Fallout from the Shipman caseBMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7244.1271 (Published 06 May 2000) Cite this as: BMJ 2000;320:1271
Deaths should be investigated more plainly and effectively
- J M N Hilton, director (firstname.lastname@example.org)
- New South Wales Institute of Forensic Medicine, Sydney, Australia
- London N1 3DL
- Centre for Professional Ethics, University of Central Lancashire, Preston PR1 2HE
- Department of Public Health Sciences, Medical School, Edinburgh EH8 9AG
- Bethnal Green Health Centre, London E2 6II
- Stockport SK6 5PQ
- Health Centre, Sheffield S20 1BJ
- Department of Sociology, Staffordshire University, Stoke-on-Trent ST4 2DE
- Duke University Medical Center, Durham, NC 27707, USA
- Street, Somerset BA16 OHB
EDITOR—O'Neill's editorial and the news article by Dyer, which both arose from the Shipman case, raise several points that merit further consideration.1 2
The fact that a central registry of doctors' prescribing habits is geared to financial rather than good practice principles perhaps reflects the current fiscal climate. Concern about death certification and coroners dates back to the Brodrick committee.3 I wonder what was entered on the death certificates of Shipman's patients, how carefully the certificates were scrutinised by the registrar of births, deaths, and marriages, and what was the degree of training and expertise of those scrutinising them.
Australian experience mirrors that of the United Kingdom, with inaccuracies in death certificates. Surely, however, characterising the immediate cause of death of valued citizens, irrespective of their age or sex, can never be meddlesome. Inaccuracy in documenting any aspect of medical practice should not be readily accepted.
The English coronial system was adopted by many former colonies but has largely tended to diverge from English practice. In New South Wales the coroner's act requires any person to report any death or suspected death within a defined category to a member of the police or a coroner. This is a general duty and not one peculiar to the medical or nursing professions. Some 6000 of around 50 000 deaths are so reported each year. Generally, every coronial death will have a full necropsy, 4500 by a forensic pathologist.
Pathologists conducting necropsies should always have a high index of suspicion. Although interpreting opiate concentrations in fresh cadavers is difficult and made much worse by decomposition, postmortem drug screening reveals the presence of most therapeutic drugs and many poisons and is both rapid and inexpensive using blood and urine samples.
In this brave new fiscal world the cost effectiveness of necropsy and …