Procurator Fiscal coat of arms
A lawyer employed within the Crown Office and Procurator Fiscal Service–which is part of the Scottish Government and its forensic system–who is responsible for initiating criminal prosecutions. The Procurator Fiscal’s best known role is as local public prosecutor, but he or she has a separate duty to investigate all sudden, suspicious, accidental, unexpected and unexplained deaths and any deaths occurring under circumstances causing serious public concern (see below).
Deaths which must be reported to the Procurator Fiscal
Sudden deaths, Any death…
• Where there is evidence or suspicion of homicide
• By drowning; any death by burning or scalding or as a result of fire or explosion
• Caused by an accident involving the use of a vehicle including an aircraft, a ship or a train
• Resulting from an accident in the course of work, including voluntary or charitable work;
• Where the circumstances indicate the possibility of suicide
• Following an abortion or attempted abortion whether legal or illegal
• Of a person subject to legal custody, including any death of such a person outwith a Police station or prison (for example during prisoner transport or in hospital)
• Occurring in health premises in the community including a GP’s surgery, health centre, dental surgery or similar facility
• Due to violent, suspicious or unexplained circumstances.
Deaths related to neglect or complaint, Any death…
• Where the circumstances seem to indicate fault or neglect on the part of another person
• If not already reported, where a complaint is received by a Health Board or NHS Trust and the complaint is about the medical treatment given to the deceased with a suggestion that the medical treatment may have contributed to the death of the patient.
Deaths of children, Any death…
• Of a newborn child whose body is found
• Which may be characterised as sudden unexplained death in infancy (SUDI) or the like
• Of a child from suffocation including overlaying
• Of a child in foster care;
• Of a child in the care of a Local Authority
• Of a child on a Local Authority “at risk” register.
Public Health, Any death…
• Caused by an industrial disease or industrial poisoning
• Due to a disease, infectious disease or syndrome which poses an acute, serious public health risk including:
– Any form of food poisoning
– Hepatitis A, hepatitis B (± delta-agent co-infection (hepatitis D)), hepatitis C and hepatitis E
– Any hospital acquired infection
– Legionnaires disease
Deaths associated with medical or dental care, Any death…
• Which was unexpected having regard to the clinical condition of the deceased prior to his or her receiving medical care
• Which is clinically unexplained
• Which appears to be attributable to a therapeutic or diagnostic hazard
• Which is apparently associated with lack of medical care
• Which occurs during the administration of a general or local anaesthetic;
• Which may be associated with the administration of an anaesthetic;
• Caused by the withdrawal of life sustaining treatment to a patient in a persistent vegetative state (This is to be distinguished from the removal from a life-support machine of a person who is brain stem dead and cannot breathe unaided.);
• Occurring as a result directly or indirectly of an infection acquired while under medical or dental care while on NHS premises, including hospitals, GP surgeries, health centres and dental surgeries.
Any drug-related death–as a result of ingestion of any drug where the death does not fall into any category above
Any death not falling into any of the foregoing categories where the cause remains uncertified or where the circumstances of the death may cause public anxiety.
Deaths associated with medical or dental care, including deaths which may be due to medication (however administered) or diagnostic or therapeutic procedures (operations, investigations, X-ray procedures, etc). “Medical care” should be interpreted broadly and includes surgical, anaesthetic, nursing or any other kind of medical care whether being given in a hospital, a GP’s surgery, the patient’s home or elsewhere. It also includes deaths from “hospital acquired” infections.
Deaths where there is a possibility of criminal proceedings, including homicide but also from a road traffic death, an overdose of controlled drugs, an accident at work or a contravention of food safety legislation. In any case where it will be necessary to prove the fact and cause of death in subsequent court proceedings, the Procurator Fiscal will instruct a post mortem examination by two pathologists. This may be two forensic pathologists or it may be a forensic pathologist and a specialised pathologist, for example a paediatric pathologist if the death is that of a child.
Deaths for which the disease can be accurately diagnosed in life and cause of death certified without a post mortem examination–e.g., mesothelioma, which requires a combination of radiological evidence and an ante-mortem pleural biopsy with histologic examination using immunohistochemical staining techniques (e.g. positivity for Calretinin, CK 5/6, EMA, Vimentin) may conclusively diagnose mesothelioma and suffice to allow settlement of a compensation claim.
The Procurator Fiscal’s right and duty to investigate such deaths derives from Scottish Common Law (i.e. custom and practice which has developed over the centuries and now has the force of law) and it is reinforced by the Fatal Accidents and Sudden Deaths Inquiry (Scotland) Act 1976.
All reportable deaths must be notified to the Procurator Fiscal as soon as possible after occurrence and before any steps are taken to issue a death certificate. Because the Procurator Fiscal is less interested in establishing any non-suspicious cause of death, the rate of post-mortem examinations is much lower (25%) in Scotland than it is in England (90+%).