What doctors should do if the Procurator Fiscal requires a statement
The Procurator Fiscal (PF) may request a witness statement from GPs or other health professionals to investigate a death and decide whetherto proceed with a fatal accident inquiry (FAI).
The GMC states that doctors should disclose relevant information about a patient who has died to help a PF with a Fatal Accident Inquiry.1 Not all cases proceed to an FAI. However, doctors must be prepared to give evidence at a potential FAI and should consider this when drafting their statement.
The procurator Fiscal: A recap
One of the duties of the PF is to undertake inquiries into sudden or unusual deaths. This role is similar to that of the coroner in the remainder of the UK. There are 11 PFs each covering a specific geographical location. In total, PFs investigate around 14,000 sudden deaths each year.
There are some deaths that must be reported to the PF. These include:
potentially violent or unnatural deaths (including accidents or suicide)
- sudden deaths of unknown cause
- deaths in prison or police custody
- deaths as a result of an industrial or infectious disease that may pose a serious risk to public health.
Doctors should also report deaths if there were contributory medical causes, including any complications or deficiencies in care. If a death is the subject of a complaint you should also discuss this with the PF. This list is not exhaustive and if you are unsure about whether or not to report a death, you should contact the PF, who will be able to advise you further. The Crown Office and Procurator Fiscal Services have produced useful guidance for doctors in this regard.2
In addition to doctors, police officers and the Registrar of Births, Deaths and Marriages may also report a death to the PF. If a death is sudden the Procurator Fiscal will often ask the police to interview medical and nursing staff and family members to produce a report to assist them in collating the relevant information.
Deaths may sometimes be reported because no-one has been able to issue a death certificate. The PF must decide whether a postmortem is necessary to establish the cause of death. In most cases reported to the PF, early inquiry can rule out suspicious circumstances and establish that the death was due to natural causes.
However, the PF has a duty to inquire into deaths that occur due to violence, unnatural circumstances, in custody or sudden deaths with unknown cause. The PF will decide whether there is a need for a criminal prosecution, or if a Fatal Accident Inquiry should be held, under the Fatal Accident
and Sudden Deaths Inquiry (Scotland) Act 1976.3
Fatal accident inquiries
The PF investigates many more cases of sudden death than actually result in FAIs. FAIs take place with nothing like the frequency of coroners’ inquests in the remainder of the UK. There are around 50 to 60 FAIs held each year. An FAI must be held when a death was caused during employment, or while in legal custody, ie, while being held at a police station or prison.
In other circumstances, an FAI may be held where there are issues of public safety or matters of general public concern arising from a death, and there is a need to highlight or investigate dangerous circumstances or systems that have caused or contributed to it.
The views of the deceased’s relatives are also taken into account when deciding whether to conduct an FAI. The PF makes an application for an FAI to the sheriff whose sheriffdom appears to be most clearly connected with the circumstances of the death. If an FAI is held, this is independent to any other criminal or civil proceedings.
Any individuals whom the PF believes may be able to provide relevant information will be asked to give evidence. GPs will be asked for statements if they were involved in the deceased’s care prior to death. They are often also asked for a background medical statement, even if the death occurred in hospital, since they will have access to the full GP medical records and are likely to have known the patient best.
FAIs are held by the sheriff in court. They may take several days, depending on the complexity of the case. At the end of an FAI, the sheriff makes a determination. The determination will set out where and when the death occurred and the cause of death. The sheriff may also, if he or she thinks it appropriate, comment on any precautions by which the death might have been avoided and any defects in systems that caused or contributed to the death. However, an FAI cannot make any findings of fault or blame against individuals.
- General Medical Council, Confidentiality (2009)
- Death and the Procurator Fiscal: Information and Guidance for Medical Practitioners (October 2008)
- Fatal Accidents and Sudden Deaths Inquiry (Scotland) Act (1976)