Laws governing doctors' obligations to report deaths in medical settings to coroners need to be standardised nationally, and guidelines for doctors must be made more accessible, according to an Ethics and Law article published in the Medical Journal of Australia.
Currently, there are variations, state by state, in the requirements for doctors to report deaths, and in the penalties for failing to do so.
Professor Michael Buist and Dr Sarah Middleton, from the University of Tasmania, used a hypothetical case of a young woman with end-stage cystic fibrosis (CF) to illustrate the differences between states and the complicated legal reasoning doctors currently must negotiate when deciding whether to report cases to the coroner.
In the hypothetical case the woman presents to the emergency department with a pneumothorax
... a chest drain is inserted with relief of symptoms. Three days later the drain is clamped and a chest x-ray is planned for 4 hours later. The request for x-ray is not received and no x-ray is done. A tension pneumothorax develops, leading to cardiac arrest and hypoxic brain injury. The patient is put on life support, which is subsequently turned off after discussion with the family, and the patient dies.
As a preventable death caused by an adverse event, Buist and Middleton contend that such a case "should be reported to the coroner"; however, they use it to demonstrate how reportable cases may be defined differently across the states and territories.
"In Tasmania, the Northern Territory and Western Australia, the [case report] death does not fall into the medical-setting category of reportable death as it did not occur during or as a result of an anaesthetic", they wrote.
In the Australian Capital Territory, the death would be reportable because it occurred within 72 hours of "an invasive medical procedure". In South Australia it is not reportable because it did not occur within the 24 hours prescribed in that state.
In NSW, the death would be reportable if it "was not the reasonably expected outcome of a health- related procedure". In Victoria the death would be reportable because it was, or may be, "causally related to the procedure".
In Queensland, a reportable medical-setting death includes a situation where a patient dies after "failing to receive health care" if the failure is likely to have caused or contributed to the death and when an independent person would not have expected that there "would be a failure to provide health care that would cause or contribute to the person's death".
The penalties for not reporting a reportable death range from fines of $1000 (WA) to $10 000 (SA), and even jail time (SA, ACT). In all jurisdictions, failure to report a reportable death may constitute professional misconduct.
The problem for doctors, Buist and Middleton claim, is that "reportable death relies as much on legal analysis as medical judgement".
"It is not surprising that doctors can face difficulty deciding whether or not to report a death", they wrote. "Ideally, ... guidelines should be developed by lawyers, doctors and coroners working in conjunction. Further, where the existing law is unclear, legislative amendment should occur hand in hand with the development of guidelines.
"Coroners' guidelines offer a practical and inexpensive measure that might go some way towards creating better accuracy in reporting."