Diagnostic Use
You can report a death to the Coroner via the Death Docs website or by contacting the NIIO Office. To refer a death to the Duty Coroner, first complete the CR2204 Hospital Record of Death (HROD) form and send this to the Duty Coroner at the National Initial Investigation Office (NIIO) at NIIO@justice.govt.nz. Do not fill out a HP4720 Medical Certificate of Cause of Death (MCCD) if reporting to the Coroner.
To discuss the death with the Duty Coroner, contact the NIIO Office at 0800 266 800 which is available 24/7.
When the deceased is under 28 days of age, these cannot be reported to the Coroner via Death Docs. You should complete the screening questions and if it recommends that you report the death to the Coroner, then you must complete the report by paper or by phone. Stillbirths are not reported to the Coroner.
Referral to the coroner is required when:
No doctor can reasonably issue a Medical Certificate of Cause of Death because not enough is known about the cause of the illness leading to death.
OR
The death is due to trauma, suicide or other unnatural means and/or subsequent complications.
OR
The death occurs during, or appears to be, the result of specific medical (including the administration of a medicine), surgical, dental or similar operation or procedure, including the administration of, or recovery from anaesthesia, and was medically unexpected.
OR
The patient was institutionalised or in official custody or care (as defined in the Coroner’s Act 2006) prior to this hospitalisation.
OR
A woman has died while giving birth or appears to have been the result of that woman being pregnant or giving birth.
Referral to the Coroner is not required:
Just because death occurs within any particular time period (e.g. 24h or 48h) after a procedure, although the proximity of a procedure should be a factor in assessing the likelihood of a causative relationship.
OR
If a reasonable clinical assessment by a registrar or specialist well acquainted with the case finds no causative relationship between any procedure and death.
OR
If the patient is >70 years, death was due to accidental injury arising principally by virtue of infirmities that were attributes of the person’s age, and the accident and death were not otherwise suspicious, violent or unnatural and there is no requirement for a Coroner’s inquiry i.e. the person was not an institutionalised patient.
AND
Death was due to accidental injury arising ‘principally’ by virtue of infirmities that were attributes of the person’s age.
AND
Except to the extent that the death involved injury by accident, it was not violent, unnatural, or in some way a death in respect of which the Coroner’s Act (2006) requires an inquiry to be conducted. For example, if the patient had been institutionalised or was under the care of the State and was >70 years old and had died as the result of an accident principally by virtue of their infirmities then the death must be referred to the Coroner since the person had been institutionalised or under the care of the State.
If you are unsure if referral to the Duty Coroner is required, first discuss with the registrar or consultant who is well acquainted with the case.
If you are still unsure if referral to the Duty Coroner is required, then only the registrar or the consultant should call the Duty Coroner to discuss the case further. Contacting the Duty Coroner is not the role of a junior member of the medical staff.
Coroners are not doctors; they are all lawyers. Some do have a background in nursing, but it is helpful to explain the case in plain non-medical terms.
IF THERE IS ANY DOUBT ABOUT WHETHER OR NOT A CASE SHOULD BE REFERRED, THEN PHONE THE ON DUTY CORONER.
If the family wish for the deceased/tūpāpaku to be urgently released, please inform the Coroner about this directly. The Coroner is entitled (not obligated) to authorise an urgent post-mortem examination, and if agrees, will arrange this with the On-Call Forensic Pathologist, as appropriate.
For verbal reports on coronial post-mortems, contact the Forensic Administrator on extension 21735. Copies of coronial post-mortem reports are only issued by the Coroner’s office (09) 916 9419.
If you need to contact the Forensic Pathology service, please call the hospital switchboard using the number below and ask to be connected to the On-Call Forensic Pathologist.