Rising deaths put pressure on coroners

New Zealand's rising population and diminishing personal relationships with doctors are among the issues putting a strain on the country's coroners, Chief Coroner Judge Deborah Marshall says.

Coronial Services took jurisdiction of almost 200 more cases last year – a rise which amounts to the workload of one coroner for an entire year.

The majority of deaths are from natural causes (53 percent) but each conversation with a doctor or healthcare professional, and every post-mortem – regardless of the final cause of death – adds to the workload of the country’s 17 coroners.

In 2018, there were 5608 deaths reported to Coronial Services, up from 5564 the year before. Coronial Services accepted jurisdiction for 3573 of those deaths (compared with 3404 in 2017), according to the annual report.

Along with the increase in the number of deaths comes an increase in the time it takes to close files, with each coroner managing about 300 cases at a time.

This means the amount of time family and loved ones have to wait to get a final cause of death has also increased.

Rising population, rising workload

It took 345 days on average to close a case, an increase of 34 days when compared with the previous financial year.

Speaking to Newsroom, Marshall said she expected the workload to keep rising with the population.

Coronial Services worked with what they had when it came to funding and resources, and she didn’t want to comment further than that.

The latest population estimates from Stats NZ put the number of people living in New Zealand at 4.93 million, up from 4.84m a year earlier.

As the baby boomer population grows older, the issue will compound.

Marshall said most of the boomers died of natural causes, like the rest of the population. However, people tended to have a less close personal relationship with their GP which could lead to problems.

They might be in a rest home, or be registered with a practice where they saw whichever doctor was available, making it harder for doctors to definitively conclude whether the person died of natural causes.

Law changes in 2016 were supposed to improve the speed and quality of coronial investigations. Part of that was making it easier for GPs and healthcare professionals to retain jurisdiction of cases, but the changes haven’t reduced the coroners’ workload.

Emerging trends

While more than half of deaths are from natural causes, the number of deaths from motor vehicle accidents remain stubbornly high (12 percent), with the number of deaths by suicide also continuing to rise (13 percent).

Marshall said it was important for coroners to communicate among themselves and with other agencies in order to identify trends and make recommendations that could have prevented these deaths.

Recommendations highlighted in the annual report included those relating to the death of Christie Marceau in 2011, the suicide of an 18-year-old Christchurch boy, and a plane crash that killed Eric Bennett and Katherine Hertz in 2013.

A coroner’s recommendations almost always received a response from the agency or authority at which they were directed. However, during her last appearance before MPs, Marshall said a formal response to recommendations should be mandatory, but agencies should not be forced to implement any changes.

Issues like lowering the suicide rate went beyond a coroner’s expertise, Marshall said, adding that a coroner could only make a recommendation relating to the specific death – as coroner Brigitte Windley did following the death of 18-year-old Christchurch boy Michael John Bain.

“We can report on it and make recommendations about particular deaths, but you need that all-of-government response in looking at [how to deal with a wider issue].”

While it was good New Zealand was now talking about suicide, she said there was a lack of guidance on how to talk about it in order to prevent further deaths, which was where the Mental Health and Addictions Inquiry came in.

The inquiry panel reported back to Health Minister David Clark at the end of last year, with the Government's response expected in the second half of April following a delay due to the Christchurch terror attack.

Marshall pointed out other cyclical trends which coroners tried to spot early and keep an eye on, such as the opioid crisis afflicting the United States and other countries.

So far there had been nothing to the level of the epidemics seen overseas, but the Institute of Environmental Science and Research (ESR) was keeping watch at the border and in emergency departments.

Rise in synthetics deaths

One trend which has caught the nation’s attention is the rise of deaths from synthetics.

In 2017, there was a spike in the number of deaths of people who had used synthetic drugs.

After Coronial Services noticed some cases where the person had used synthetics, Marshall said they tried to find out whether the issue was more widespread.

The coroners were only seeing cases that resulted in deaths, not hospital admissions or other issues.

St John ambulance service and police were most aware of the spike, as they were dealing with hospital admissions and people collapsing or having seizures on the frontlines.

Coronial Services had worked with St John, the police, the Auckland District Health Board and the Ministry of Health to build a clearer picture of the problem, Marshall said.

“We realised we had a problem… then we realised the extent of [other services'] involvement with it as well.”

She made a public statement with police about synthetics in mid-2017 - a rare move for a Chief Coroner - to raise awareness and change the way the drugs were being framed. At that stage, they were still referred to as “synthetic cannabis”, which was misleading.

Marshall said it was important for people to know synthetic drugs were chemicals, and often unknown chemicals of unknown strengths.

Marshall said it was important for people to know the drugs were chemicals, and often unknown chemicals of unknown strengths.

“You are always going to get those cyclical new causes of death that grab our attention until somebody figures out how to solve it.”

At the time of the statement in mid-2017, there had been at least seven confirmed deaths from synthetics, with further hospital admissions.

Last month, the number of confirmed deaths remained at seven, with a further 55 deaths provisionally attributable to synthetics since June 2017.

There were also a number of cases where synthetics were a contributing factor, but synthetic cannabis toxicity was not the ultimate cause of death.

A joint working group was set up ahead of Marshall’s public statement, while last month the Government introduced the Misuse of Drugs Amendment Bill to crack down on the harm done by synthetics.

The proposed law would mean harsher penalties for suppliers, while officially giving police discretion to deal with users. The proposed changes would also makes the two main chemicals used in synthetics, 5F-ADB and AMB-Fubinaca, Class A drugs.

Identifying Christchurch victims

While Marshall is not often in the spotlight, she again faced the public following the Christchurch mosque attacks, where 50 people were killed.

Families of those who died became anxious in the days following the shootings, as Islamic tradition dictated the deceased should be buried as soon as possible after death.

Coroners and dozens of disaster identification specialists worked hard to follow the correct identification procedure, but for many the international best-practice process was too slow.

Chief Coroner Deborah Marshall had to explain to victims' families, and NZ, the process of identification, following the Christchurch attack. Photo: Supplied

Marshall stood next to police in Christchurch, the Sunday after the attacks, in an effort to explain the procedure, and why it was taking so long.

“There could be nothing worse than giving the wrong body to the wrong family, and we find from overseas examples when you try to speed up the process, or missteps, that is exactly what happens.

“And it’s not going to happen here,” she said at the time.

In the wake of Christchurch, Prime Minister Jacinda Ardern said identification procedures would be reviewed to make sure they were fit for purpose in situations where there were multiple deaths.

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