What psychiatrists should know about inquests into the death of their patients

Psychiatrists are the subject of relatively few patient complaints compared with other medical indemnity insurance clients.

A recent BMJ Safety and Quality review of 18,907 Australian patient complaints shows 6% involved psychiatrists.

However, psychiatrists are more likely than most other doctors to be called upon to provide evidence at coroners’ inquests, particularly those involving a patient’s suicide.

Most states offer useful guides to help witnesses understand what to expect at an inquest. Here are three useful links:

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These are 10 things to know about Coronial Inquests:

  1. An inquest is a court hearing presided over by a Coroner.
  2. Coroners investigate sudden and unexpected deaths to determine the identity of the deceased and the date, place, circumstances and medical cause of death.
  3. If the Coroner wishes you to give evidence, you will receive a summons in person, usually from a police officer. If you do not appear in court as instructed, the Coroner may issue a warrant for your arrest.
  4. Although a summons can be confronting, there is no reason to believe your conduct is being questioned.
  5. It is advisable to contact your medical indemnity insurance provider before supplying a statement to police or the Coroner, or appearing at an inquest in person.
  6. If you have not been called to give evidence and you believe you should be called, you can apply in writing to do so.
  7. You cannot be sanctioned at an inquest but the Coroner has the right to criticise your conduct if there is reason to do so. The Coroner can also refer matters to the police for further investigation or bring concerns to the attention of oversight bodies such as AHPRA.
  8. It is best not to speak to the media before or during an inquest.
  9. The duration of an inquest can vary from an hour to months, depending on the complexity of the case and the number of witnesses called to give evidence.
  10. There are usually court-provided support services available to people called as witnesses at an inquest. 

This publication is general in nature and is not comprehensive or constitute legal or medical advice. You should seek legal, medical or other professional advice before relying on any content, and practice proper clinical decision making with regard to individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgment or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Tego Insurance Pty Ltd is not responsible to you or anyone else for any loss su­ffered in connection with the use of this information.