A death can leave families with unanswered questions. Sometimes the medical explanation is unclear. Sometimes there are concerns about care, delay, neglect, safeguarding failures, pressure sores, falls, medication, hospital discharge, mental health treatment, or the actions of an attorney, carer, care home or public body.
A coroner’s inquest is not a civil claim and it is not a criminal trial. It is a public investigation into certain deaths. Its purpose is to answer the statutory questions of who died, when they died, where they died and how they came by their death. In some cases, especially where Article 2 of the European Convention on Human Rights is engaged, the inquest may examine the wider circumstances in which the death occurred.
Linley James Solicitors can help families and interested persons understand the coronial process, prepare for hearings, obtain and review evidence, ask focused questions, and decide what further steps may be needed.
When a coroner may become involved
A death may be reported to the coroner where it appears to be violent, unnatural, unexplained, occurred in custody or state detention, or where the cause of death cannot properly be certified.
In practical terms, coronial involvement may arise after:
- a fall or unexplained injury;
- a choking incident;
- a medication error or missed medication;
- pressure sores or tissue damage;
- malnutrition or dehydration;
- unsafe hospital discharge;
- delayed medical treatment;
- suspected neglect in a care home or supported living setting;
- suicide or possible suicide;
- death following police, prison, mental health or state involvement;
- death where safeguarding concerns existed before death;
- death where family members dispute the explanation given.
The fact that a person was elderly, frail, disabled, living in a care home, or had dementia does not mean the death should automatically be treated as natural. Age and frailty may explain vulnerability. They do not explain away possible neglect, delay, poor care or abuse.
What the coroner can and cannot decide
The coroner can investigate the death, decide what evidence is required, identify interested persons, call witnesses, consider expert evidence, hold pre-inquest review hearings, and reach a conclusion at the end of the inquest.
The coroner cannot award compensation. The coroner cannot determine civil liability. The coroner cannot convict anyone of a criminal offence. However, the evidence heard at an inquest may be extremely important for later civil claims, safeguarding reviews, complaints, regulatory referrals, police investigations, or applications concerning attorneys and deputies.
How Linley James Solicitors can help
Linley James Solicitors can assist with:
- advising whether coronial involvement should be sought;
- preparing a focused chronology of events before death;
- applying for interested person status;
- reviewing medical, care, safeguarding and financial records;
- identifying missing documents;
- preparing submissions for a pre-inquest review hearing;
- considering whether Article 2 may be engaged;
- considering whether a jury may be required;
- suggesting witnesses and expert evidence;
- preparing questions for witnesses;
- representing clients at pre-inquest review hearings;
- representing clients at the final inquest;
- advising on Prevention of Future Deaths reports;
- advising on possible civil, safeguarding, OPG, CQC or police routes after the inquest.
Why preparation matters
A coroner’s hearing can feel daunting. Families may be grieving, angry, confused or worried that important facts will be missed. Proper preparation helps turn general concern into a clear evidential account.
The strongest approach is usually to identify:
- what was known before death;
- who was responsible for care or treatment;
- what records exist;
- what records are missing;
- what changed shortly before death;
- what opportunities were missed;
- what questions need to be answered;
- what future risk remains for others.
Contact Linley James Solicitors
Contact Linley James Solicitors to discuss coroners’ inquests, pre-inquest review hearings, vulnerable adult deaths, care-home deaths, safeguarding concerns, Article 2 inquests and related legal issues.
0207 060 1210