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The National Medical Examiner Scheme. Death Certification MCCDs. Coroner. Cremation

  

Applies for deaths certified from 00:00 9 September 2024


Link to Guidance for Completion of MCCDs

Click below

Local Medical Examiner Offices

 

Email:
Coroner’s Offices

HM Coroner Referral Coventry: Notify a death

HM Coroner Referral Warwickshire: Notify a death

  • Click on the “Refer a death to the Coroner” portal on the page and type in their referral
  • Then choose “Referrer category GP”and “Referrer code GP01” on the second page
  • At the top of the second page there is also a facility to attach documents such as brief medical summary’s etc.
  • At the end of the form, click ‘submit’ and the referral will come direct to us
  • Once submit is pressed there is the option for the GP to save or print the document
After the Death Occurs

 

Process for Referring Deaths to the Medical Examiner following a Death in the Community in Coventry & Warwickshire

 

 

 

Overview of the National Medical Examiner Scheme

 

Completing the MCCD

*4 MCCDs exist in total (in English) for:

  • Live born child dying within 28 days
  • Other cause of death (see above)
  • Equivalent forms for issue by the Medical Examiner

Under the new regulations, any medical practitioner (the Attending Practitioner AP) who has “attended” the deceased during the deceased’s lifetime will be eligible to complete the MCCD and propose a cause of death if known to the best of their knowledge and belief

The requirement is to have “attended” the patient, not “seen” the patient, and this can be taken to mean “provided healthcare for” – which could include remote management, MDT discussions, telephone consulting, etc.

There is a duty placed upon the relevant attending practitioner that they must be available, as far as reasonably practicable, to respond to any enquiries that the appropriate medical examiner may have in connection with the attending practitioner’s certificate. Where an attending practitioner is unable to carry out any duties imposed on the practitioner under this Part within a reasonable time, another attending practitioner in relation to that death must carry out those duties

The Medical examiner may invite the attending practitioner to revise their MCCD (in which case the attending practitioner will either issue a revised MCCD, or decline to do so, giving their reasons for this)

An electronic version of the MCCD at some future unspecified date subject to a further change in legislation

Cremation

One of the early stated aims of the rollout of medical examiners was to achieve an effective levelling up of the scrutiny of all deaths, whether the deceased went for cremation or for burial. The new MCCD will allow for cremation (subject to the absence of a medical device or hazardous implant) without a Cremation Form 4 which is now abolished

Crematorium Medical Referees will still authorise cremation for stillbirths, coronial cases, anatomical research cases, suitable body parts and deaths occurring within the British Isles but outside of England and Wales and therefore outside of Medical Examiner scrutiny

Information Sharing

The medical examiner has a statutory basis to have access to relevant medical records

Note that GDPR does not apply to the medical records of deceased persons, and so the Access to Health Records Act 1990 will govern this information sharing. The usual Common Law Duty of Confidentiality (CLDoC) also continues to apply to records of deceased persons, but Medical Examiner scrutiny is viewed as a “direct care”activity – as such, no consent (from the deceased or anyone else) is required to share relevant information with the ME. It is generally expected that proper scrutiny is what the deceased would want

The obligation on the relevant practitioner (to share relevant information) is in Part 2 of the Regulations – relevant information is defined as the “relevant health records and any other information considered” (with a view to establishing the cause of death to the best of the practitioner’s knowledge and belief).

The Medical Examiner’s office then either:

  • Has direct access to scrutinize the GP record e.g. via cross-organisational sharing in EMIS Web or similar
  • Or expects the attending practitioner / the GP practice to make available the relevant medical records

We would consider having the above cross-organisational data sharing in place, to meet the attending practitioner’s obligations to “make available” the relevant records

If there is any other information considered that needs to be shared, then this can be shared in the covering note/letter/email/eRS referral, as per local agreements where cross-organisational data sharing arrangements are not in place

Coronial Referral

A death should be referred if:

  • The death was due to poisoning including by an otherwise benign substance
  • The death was due to exposure to, or contact with a toxic substance
  • The death was due to the use of a medicinal product, the use of a controlled drug or psychoactive substance
  • The death was due to violence, trauma or injury
  • The death was due to self-harm
  • The death was due to neglect, including self-neglect
  • The death was due to a person undergoing any treatment or procedure of a medical or similar nature
  • The death was due to an injury or disease attributable to any employment held by the person during the person’s lifetime
  • The person’s death was unnatural but does not fall within any of the above circumstances
  • The cause of death is unknown
  • The registered medical practitioner suspects that the person died while in custody or otherwise in state detention
  • There was no attending registered medical practitioner, and there is no other registered medical practitioner to sign a medical certificate cause of death in relation to the deceased person
  • Neither the attending medical practitioner, nor any other medical practitioner able to sign the medical certificate cause of death, is available within a reasonable time of the person’s death to sign the certificate of cause of death
  • The identity of the deceased person is unknown

If there is any doubt the Medical Examiner or Coroner’s Office should be contacted for further advice

Recognised causes of death for MCCDs

Royal College of Pathologists Cause of Death List

 

Guidance on Hazardous Implantable Devices

Implants that could cause issues during a cremation include, but are not limited, to:

  • Pacemakers
  • Implantable Cardioverter Defibrillators (ICDs)
  • Cardiac resynchronization therapy devices (CRTDs)
  • Implantable loop recorders
  • Ventricular assist devices (VADs): Left ventricular assist devices (LVADs), Right ventricular assist devices (RVADs), or Biventricular assist devices BiVADs)
  • Implantable drug pumps including intrathecal pumps
  • Neurostimulators (including for pain & functional electrical stimulation)
  • Bone growth stimulators
  • Intramedullary Fixion nails
  • Any other battery powered or pressurised implant;
  • Radioactive implants used to treat tumours, such as metal wires, seeds or tubes
  • Radiopharmaceutical treatment (via injection)

 

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Rugby & South Warwickshire Guidance  
North Warwickshire Guidance  

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