About Medical Examiner Service

What is the Medical Examiner Service?

The Medical Examiner Service for Wales provides independent scrutiny of all deaths that occur in Wales that are not referred directly for investigation to Her Majesty’s Coroner. The aims of the Service are to:

Strengthen safeguards for the public. By:
- Providing robust, systematic and independent scrutiny of all deaths not referred directly to the Coroner (cause of death and circumstances surrounding it)
- Ensuring that the right deaths are referred to a Coroner and to individual care organisations for further investigation where appropriate, and
- Providing intelligent analysis and system level reporting of concerns found during scrutiny
Improve the quality of death certification. By:
- Completing the Medical Certificate of the Cause of Death directly where appropriate, or providing expert advice to doctors (usually the Qualified Attending Practitioner on behalf of the clinical team that provided the last episode of care to the deceased) based on discussion and a review of relevant clinical records
Avoid unnecessary distress for the bereaved. By:
- Giving an explanation regarding the cause of death and answering questions about the circumstances of death; answering questions or concerns about care given; and notifying appropriate parties where further investigation is required,

The scrutiny is undertaken by an independent Medical Examiner, who is also an experienced medical doctor, supported by dedicated and trained Medical Examiner Officers. They follow a systematic process of enquiry based on the following three key sources of information:

Clinical Notes
The Qualified Attending Practitioner (a doctor on behalf of the clinical team that last treated the deceased before they died), and
The bereaved

It is important to understand that the service aims to scrutinise all deaths and so scrutiny is not undertaken because there are any concerns about the care given to the person before they died.

Roles within the Medical Examiner Service

The Medical Examiner Service for Wales reviews clinical records and interacts with qualified attending practitioners and the bereaved to address three key questions:

What did the person die from? (Ensuring accuracy of the medical certificate of cause of death)
Does the death need to be reported to a coroner? (Ensuring timely and accurate referral – there are national requirements)
Are there any clinical governance concerns? (Ensuring the relevant notification is made where appropriate)

In undertaking this function, the Service employs two main roles:

Royal College of Pathologists

Royal College of Pathologists website

FAQs

Why has a Medical Examiner Service been created?

The Medical Examiner Service has been created because it has been recognised that an independent scrutiny of a death, undertaken by a Medical Examiner, who is a qualified and trained doctor but who is independent of any care provided and the organisation who provided it, allows the cause of death to be more accurately identified, and the circumstances surrounding the death to be more objectively assessed in order to identify any concerns about the treatment or care provided that may require further investigation.

What does this mean for the Bereaved?

The introduction of the Medical Examiner Service means that the bereaved will have the opportunity to speak to someone who wasn’t involved in the care of their loved one but who is able to listen to any concerns there may be about the care provided and to explain in more detail the cause of death and the circumstances that led up to it.

Where the Medical Examiner believes that a more thorough and in depth investigation into a death is needed they will be able to ensure that this happens and that the results of that investigation are fed back to the bereaved. This has not always been the case before and has sometimes led to people believing that either their concerns have not been listened to at all, or that they have been listened to but have been ignored or covered up in some way.

How does it work?

The Medical Examiner Service has four Regional Hub Offices as follows:

North Wales (covering the Betsi Cadwaladr health board area)
Mid and West Wales (covering the Hywel Dda and Swansea Bay health board areas)
South Wales Central (covering Cwm Taf Morgannwg and Powys health board areas)
South East Wales (covering Cardiff & Vale and Aneurin Bevan health board areas)

Each Region has a team of Medical Examiner Officers who gather all the relevant information on a person’s death from reviewing the clinical notes, from discussions with a member of the clinical team that provided the last episode of care for the deceased, and from discussions with the bereaved. This information is then reviewed by a Medical Examiner using a structured scrutiny process, ensuring that all deaths receive the same scrutiny wherever they occur and whoever undertakes the process.

From this scrutiny process the Medical Examiner is able to:

Advise the Qualified Attending Practitioner on the most appropriate cause of death to record on the Medical Certificate of the Cause of Death (the Qualified Attending Practitioner is the person legally required to sign the certificate), and
Identify any concerns that may need further investigation, either by a coroner or by the organisation that provided care to the deceased.
Answer questions that the next of kin may have about either the cause of death or the care surrounding it.

How long does the process take?

Based on the scrutiny process the Medical Examiner will agree a cause of death with the doctor who has been involved in the care of the person who has died (the Qualified Attending Practitioner) to allow the death to be registered with the Registry Office.

The Medical Examiner’s scrutiny process commences when we receive the medical records, a proposed cause of death from the clinical team, and the contact details for the family. The scrutiny process will take between 24 and 72 hours and the next of kin will be contacted during this time.

Once the completed MCCD has been received from the attending practitioner, the ME will check it has been completed in line with the current regulations and countersign the MCCD, we will then send this to the register office - the register office will then contact the family to arrange an appointment to register the death over the following 5 days

In a small minority of cases it may not be possible to meet this timeframe (if it has been identified that further investigation by the coroner is required and that this will require access to the body for example), but every effort will be made to ensure that any delay is kept as short as possible and that the requirements of the faith and the bereaved are met.

How is the Service accessed?

In general terms there is no need to contact the Medical Examiner Service directly as a Medical Examiner Officer will contact the relevant individuals, such as the Qualified Attending Practitioner and the Next of Kin recorded in the records of the person who has died. However if you would like to speak to the team please contact them using the details at the end of the page.

Any concerns raised by the bereaved will be considered by the Medical Examiner undertaking the review and any findings or outcomes will be discussed with the bereaved by the Medical Examiner or Medical Examiner Officer when the scrutiny is complete. If the Medical Examiner feels that there were issues with care or events revealed through scrutiny of the clinical notes or from discussion with the Qualified Attending Practitioner (a doctor, on behalf of the clinical team that treated the patient before they died) this will be fed back to the Next of Kin and the relevant care organisation for further action.

The Medical Examiner Service does not undertake further investigation of cases where concerns have been identified, this is the responsibility of the care organisation concerned.

Get in Touch

If you have a query for our Medical Examiner Service. Please contact us below: