THE DEATH of large numbers of young people from swine flu could result in significant pressure on the coroner system and on hospital mortuaries, the country’s leading medico-legal expert has said.
Prof Denis Cusack, president of the Coroners Society of Ireland, told The Irish Timesthat while the indications were that influenza A (H1N1) had a very low mortality, "in the event of a mutation of the virus, we have to be prepared for a greater number of deaths".
“If the death in a younger person from influenza A (H1N1) was sudden and unexpected and the deceased had not attended a doctor for that illness in the required statutory period for death certification under the Civil Registration Act 2004, reporting to the coroner would be mandatory,” he said.
Prof Cusack said that where a doctor had not attended the deceased in the previous 28 days or in the case of the death of a person in prison or a nursing home from influenza, a postmortem may be required to exclude other possible causes of death.
“In the expectation of a greater number of cases being reported to coroners and an increase in the number of postmortems needed, I believe that although there will be pressures, the system will cope.”
Asked if a high death rate from influenza A (H1N1) would place a significant strain on hospitals and pathologists, Prof Cusack said the storage of bodies could be an issue.
“Most mortuaries have space for up to six bodies, so even without an increase in the number of coroners’ cases, there could be a strain on the system.”
There may be a need for temporary mobile storage facilities, he said.
He acknowledged there could be delays in death certification but said coroners would work with GPs to ensure a “reasonably rapid response”.
In the event of a significant number of the State’s 96 coroners being struck down with the H1N1 bug or other pressures on the system, he said that under current legislation it was still legal for a GP or hospital doctor to carry out a “superficial” postmortem involving the external examination of a body.
“This would be done under the direction of a coroner,” he added.
Prof Cusack confirmed the Coroners Society of Ireland had written to the chief medical officer of the Department of Health and the Coroners Service Unit in the Department of Justice to address these issues.
An editorial in the current issue of the Medico-Legal Journal of Ireland, written by Prof Cusack, points out the obligations of coroners here arising from Article 2 of the European Convention on Human Rights. The convention states: "Everyone's right to life shall be protected by law".
According to the editorial, it is this reference to the right to life that obliges the State “to investigate when such life comes to an end in certain circumstances involving the State, its agents and organs”. In practice, it means a coroner here must consider whether there is an Article 2 obligation to investigate a death.
Deaths of children in care, deaths of older people in residential care and deaths of people in detention are examples of circumstances in which the use of Article 2 of the convention would be required, the editorial states.
Of about 28,000 deaths in the State in 2007, some 12,500 were reported to coroners, who directed that 5,800 postmortems be carried out. About 2,200 deaths required formal inquest hearings.