1 st September coroners draft.

Coroner Doctors and Medical Registration.

Continuing Medical Registration

As of 2011, there is no forensic medicine specialty under the schemes directed by the Irish Committee on Higher Medical Training. The Faculty of Pathology at RCPI has six subspecialty divisions – Chemical Pathology, Haematology, Histopathology, Immunology, Microbiology, Neuropathology. There is no specific forensic specialty.
The Medical Council has responsibility for the whole life long panoply of medical training and knowledge churning. This includes undergraduate education, internship, postgraduate training and professional competence and lifelong learning. “Good quality patient care requires each registered medical practitioner to continuously participate in learning activities.”

From 1st May 2011, doctors should be enrolled in a Professional Competence Scheme and engaging in professional competence activities. The Medical Council will develop professional competence schemes which will be run through the Postgraduate Training Bodies. There are two main constituents – Continuous Professional Development and Clinical Audit. The proposed minimum credits are 50 credits per year and 250 over a five year cycle. All doctors should engage in clinical audit and be involved in at least one audit per year.
Doctors should spend one hour per month in clinical audit activity.
Continuous professional development credits are earned for regional and national scientific meetings, conferences, workshops, international conferences organised by specialist groups and personal learning.

Coroners and Justice Act 2009 (UK)
In the England and Wales, the Chief Coroner must be a judge of the High Court or Circuit Court. Similarly a Deputy Chief Coroner must be the same. A Medical Adviser is appointed to the Chief Coroner t provide advice and assistance. A Medical Advisor or Deputy must be a registered medical practitioner for the previous five years and practises as such or has done within the previous five years. The Chief Coroner may make regulations regarding the type and amount of training that senior coroners, area coroners, and assistant coroners may require.
Medical Examiners are appointed by Primary Care Trusts in England and Local Healthy Boards in Wales. This person must be a registered medical practitioner throughout the previous five years and must have practised within that five year period. There is provision for the laying down of specific training for these posts. The Medical Examiner receives a copy of the attending practitioner’s certificate of the cause of death. The medical examiner is required to make whatever enquiries appear to be necessary to confirm or establish the cause of death. The medical examiner must confirm the cause of death on the certificate and to notify the registrar of that or when unable to do so, the examiner must refer the case to the coroner. A senior coroner may refer a case to the medical examiner who may issue a certificate stating the cause of death to the best of his/her knowledge, or when the examiner is unable to establish the cause of death, to refer the case back to the coroner. The medical examiner may discuss the case with the informant or with some other person (unspecified) that the examiner deems appropriate.
The Chief Medical Officer of the Department of Health after consulting the Registrar General and the Statistics Board may issue guidance as to how certificates and other forms under regulations are to be completed.
A National Medical Advisor may be appointed. He/she has been registered and practised throughout the previous five years. Their purpose is to issue guidance to medical examiners to perform in an effective and proportionate manner. And of course under whatever functions are conferred by regulations made by the Secretary of State.

Coroners Act 2009 (New South Wales)
A person is qualified to be a State Coroner or Deputy State Coroner only if that person is a Magistrate. Coronial Medical officers are appointed by the Director-General of the Department of Health. The Coroners Act 1980, Section 47 A contains the definitions of the medial officers. The Coronial Medical Officers must carry out a particular post mortem ordered by the State Coroner. A coroner may direct any medical practitioner to perform a post mortem and the coroner may direct any person that coroner considers has sufficient qualifications to carry out a special test related to the autopsy.

Coroners Act 2006 (New Zealand)
A coroner in New Zealand is a warranted judicial officer who must have been a barrister or solicitor for at least 5 years. There is a chief coroner who must be a District Court Judge or coroner before appointment and 14 coroners spread over 9 locations. The term of office of the Chief Coroner is limited to 8 years. The coroners act full-time unless otherwise authorised by the Attorney-General.

United States
There is a mixture of systems for investigations of the causes of death. There is a variation in roles and terminology. The states and counties set their own rules and qualifications. There are two systems and a mixture of both in the US. In February 2011, there were four county medical examiners only; 16 plus District of Columbia Statewide Medical Examiners; One District Medical Examiner, 11 only coroners offices by county or multi-county districts and 18 mixture of medical examiners and coroners offices in the United States. (www.npr.org/2011/02/03/131242432/graphics-how-is-death-investigated-in-your-state)
In New York, the relevant service is the Office of the Chief Medical Examiner. He/she investigates the cause of death of those who die within New York City from criminal violence, by accident, by suicide, sudden death while in apparent good health, when unattended by a doctor, in a prison or when someone dies in an unusual manner or when an application is made for cremation. In New York State, there are coroners and medical examiners. In some areas, for example Tioga County, the coroner is elected by the people.
There are specific accreditation and training requirements for coroners/medical examiners in New York State. Some counties have elected coroners many of whom are undertakers and others just have medical examiners who must be medical practitioners. Initial accreditation requires 54 credits of educational accreditation and 36 credits from New York State Association of County Coroners and Medical Examiners sponsored training courses in the first year of service. To be reaccredited, every 3 years, the appointee needs a total of 36 credits in continuing education. At least 18 credits must be from the NY State sponsored activities.

Coroners Act (Ontario, Canada) 1970
Coroners are legally qualified medical practitioners for Ontario. The Act is administered by a Chief Coroner and a Deputy. There are regional coroners appointed. A forensic pathologist and deputies are appointed. The Chief Forensic Pathologist maintains a register of pathologists who are authorised to provide services under the Act. There is a “Death Investigation Oversight Council” which has a supervisory role and has to produce an annual report to the Lieutenant Governor. Quality Assurance, performance measures and accountability are part of its remit.
The Royal College of Physicians and Surgeons of Ontario must notify the Chief Pathologist if the licence for the practice of medicine of a pathologist who is on the register is revoked, suspended or cancelled.

Coroners Bill 2007 (Ireland)
The qualifications to be appointed as the Chief Coroner or the Deputy Chief Coroner require the appointee must be a practicing barrister or solicitor of at least 10 years standing or a registered medical practitioner for at least 10 years. A coroner or an assistant coroner may be a barrister or a solicitor or a registered medical practitioner for at least 5 years. Time spent as a solicitor or a barrister and then changing discipline is allowed to count in part for the 5 necessary years.
A member of the Garda Siochana acting in support of the coroner is deemed to be a coroner’s officer except where the direction of the coroner is in conflict with the direction of the Garda Commissioner. The Chief Coroner may enter into a deal with the Garda Commissioner to engage specific Gardai to act in support of the coroner where there are interested persons. However, a Garda may not act as coroner’s officer in the death of a person in or immediately after being in Garda custody.
An Advisory Committee may be set up to advise the minister. It features in Schedule 2 of the Bill. The Advisory Committee may advise the Coroner Service and as appropriate the minister regarding the entire coronial system. This includes appeals. The personnel in the Committee consists of the Chief and Deputy Chief Coroner, two coroners, a Garda above the rank of Inspector, the Director of the Coroner Service, an officer of the minister, a representative of any other government minister who is concerned with or responsible for activities relevant to the Coroner Service and such other persons as the Minister shall from time to time appoint. The Chief Coroner or Deputy shall be the chairperson.

Coroners Act (Northern Ireland) 1959.
A coroner must be either a barrister or a solicitor of at least 5 years standing. A medical practitioner who was a coroner before the Act came into force could continue in office. A list of registered medical practitioners is kept by the Secretary of State to conduct post-mortem examinations or analyses and this list is made available to coroners.
Thus Ireland, Canada and parts of the United States utilise registered medical practitioners as coroners.
In the United States of America, Forensic Pathologists re quire 13 years of education training including 4 years of undergraduate college, 4 years of medical school, 4 years residency in anatomical and clinical pathology and 1 year in a forensic pathology fellowship.