Inquest Procedure: When to Instruct Multiple Experts in Hospital Deaths

In the context of a coronial inquest following a hospital death, the instruction of multiple medical experts may be necessary to address the multifactorial nature of clinical care. For legal practitioners, identifying when a single expert is insufficient is critical to ensuring the Coroner has the appropriate breadth of evidence to address the scope of the investigation, particularly in cases involving sequential care pathways or multidisciplinary clinical decisions.

The Threshold for Multidisciplinary Expert Input

Under the Coroners and Justice Act 2009, the Coroner’s duty is to determine who the deceased was, and how, when, and where they came by their death. While the Coroner may call for independent evidence to assist, instructing multiple experts should be approached with a clear focus on the specific clinical questions arising from the index events. The threshold for instructing multiple experts is typically reached when a case involves distinct clinical phases where independent breaches of duty are alleged, or where the clinical outcome resulted from the interaction of different medical disciplines.

For instance, in a case involving an unexpected cardiac arrest following surgery, the inquest may require expert opinion on both anaesthetic management and surgical management. Instructing a single expert to cover both areas may risk an inadequate analysis of the relevant clinical standards for either discipline.

Clinical Context and Subspecialty Differentiation

The utility of medico-legal evidence in inquests often relies on subspecialty precision. The following areas frequently demand nuanced, multidisciplinary perspectives:

• Acute and Emergency Care: Where the focus is on triage protocols and the recognition of clinical deterioration, an A&E consultant may be required to address the initial presentation, while a specialist in the patient’s underlying condition addresses subsequent management.
• Obstetrics and Paediatrics: Cases involving maternal or neonatal deaths may require the integrated input of obstetricians regarding intrapartum management, alongside neonatologists or paediatricians who can evaluate the infant’s physiological status.
• Polytrauma: Management of major trauma may necessitate input from different surgical specialties alongside intensivists regarding ventilatory management and haemodynamic stability.

Procedural Considerations

While Civil Procedure Rules (CPR) Part 35 governs expert evidence in civil litigation—specifically the expert’s overriding duty to the court (CPR 35.3) and the use of joint statements (CPR 35.12)—these principles provide a framework for professional conduct in inquests, even though the formal strictures of the CPR do not automatically apply in the same manner.

When managing multiple experts, the instructing solicitor must ensure that each expert’s report is focused on their specific field of expertise. A common pitfall is the attempt to use one report to bridge disparate fields, which can lead to challenges during oral evidence at the inquest. Expert witnesses from different disciplines are not required to provide a unified joint statement unless directed by the Coroner, but they must be prepared to have their evidence considered alongside the findings of other clinicians involved in the patient’s care.

When a case spans multiple clinical domains, sourcing experts who understand the boundaries of their respective fields is vital. This is particularly relevant when coherent analysis is required across sequential failures and when the instruction of a Single Joint Expert—governed by the court’s power under CPR 35.7 and the procedural requirements for instructions under CPR 35.8—is being contemplated to avoid excessive expert attendance at the inquest.

Practical Takeaway for Instructing Solicitors

When preparing for an inquest, consider whether the alleged index events span different “worlds” of clinical practice. If the evidence involves both systems-based processes and complex individual clinical decision-making, instructing independent specialists for each may be appropriate. This ensures that the Coroner receives evidence that adheres to the standards of subspecialty practice. The inquest and clinical negligence strategies employed by instructing solicitors should ensure that no gaps exist between the disciplines which could be exploited during questioning, ensuring that each expert witness provides a focused, robust opinion within the scope of their clinical training.