All such deaths must be reported to the coroner

EDITOR,—S J Calder and colleagues reviewed the certification of cause of death in patients dying soon after proximal femoral fracture.1 Their report perpetuates common misconceptions regarding matters relating to death certification and deaths referable to the coroner. It starts with a false premise: that there is any option over reporting a death related to trauma. There is a statutory obligation for all deaths that may be related to trauma to be reported to the coroner, as directed in the Registration of Births and Deaths Regulations 1987 (regulation 41(1)).2 Although, as the authors correctly state, the only person with this statutory obligation is the registrar of births and deaths, doctors should feel obliged to report these deaths, if only to assist the surviving relatives and to fulfil their common law duty.3 The coroner is obliged to hold an inquest into all deaths due to trauma under section 8 of the Coroners Act 1988.4

When registering the death, relatives may be surprised when, having placed their trust in the doctor that all is in order with the certificate, they are informed that the death must be reported to the coroner. The practice of deceiving the registrar by knowingly omitting the fracture from the certificate purely to avoid the possibility of having to attend an inquest is to be strongly condemned. This practice is due to doctors' unnecessary fear of the function, purpose, and procedure of an inquest.

There is no time limit for referring these deaths to the coroner. The 28 day rule of thumb described in the paper and claimed to be used by junior staff has no legal justification. Also, the suggestion that the inquest is a mere formality in addition to the necropsy is untrue.

The legal facility to mention femoral fractures related to age on the death certificate without this rendering an inquest mandatory, as the authors request, already exists, as the mention of the fracture on the certificate does not mean that an inquest is necessarily held. If the fracture is due to osteoporosis it is often regarded, in the appropriate circumstances, as a natural cause of death. A necropsy is usually required to assess the degree of osteoporosis and thus confirm the natural cause of death. A fall may result from an osteoporotic fracture rather than the other way around. The death must, however, be reported to the coroner. When there is a possibility that trauma played a part in a death it is for the coroner to determine whether the death was due to trauma or natural causes.