual frequency of sudden unexpected death due to cardiac or unidentified causes, in English adults of employment age, was 11/100,000 (3481 annual deaths). In 4.1% of sudden unexpected deaths under 65 years, no cause was found. Until it becomes accepted practice to identify these cases by a name, such as Sudden Adult Death Syndrome (SADS), it will not be possible to study their aetiology systematically.

Heat-related mortality in selected United States cities, summer 1999.

As part of a public health response to severe heat waves in the midwestern and northeastern United States in the summer of 1999, the authors actively solicited the number of heat-related deaths from 38 medical examiner and coroner jurisdictions comprising 35 metropolitan areas to enumerate heat-related deaths in areas affected by heat waves. They also determined the usefulness of these data for surveillance and rapid investigation of heat-related deaths. A total of 334 heat-related deaths were reported during the study period of July 1 - August 31. Minor changes in data collection and diagnostic criteria in some medical examiner and coroner jurisdictions would allow for greater comparability among jurisdictions. The National Association of Medical Examiners' position paper on heat-related mortality diagnosis provides important guidance to medical examiners and coroners regarding the certification of heat-related deaths and may require some refinement to address certain issues. Among these are certifying manner of death and classifying potential causes of heat-related death not involving hyperthermia or heat stroke, but where heat is a potential contributing factor to death. Medical examiners and coroners are an important resource for heat-related mortality research, and improvements in data collection and reporting could yield tremendous benefits to our understanding of and interventions for heat-related deaths.

Death Investigation in Canada

A survey of death investigation systems in Canada was conducted by questionnaire and included questions on the type of system used (coroner or medical examiner), budget, method of appointment and qualifications of coroners and medical examiners, responsible department of government, training requirements, laboratory facilities, and the utilization of investigators and pathologists by each jurisdiction. Of the population of Canada 81.5% reside in coroner jurisdictions, the primary death investigator in 81% of the population is a licensed physician. The majority of jurisdictions either require or provide training in death investigation. All death investigation systems are under the respective provincial or territorial department of Justice or Attorney General with the chief coroner or chief medical examiner appointed by their respective provincial cabinet. The qualifications of the chief coroner vary with jurisdiction, while in 75% of medical examiner jurisdictions the chief medical examiner must be a pathologist. On a per capita basis medical examiner systems are less expensive to operate than coroner systems.

Sudden unexpected cardiac death: methods and results of a national pilot survey

In order to develop a methodology for measuring the occurrence and circumstances of sudden unexpected adult deaths due to cardiac and to unidentified causes throughout England, a stratified random pilot sample of 12 of the 133 coroner's jurisdictions in England was invited to survey prospectively a quota sample of 78 consecutive white Caucasians, aged from 16 to 64 years, with no history of ischaemic heart disease, who were last seen alive within 12 h of being found dead, and for whom a coroner's post-mortem examination found either a cardiac or no identifiable cause of death. Eleven (92%) coroners participated. In a median of 105 days (range 21–169), 65 cases (83% of the quota) were ascertained (54 (83%) males). Of the ascertained cases, registration forms were received on 62 (95%), tissue specimens on 63 (97%), and post-mortem reports on 58 (89%). Death was witnessed in 58%, of which 35% were ‘instantaneous’. The median time from symptom onset to death was 40 min. In unwitnessed deaths, the median time since last being seen alive was 90 min. Sixty-eight per cent of all deaths were attended — by a relative in 34%, passer-by (8%), ambulance crew (32%), nurse (11%), doctor (38%), and police (9%). Cardio-pulmonary resuscitation was attempted in 38 of the 42 attended deaths. Sixty-seven per cent were taken ill at home, 12% at work, 12% in a public place, and 10% elsewhere. The certified cause of death was ischaemic heart disease in 89%, in whom coronary thrombosis and/or myocardial damage was absent in 6 cases (9%). In the remainder, the certified cause was hypertensive heart disease (5%), hypertrophic obstructive cardiomyopathy (3%), ‘cardiomegaly’ (1.5%) and ‘sudden cardiac arrhythmia’ alone (1.5%). A retrospective audit of coroner's records revealed the median case ascertainment rate was 75%. This approach to surveying sudden unexpected adult death nationally resulted in a high response rate (92%) from coroners, consultant pathologists and their staff, the identification of a large proportion of eligible cases, and complete information in most of the identified cases. In from 2% to 15% of cases, death may have been either purely dysrhythmic or due to a sudden adult death syndrome.

Inner urban and national suicide rates, a simple comparative study.

The authors have calculated the suicide rate per million for individual causes of death in the Inner North London Coroner's jurisdiction and also a composite rate for all methods of self-destruction. These have been compared with the rates for England and Wales in the years 1979-1985 inclusive. Also calculated has been a total 'non-accidental' death rate comprising all deaths by self-destructive behaviour. For certain causes the two rates are similar but for the remainder there are wide differences. The effect of the law relating to suicide verdicts has been described and its effects discussed.

Asthma deaths: a review.

This paper describes a retrospective autopsy study of 285 asthma deaths in the coroner's jurisdiction in North and West London over a period of 30 years. The survey comprised 143 females and 122 males, with a strikingly large number of deaths occurring in the 1960–1970 era, covering the period that Isoprenaline inhalers were in common and widespread use. The study confirms a seasonal variation, in that deaths occurred more frequently in the third quarter of the year in both males and females, with a further increase in deaths in females in February and March. The age distribution shows that the majority of deaths occurred between 45 and 75 years of age, with a separate peak in males aged 25–29 years. The majority of deaths occurred at home.