§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Budgen.]
10.12 pm§ Mr. J. Enoch Powell (Down, South)I seek this opportunity to engage the House for a short time regarding certain circumstances in which many people in the course of a lifetime find themselves involved, in which none would willingly so find themselves, and which arise at times of great personal stress. I refer to the release of a body for interment following a coroner's inquest and a post mortem examination.
Those circumstances and the desirability of raising the matter tonight came to my attention at the end of July as a result of a cry for help from my constituency in circumstances which I shall explain. There is no reason, for the purpose of this debate, why those concerned should be identified, and I do not propose to do so, for obvious reasons.
A certain person was on 15 June found dead in South-East London. It was decided that a coroner's inquest was required and the coroner decided that a post mortem should be carried out. All that took place promptly on 15 June. The pathologist conducting the post mortem examination decided that a pathological report was needed in order that, following the post mortem, he might give his advice to the coroner.
Accordingly, the necessary specimens for examination were on the same day, 15 June, despatched to the Metropolitan Police laboratory. Reminders were then sent at intervals of three weeks, two weeks and one week from the coroner's court to the laboratory complaining that the report was not forthcoming. I believe it was on 7, 23 and 28 July that successively these urgent requests for the report were addressed to the Metropolitan Police laboratory.
The report was eventually made on 31 July, 45 days after the request for the report had been addressed to the laboratory. It might be thought that that would at last have seen the end of the delay. That was not to be so; for on 20 July, 10 or 11 days before the report was received, but when it was already 35 days outstanding, the pathologist who had been concerned in the post mortem examination left for a six-weeks' holiday in the United States.
This had the consequence, since the coroner required the same pathologist as had conducted the post mortem examination to tender the expert advice to his inquest, of a further delay until 24 August, when—admittedly a few days earlier than had been expected—the pathologist returned from holiday. The report was considered immediately by the pathologist, the coroner came to his conclusion and the body was released for interment after a lapse of 10 weeks from the time of death.
I obtained these facts from the Home Office and am grateful to the two Ministers who have been in correspondence with me over these weeks. I believe that the facts that I have placed before the House are accurate, and it is not my intention to dispute them. However, it appeared to me that I ought not to pass over circumstances which had resulted in so long a delay between the opening of a coroner's inquest and the release of a body for interment, which in my view amounted to nothing less than a scandal.
1082 I see no reason to call in question either the actions or the judgment of the coroner. Although the coroner has discretion to release a body before the verdict at the inquest, nevertheless there was a principle, by which I understand she felt herself bound, that the advice should be tendered by the same pathologist as had been concerned in the post mortem examination.
So there are two separate causes of delay which fall to be considered, both of which can, I hope, be avoided, or greatly reduced in similar circumstances in the future as a result of what happened in this case and as a result of this debate.
The first cause was the apparent inability of the Metropolitan Police laboratory to carry out the tests requested until six or seven weeks after the request had reached it.
Two qualifications have been suggested to me in that context. The first is that the substances, the presence of which was in question, require a painstaking analysis to demonstrate their presence. However, as I understand that the analysis had not been completed by 27 July, four days before the final report was published, I cannot think that the complication or difficulty of the analytical process can seriously be regarded as relevant to the delay.
I take it that I am not being told that throughout the six weeks the laboratory was working away at the processes that are necessary to determine the presence of those substances. The fact is that there was a delay of almost six weeks in putting the tests in hand.
I am also told that the forensic laboratory of the Metropolitan Police is "invariably busy" and that "a coroner has no particular priority over other equally pressing work". I can imagine circumstances in which it is necessary for higher priority to be given to other requests addressed to the forensic laboratory, and I can understand that, in such circumstances, some delay in the routine work that forms the staple of its operations is inevitable; but I am unable to accept that it can be normal, or, if it is normal, that such abnormality is acceptable, for requests from a coroner's court for a pathological examination to take 45 days to be met.
I hope that the Minister of State will make it clear whether that sort of delay between a test being requested and being carried out is normal.[Interruption.] If, as a result of his present conversation and previous inquiries, the hon. Gentleman finds himself obliged to admit that such delays are normal, I hope that he will be able to tell the House what steps are being taken to reduce them. It would be intolerable if we had to accept that a coroner's court request for a pathological report on specimens should normally have to wait six weeks.
Either it is a normal delay, in which case it is intolerable and we want to know from the Home Office what is being done to reduce these delays drastically; or we should be told that it was an abnormal delay and we want to know what steps have been taken to prevent a recurrence of such abnormal delays. So much for the first of the two causes of the delay.
The second cause was the fact that the pathologist—knowing, or at any rate being in a position to be aware, that the case was awaiting a report and his decision—went abroad for a lengthy holiday which added another 25 days to the delay in releasing the body.
1083 I cannot seriously believe that it is unavoidable that, in order that a public servant may take a holiday of generous but not unreasonable length, all the work in his hands has to be delayed until his return from holiday.
I hope that the Minister of State will clarify two points. Is it really the case that whenever a pathologist who has been concerned in the post mortem in an uncompleted inquest in a coroner's court goes on holiday, the inquest has to be held up until he returns? If so, it is a situation which should be remedied. It seems to me unreasonable from the point of view of the pathologist, unreasonable from the point of view of the coroner's court, and unreasonable from the point of view of all persons who are in any way involved in the inquest.
If, on the other hand, there is a way of avoiding this, if there is a routine whereby the consequences of the pathologist's going on holiday can be prevented from causing this unconscionable delay, I hope that the Minister of State will be prepared to explain it to the House, and that he will say that arrangements have been made to prevent a recurrence of what happened in this instance.
I conclude in expectation of the Minister's reply to those points, notice of which was given to him, although in any case it would be clear to him that those are the issues which the case raises. I look forward to his clarification.
Those of us who have not personally gone through the experience which the family had to undergo in this case—although many people have had personal experience of the kind of tension which in the most unproblematic circumstances attends upon a coroner's inquest being required upon a relative—cannot easily imagine the distress, anxiety and misery which were caused. That in itself would be sufficient justification for my detaining the House and the Minister tonight; but I should like to be in a position to tell those concerned, after the debate, that the anxiety and stress that they suffered have been the means of securing that, in all probability, it will never be repeated in like circumstances for others who have the same misfortune as they did.
§ The Minister of State, Home Office (Mr. Timothy Raison)A few minutes ago, in our earlier debate, I was critical of the right hon. Member for Down, South (Mr. Powell), but I cannot cavil at his raising this unhappy matter in the House this evening.
First, I should like to express my sincere sympathy to the family of the man concerned, whom the right hon. Gentleman did not name, on the bereavement that they have suffered and my regret for the additional distress that they were caused by the time that elapsed before the body could be released for funeral purposes.
I reiterate the regret expressed by my right hon. Friend the Home Secretary that he was not able to send an earlier reply to the right hon. Gentleman's letter of 13 September. However, as the right hon. Gentleman understands, it was necessary to make detailed inquiries of the coroner.
The deceased, a single man who had left his home in Northern Ireland three years previously, died on 15 June this year. At the outset the death was treated by the police as a possible homicide and it was reported to the coroner, who immediately commissioned a pathologist to carry out a post mortem examination. This was performed on the same day, 15 June, and specimens of body fluids and tissue were sent for analysis.
1084 I should at this stage explain that the decision when to release a body for funeral purposes is a matter wholly for the coroner, but the body would not normally be released before the coroner had received the pathologist's findings in case, in the light of those findings, the pathologist felt that a further examination of the body was necessary. Moreover, when a death occurs in suspicious circumstances, it is usual in the interests of justice for the coroner not to release the body until either it is clear that no charge of homicide is to be preferred or, if a charge is preferred, until the lawyers for the defendant have confirmed that they do not require a second examination of the body to be carried out.
In this case the police decided on 25 July not to prefer a homicide charge. But, for two reasons, the coroner was not then in a position to release the body. First, the results of the analysis were not by then available to the pathologist or the coroner; secondly, the pathologist himself had gone abroad on holiday on 20 July and did not return until 24 August. Thus, even if the results of the analysis had been available on 25 July, the pathologist would still not have been able to consider them and prepare his report until after his return in August.
To take the first point, I am informed that the body specimens which had been sent by the pathologist to the police on 15 June were delivered by hand to the Metropolitan Police laboratory on 17 June. The first step that had to be taken by the laboratory was to send samples to the hospital for screening against serum hepatitis. There is always a risk that the specimens may be infectious and this routine measure is taken in such cases to safeguard the health of laboratory staff. The laboratory was informed on 19 June that the result of this test was negative. The same day, work began on testing the specimens.
As I have indicated, the police were at this stage treating the case as one of possible homicide and, because of this, the laboratory requested that certain items from the scene of death be submitted to them. These items, which included syringes and needles, were received at the laboratory on 24 June. Thereafter, detailed and rigorous tests were continued on not only a variety of body specimens from the deceased, but on the materials taken from the scene and on bio-fluids from the man who had been present when the subject of this debate died. These tests involved extensive radio-immunological analyses and mass-spectrometric examination.
The tests showed the major causative agent of death to be dextromoramide. This, I understand, is a very potent drug; even after fatal doses, it is present at only very low levels. Indeed, this presents one of the severest analytical tasks faced by a forensic science laboratory. Considerable time and effort was therefore necessary to ensure that accurate and unambiguous analyses were performed to establish the presence and quantity of the drug. Tests were also carried out for morphine and methadone.
The analytical work on the specimens, which was clearly not normal, continued until 20 July and after these were checked and discussed a report was sent on Friday 24 July by the internal distribution system to the police liaison officer for onward transmission. They were received by the liaison officer on Monday 27 July and on 31 July he took them by hand to the hospital pathology department where the pathologist was based.
This brings me to the second main point—the fact that the pathologist had already gone on holiday before the tests were complete and the results available. It was 1085 necessary for the results of the analysis to be interpreted by the pathologist in the light of the post mortem examination which he himself had performed. He alone could inform the coroner of the cause of death and without such information the coroner would not release the body in case further tests were necessary—more particularly since in this case the funeral was to take place outside this country and the body would be inaccessible for further tests should the need arise.
§ Mr. J. Enoch PowellNo. The funeral was to take place in my constituency.
§ Mr. RaisonI apologise to the right hon. Gentleman if what I said was misleading. I do not challenge the fact.
The coroner was in correspondence with solicitors acting on behalf of the family in the right hon. Gentleman's constituency, who were fully informed of this decision and of the coroner's reasons.
I have already explained that the decision when to release a body is the coroner's alone. It is not a matter in which the Home Secretary can intervene The Divisional Court decided on 9 April 1974, in R.v Bristol Coroner, ex parte Kerr, that the coroner has the right to retain a body until the conclusion of the inquest, though he has discretion to release it sooner.
I understand that the right hon. Gentleman takes the view that the release of the body for funeral purposes should not be delayed solely because of the absence, for whatever reason, of the pathologist who carried out the post mortem examination. But the commissioning of a pathologist by the coroner for this purpose, and summoning him to attend the inquest to give evidence of his opinion of the cause of death, is governed by statute.
It would not be right for a coroner, in deciding whether to release a body, to accept information as to the cause of death from a person who had considered only the histological findings when that person had not himself conducted the post mortem examination. The coroner would need to be satisfied by the pathologist who had been commissioned to conduct the post mortem examination, and who himself had requested the histological tests to be carried out, that no further examination of the body was required to enable him to give his opinion as to the cause of death. Hence the coroner had no real alternative but to await the return of the pathologist from holiday on 24 August before finally releasing the body for funeral purposes.
§ Mr. PowellIs the Minister saying that if the pathologist had gone on six months' leave the body would still have been awaiting interment, or that if a pathologist unfortunately died it would remain in the possession of the coroner permanently?
§ Mr. RaisonI shall meet that point. I am afraid that it would not have been possible for a locum to have been appointed to complete the pathologist's duties. The alternative would appear to have been for the coroner to commission a second pathologist to carry out another post mortem examination, which would have been an additional charge on public funds. There is that possibility. However, the conduct of a coroner's duties in such matters is for the individual coroner.
I should explain that the pathologist is an independent expert who is commissioned by the coroner; as a medical witness he is responsible to the court. I have no authority to comment on the way in which the coroner's pathologist carries out his responsibilities. Of course there is the argument that the difficulty would not have arisen if the laboratory results had been available before the pathologist went on holiday, but I would make two points about that. First, it is important to note that at no time was the laboratory informed that the pathologist was leaving the country for five weeks on 20 July. Secondly, even if it had known it, it is by no means certain that it could necessarily have completed the tests any sooner than it did. As I said, in this case, particular care had to be taken in the forensic analysis because of the possibility that depending partly on the outcome, serious criminal charges might result. I am satisfied that there was no undue delay on the part of the laboratory in processing the material. Indeed, in the circumstances of this case the period of 26 working days actually taken to carry out the tests and process the results does not seem altogether unreasonable.
Again, I genuinely sympathise with the distress caused to the dead man's relatives by the time which elapsed before the body could be released, even though the coroner had explained the reasons for it. The delay was in effect, forced on the coroner by the unfortunate coincidence of two events: the time quite legitimately needed by the laboratory to carry out lengthy and rigorous tests and the timing of the pathologist's departure on holiday. It is our general experience that coroners are keenly aware of the distress caused to bereaved relatives by delay in releasing the body in these circumstances, and that they do their best to reduce it to a minimum. Let me again, however, make clear my deep sympathy for the family over this affair. If there are lessons to be learnt from this unhappy story, I certainly hope that they will be learnt.
§ Mr. PowellBefore the Minister resumes his seat, may I express my appreciation for the last words that fell from his lips and my hope that this debate will be recommended reading among both coroners and pathologists likely to be employed by coroners?
§ Question put and agreed to.
§ Adjourned accordingly at twenty-two minutes to Eleven o' clock.