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Robin Muchetu, Senior Reporter
THE establishment of a Coroner’s Office via the Coroner’s Office Bill 2019 will change the face of forensic pathology in the country with more unnatural deaths being investigated, bringing closure to affected families.
According to the Bill, it provides for the establishment of an office responsible for investigating all deaths that come about as a result of unnatural causes. It also sets out the appointment, functions, and powers of the Coroner-General, Deputy Coroner-General and coroners in relation to postmortems, inquests and their findings.
The Bill repeals the Inquests Act [Chapter 7:07], and amends the Birth and Deaths Registration Act [Chapter 5:02] and the Burial and Cremation Act [Chapter 5:03]. Dr Blessing Zambuko (BZ), a Government Consultant Pathologist at the United Bulawayo Hospitals and Mpilo Central Hospital in Bulawayo took time to explain the importance of establishing this office with Robin Muchetu (RM).
Below are excerpts of the interview.
RM: What is the Coroner’s Office Bill all about?
BZ: The Coroner’s Office Bill is a Bill that is intended to establish a Coroner’s Office; the Coroner being an officer of the State who is responsible for investigating all unnatural deaths and other classes of death included under this blanket.
RM: What is an unnatural death and what kinds of deaths are investigated by a Coroner?
BZ: Unnatural deaths are those that were not due to an illness that is naturally acquired such as infections, cancers, diabetes, and hypertension to name a few. As we are all aware, falling sick is part of life, and one can die from that illness.
Anything outside that category of natural death is classified as unnatural, such as accidental deaths and acts of God. “Acts of God” are natural disasters but cause deaths of persons that were previously not ill, so we do consider them unnatural deaths.
Other types of deaths that will be investigated by the Coroner include homicides, suicides, poisonings, electrocution and people who die within the first 24 hours of being admitted into a health institution. The latter class of death is investigated not because it is automatically considered unnatural but because it is possible the deceased may have passed on before the medical doctors have managed to establish the nature of the illness, natural or otherwise.
If one dies within 24 hours of a surgical procedure or anaesthesia we want to make sure nothing untoward has happened to that person. It may still be a natural disease process, but it is a death that is of interest from a public health perspective.
All maternal deaths are investigated by the Coroner too because it is of public health interest. As a society we don’t want people to die while giving birth. The death of person who is in custody or is being escorted to a police cell, prison, health institution or other place of custody is considered an unnatural death too under this proposed legislation. In addition, any case of suspected medical negligence is investigated automatically.
RM: Is this Bill a first in the country?
BZ: This practice (of investigating all unnatural deaths) has been there before. The Inquest Act has been taking care of such issues and empowered magistrates to be the ones who investigate all unnatural deaths. They would get the Sudden Death dockets from the police, pathologists, and other doctors and investigated further.
The Coroners Bill will still ensure that these unnatural deaths are investigated though now in a wholesome manner as legislation was fragmented before. The Act will seek to harmonise these pieces of legislation into the Coroner’s Office Act.
RM: What does one do when they query the cause of death of a loved one?
BZ: The interface with the public is with the police, if you have any queries regarding the death of a deceased you convey them to the nearest police station and they will then put in place processes to investigate the sudden death docket, suspected negligence of a medical officer, or suspected foul play death. The police will then request a post-mortem if it is required or apply for exhumation in those cases where the deceased has already been buried.
The families are also advised that they will shoulder the expenses incurred, if they wish to get a second or third opinion from private pathologists after the State has completed its investigations. The police may also seek the opinion of a second Government pathologist if the first State appointed pathologist did not give satisfactory results.
RM: The country is faced with an acute shortage of forensic pathologists, what is being done in this regard and how has it affected the health sector.
BZ: The country is faced with a challenge of Anatomic Pathologists who do post-mortems; there are about six or seven in the whole country and some of them are in private practice and not working for the Government. These pathologists can do all post-mortems be it forensic, medico-legal or medical interest.
In Bulawayo there is only one Government pathologist, myself, covering the southern region and there are four Anatomic and Forensic Pathologists in Harare who cover the northern region. At the moment we rely on senior doctors that have been attached to the Department of Pathology for many years and do perform post-mortems competently to the required standard. Sometimes the country gets the services of Cuban Forensic Pathologists who come and assist but at the moment there are none.
There is a challenge in this area for our country because the degree of difficulty varies for each post-mortem. Some are very simple to perform, and questions can be answered easily while some are complex, and you need additional investigations done after the post-mortem such as toxicology, histology, microbiology, and you may need the aid of other forensic investigators that are not pathologists. Say people who specialise in insects for instance, because insect activity may be used to determine the time of death. The degree of expertise required may differ with each case.
RM: What is being done to aid the situation?
BZ: Doctors in the districts have received training on how to do basic post-mortems for some cases, so a number of cases will be concluded in the districts while the rest are referred to Bulawayo or Harare depending on the degree of difficulty. This lessens the load that pathologists have.
The Coroners Bill is structured in a way that it will call upon medical officers that are deemed competent to do the post-mortems and these doctors can refer upwards if they see the need for additional expertise. We can go as far as requesting the services of a pathologist to be brought in from outside the country if he has the kind of expertise and experience that is required for a particular case.
RM:What other challenges does the profession face?
BZ: One challenge is that of equipment and other consumables which range from simple to very complex and expensive. However, some of the equipment is barely available and we do carry out post-mortems but in limited numbers each day because of these equipment shortages.
Support staff is also needed; a single pathologist will need to work with two or three people per autopsy. This equipment challenge can be illustrated by the situation where pathologists have to perform specialised procedures such as opening the spinal cord which cannot be done with a simple knife but needs certain electrical equipment which is not routinely available locally.
Further tests that I referred to such as toxicology for poisons, histology for microscopic changes, and x-rays to look at fractures or find bullets and other foreign objects, are not available for most of the time. The Government analyst who should perform toxicology testing on samples we refer to the lab, has not been able to process them and it has been like that for a long time. The few that have been done will have been referred to private labs and normally the relatives of the deceased will have funded that as the State may not have resources for that outsourcing.
On the issue of x-rays, it is not desirable to use the same machine for a dead body and a live patient too. We usually avoid doing that to prevent discomfort for the live patients. In terms of numbers of unnatural deaths dealt with, the average falls somewhere in the range of about 1 000 to 2 000 cases each year in the country.
RM: Is the public aware of the job of a Coroner?
BZ: Most people do not know about getting further investigations done when death is unexplained save for a few who have had the need to get second opinions from pathologists following a bereavement that they could not explain. It is vital that the public knows that no suspicious deaths are swept under the carpet in Zimbabwe as every death in thoroughly investigated.
However, it is also important to note that under the Inquest Act a magistrate does not necessarily have to hold an inquest if he/she is satisfied with the investigations that the police would have done. He/she can close that Sudden Death Docket, but if the family insists on a formal inquest being done, they can request it and it is the State’s responsibility to hold it. Inquests are not done in each and every case as it would end up being very expensive. It is the responsibility of the magistrate to decide, and if the bill is passed, this function will be performed by the Coroner’s Office.
RM: There is talk that this Coroner’s Office Bill is targeted at medical practitioners, is that true?
BZ: There is a misconception to that effect; deaths that occur under the care of a medical practitioner have always been investigated by the police and by the regulator of all medical practitioners, the Medical and Dental Practitioners’ Council of Zimbabwe. If anything like negligence, outright criminality or incompetence have been discovered at autopsy or by looking at medical records, those offending individuals have been dealt with according to the law. If improper practice has been discovered the regulator has sanctioned its people by fining them, retraining, deregistering them or referring to the criminal system in cases where there is criminality involved. The Bill will also seek to provide evidence during court cases and assist in delivering justice and this will make the public confident of the system when cases are thoroughly investigated.
RM. Thank you for your time.
BZ. Thank you.
Online Reporter
Bongani Ndlovu