The role GPs and coroners can play in reducing preventable deaths in aged care homes

Doug Hendrie

1/05/2018 3:02:41 PM

GPs need not be apprehensive when working with the coroner’s system.

Professor Joseph Ibrahim believes the Coroners Court is about finding facts, rather than an adversarial system.
Professor Joseph Ibrahim believes the Coroners Court is about finding facts, rather than an adversarial system.

‘There is a general fear amongst doctors of anything legal. We aren’t willing to voice our
opinion in these situations. But amongst our peers, we’re much freer. We say, “There are problems in aged care and this is what needs to be done”.’
That is Monash University Department of Forensic Medicine Professor Joseph Ibrahim, talking to newsGP about why there are so many preventable deaths in aged care homes.
He believes that GPs and nurses could help by looking for a broader range of risks or issues during their visits to individual patients in aged care homes.
When a preventable death occurs and the case goes before the coroner, the doctor or nurse involved can often see this situation as a potential threat. This, Professor Ibrahim said, is often not the correct approach.
The coroner’s system is designed to investigate premature death in a bid to stop systemic issues claiming more lives. Professor Ibrahim cites mandatory swimming pool fencing and suicide-proofing bridges as successes emerging from coronial inquiries.
‘The Coroners Court is not adversarial – it’s about finding facts, not gunning for someone,’ Professor Ibrahim said. ‘But the way doctors think is that the moment someone asks questions about your practice, you’re under attack. But, really, the questioning is about what happened and what could be done better.
‘When deaths occur in tragic circumstances, you get the collision of the family, court system, nurses, medical professionals – all in one place. And, as an observer, you see that everyone wants the same thing – to stop the same thing happening again.
‘But everyone speaks with a different emphasis, and you often see people misconstruing each other.’
In a paper published in the May edition of the Australian Journal of General Practice (AJGP), Professor Ibrahim and his co-authors suggest there is a much larger preventive role for GPs and nurses who provide most of the care in aged care homes.
The paper, ‘Coroners’ recommendations for prevention of resident deaths in aged care’, focuses on recommendations made by Australian coroners in investigating premature death.
The study found that coroners only described a broader role for health professionals in 10% of cases, a concern given that premature deaths in aged care homes are increasing, particularly from falls.
‘The finding … is a missed opportunity,’ the authors write. ‘It is surprising that external causes of death, other than those from complications of clinical care, rarely yielded recommendations, despite healthcare practitioners having the potential to play a significant preventive part in these incidents.
‘Our primary study showed that the rate of premature deaths increased in RACF [residential aged care facility] residents over the study period, especially in falls-related deaths. As primary care providers, GPs and RNs [registered nurses] have the potential to play a significant preventive part in decreasing these rates and improving standard of care.’
The authors suggest that one reason behind a dearth of recommendations is that the ‘nuances of the coroners’ role are often not recognised by clinicians, especially those who are rarely involved in any legal proceedings’.
The study comes after Professor Ibrahim and his team issued a comprehensive report late last year making recommendations to prevent deaths from injury in aged care homes.

aged-care ajgp coroners-court medicolegal

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