Nobody wants to talk about death....until someone dies. It helps families and friends of a loved one to be able to talk about the death, and come to terms with what has happened, and we are able to help with that process.
In the light of recent media reports about patient deaths in our facilities, as Chief Executive of the North West Hospital and Health Service, I would respectfully like to outline what happens when a patient dies in one of our facilities.
At the NWHHS, we are not able to talk about individual patient deaths to the media. The only information we are able to give to the media regarding our patients is their age, sex and medical condition. This is set out in legislation that we must comply with.
However any journalist can interview family members and get one side of the story. They have unfettered access to the community and can print anyone's story without verification or fact checking. This can be very hurtful to both the community and our hardworking staff, who are always, always affected by a death of a patient. We are not allowed to correct fallacies or untruths; we are not allowed to give our side of the story.
We accept that constraint and we also support the freedom of the press. Patient confidentiality is paramount, for the living and also for the deceased.
However, we can certainly tell you what the process is when a death occurs in the community or in hospital and I am doing so in the hope that this knowledge will help those who have experienced the death of a loved one recently.
When someone dies in hospital, the decision for the death certificate confirmation lies with the physician in charge. They determine the cause, details and referral to the coroner, which can be done based on team conversation, conversation with the coroner's office or the coroner, or based on the presentation of death.
The Director of Medical Services (the top doctor in the NWHHS) and a multidisciplinary team, including doctors, nurses and allied health professionals review the death. If the team deems further investigation of the patient journey is necessary, they will go through the medical history and the course of events leading up to the death. I can assure you, this is a robust process.
If the death in hospital is related to an incident in the process of providing healthcare, this is termed a "clinical incident'. It will be reviewed by the Commissioning Authority (the Health Service Chief Executive or delegate) who will decide whether the clinical incident warrants further investigation.
This investigation will start with a Root Cause Analysis which is a very formal strict process, with a definite timeline, bringing together nurses, doctors, specialists, allied health officers, and possibly a community member or two. This group will make a recommendation to the facility.
The death review process at the NWHHS is formalised and reported on six monthly.
When does the coroner get involved? There is a lot of information available on the Queensland Health website: https://www.health.qld.gov.au/__data/assets/pdf_file/0027/439155/ed-coroner_investigation.pdf
I will summarise those conditions here.
The coroner is a magistrate of the Coroner's Court of Queensland, who is responsible for investigating "reportable" deaths (those deaths legally required to be reported to a coroner in Queensland). Many sudden and unexpected deaths that occur in an Emergency Department are reportable deaths.
Specifically, the coroner needs to be informed when someone dies if: The cause of death is unknown, The identity of the person is unknown, The death was violent or unnatural, such as accidents, falls or suicides, The death was suspicious, The death occurred in care, The death occurred in custody or as a result of police operations, The death was the unexpected outcome of health care being provided.
The coroner will determine whether to investigate the death. Once a coronial investigation is complete, we may organise a family meeting to explain the process and the results of the investigation.
I can assure the community that when a patient dies in any of our hospitals, the family will be notified immediately. The doctor always meets with the family and talks with them straight after the event.