R (Touche) v Inner London North Coroner

A coroner must hold an inquest where there is reasonable cause to suspect that a death from natural causes was contributed to by neglect. Neglect in this context means a gross failure to provide basic medical attention to a dependent person whose need for that attention was obvious. A clear and direct causal connection is required.

More broadly, a wholly unexpected death from natural causes may be unnatural where it would not have occurred but for culpable human failure. The inquiry should consider the combination of circumstances rather than depend exclusively on a single dominant cause. If the body has been destroyed, the coroner may report the circumstances to the Secretary of State under the Coroners Act 1988, who may direct an inquest.

Following a caesarean delivery, a patient developed severe hypertension and died from a cerebral haemorrhage. Medical evidence indicated that the hospital had failed to monitor her blood pressure adequately and that prompt detection and treatment would probably, or at least possibly, have prevented her death.

The coroner regarded the death as natural and declined to hold an inquest. The Divisional Court directed that an inquest be held because the omitted monitoring and treatment might have been an effective cause of death. The coroner appealed.

By the time the fuller evidence became available, the body had been cremated. The Court of Appeal therefore considered whether there was reasonable cause to suspect an unnatural death under section 8(1)(a) of the Coroners Act 1988, whether neglect might have contributed to the death, the statutory route available after destruction of the body, the possible need for a jury, and the costs order against the coroner.

1. Appeal dismissed unanimously. Per Simon Brown LJ, with Robert Walker and Keene LJJ agreeing on the dispositive neglect ground, the available evidence gave reasonable cause to suspect that the death had been contributed to by neglect and was therefore unnatural for the purposes of section 8(1)(a) of the Coroners Act 1988.

2. The principles stated in R v North Humberside Coroner, ex parte Jamieson [1995] QB 1 governed neglect. Neglect means a gross failure to provide or procure basic medical attention for a dependent person who cannot provide it for herself. The need must have been obvious, and a clear and direct causal connection with the death is required. The evidence of wholly inadequate post-operative monitoring, coupled with the apparent basic need for routine blood-pressure monitoring, met the threshold of reasonable suspicion. The eventual inquest would remain free to reach a different conclusion on fuller evidence.

3. All three Lord Justices also accepted the broader proposition that a wholly unexpected death from natural causes may be unnatural where it would not have occurred but for culpable human failure. Simon Brown LJ and Robert Walker LJ doubted an exclusive search for a single dominant cause. They favoured consideration of the relevant combination of circumstances. Keene LJ reached the same conclusion by construing R v Poplar Coroner, ex parte Thomas [1993] QB 610 as deciding only that the particular death there had one cause, rather than requiring a single cause in every case.

4. Because the body had been cremated, the coroner's original decision under section 8 could not be impugned and an inquest could not now be commenced directly under that section. The proper course was a report under section 15 of the Coroners Act 1988. The coroner indicated that he would report the facts, after which the Secretary of State could decide whether to direct an inquest.

5. If an inquest were directed, the available material indicated that a jury would probably be required under section 8(3)(d), because recurrence of the circumstances could prejudice the health of a section of the public. Any verdict remained subject to rule 42 of the Coroners Rules 1984 and could not determine the criminal liability of a named person or any question of civil liability.

6. The costs appeal was also dismissed. Section 13(2)(b) conferred an express discretion to order a coroner to pay such costs as appeared just. That discretion was not confined to cases of misconduct or strong judicial disapproval. The Divisional Court's order that the coroner pay the respondent's costs therefore stood, and the respondent was awarded the costs of the appeal on a detailed assessment.

1. Court of Appeal: The coroner's appeal was dismissed unanimously. Since the body had been cremated, the coroner was expected to report the facts under section 15 of the Coroners Act 1988, enabling the Secretary of State to decide whether to direct an inquest. The costs order below was upheld.

2. Divisional Court: Kennedy LJ and Morrison J held that the omitted post-operative monitoring and consequent loss of timely treatment might have been an effective cause of death. They directed that an inquest be held and ordered the coroner to pay the applicant's costs.