Published: 24/03/2005, Volume II5, No. 5947 Page 28

The High Court has removed much of the uncertainty surrounding the law relating to inquests, and the way it affects healthcare providers.

Middleton, the landmark 2004 case, looked at how article 2 of the Human Rights Act affects inquests in England. The decision broadened the scope of the coroner's inquiry to consider 'in what circumstances' a death occurred.

The decision also left open the possibility that all inquests into hospital deaths might have to be full inquiries, involving expert evidence, to satisfy the requirements of article 2. The first test case was always going to be important.

In July 2003, the coroner for Bedfordshire and Luton declined to order a full article 2 investigation into a patient death at Luton and Dunstable Hospital trust. Mrs Goodson, a relative of the deceased, applied for a judicial review, arguing that the coroner should have ordered a full article 2 investigation for this and every inquest involving the death of an NHS patient.

At the judicial review in the High Court, Mr Justice Richards rejected this. He decided that article 2 comes into play only where there are serious questions about the patient's treatment: there would have to be an indication that the patient died as a result of gross negligence.

The case is under appeal, but is binding in the meantime. Whatever the final outcome, NHS managers must appreciate the importance of article 2.

Its scope to disrupt the workings of clinical teams and the general resources they will require makes it important that clinical governance and complaints systems enable senior managers to identify and investigate high-risk cases before they are scrutinised by the coroner.

Witness statements from staff must be sufficiently detailed for a possible article 2 hearing. Managers should also ensure that policies and procedures were followed - and if they were not, that there was a clear rationale.

Leslie Millin is a barrister at Capsticks inquests team. She advised Luton and Dunstable Hospital trust in this case and represented it at both hearings, and with Philip Havers QC at the High Court.