Coroner's Rule 43 aims to prevent deaths

One criticism which is often levelled at the system of coroner's inquests is the limited remit of the inquest.

The purpose of an inquest is not to apportion blame but to answer four questions: who died, when they died, where they died and how they died.

Often family members wish to see someone held accountable for their loved one's death and to have assurances that similar deaths will not occur.

A coroner does not make a finding of criminal or civil liability, although if that becomes a matter for the courts later, the coroner's judgment will have an effect on whether a medical negligence compensation claim or similar case could be pursued.

The verdicts of cause of death available to a coroner include natural causes, accident/misadventure, a narrative verdict, neglect contributed to the death or unlawful killing. It is within the context of neglect that criticisms of health services and clinical negligence have arisen.

One of the powers available to a coroner is the power to make a Rule 43 report.

If the coroner feels that the evidence gives rise to a concern that circumstances creating a risk of other deaths will occur or continue to exist, he/she may make a Rule 43 report which is sent to the organisation which has responsibility for the circumstances. A recipient of a Rule 43 report must send a written response within 56 days.

The response must give details of any action which has been or is proposed will be taken, or provide an explanation when no action is proposed.

Between July 2008 and March 2009, 207 Rule 43 reports were made in England and Wales, of which the majority, 31% (78), were sent to NHS hospitals and trusts.

Although an inquest cannot bring back a loved one or attempt to compensate their family for their loss, Rule 43 reports may at least offer some peace of mind that the circumstances which brought about the death are being addressed and that future deaths may be avoided.

If you would like further information about the fixed-fee coroner's inquest service our law firm offers or would like to discuss your case with one of our specialist medical negligence solicitors, please feel free to contact us. One of our lawyers will be happy to discuss your case and provide you with free initial legal advice.