Sir, Dr B. C. Conochie raises the role of a medical referee in detection of another Shipman (letter, August 4). This is a valid point, but referees are faced with a multitude of other problems in the completion of cremation papers.

Medical referees are statutory posts required of all crematoria. We are appointed by the relevant crematorium authority; often this is the local government, but only after we have been vetted by the Home Office — now the Department of Constitutional Affairs — as being fit for the job.

I have been a deputy medical referee for 22 years. This is a part-time job and the first nine years overlapped with my day job of consultant histopathologist, before I retired from that post. During that time I taught many medical students, who seemed to get no other practical training in dealing with post-death paperwork. This was, and still is, reflected in the standard of cremation form filling. Twice a year, when the newly qualified doctors start to work on the wards of our local hospitals I get the same crop of errors. I regularly ring the doctors. I introduce myself and ask if they have any idea who I am. The universal reply is “no” — they have never heard of the post and had no idea that all the forms are checked for accuracy. My phone call comes as a surprise.

Even more senior doctors don’t seem to appreciate the difference between a cremation certificate and a death certificate, one of identification of the body in the former case. It is very rare for me to find the answer to the question “what examination of the body did you make?” to include the word “identification”.

Although stopping another Shipman is of great importance, until something is done about the quality of undergraduate training in the post-death process this doctor will gain some protection by virtue of the mass of completion mistakes which occur on a daily basis across the country.

DR JAMES BRIGGS
Bristol

Sir, The system proposed by Dr Conochie is now in place in Tameside (Shipman country).

I have been the medical referee at Tameside Crematorium for the last six and a half years. This crematorium is computer assisted, though this was not the case during the Shipman era. I carry out a quarterly audit of the number of certificates given by all doctors, both those completing the first and those completing the second parts of the cremation certificates. If any doctor has a suspiciously high number of certificates without an adequate reason (the local hospice and some doctors at the local hospital have high numbers by reason of their field of work) then these certificates are pulled out and restudied and any causes for concern are discussed with the coroner and if necessary with the medical director of the local primary care trust.

This will go some way to pick out another Shipman but problems can arise in two specific areas.

First, the medical referee is not involved in burials which still make up approximately 30 per cent of disposals.

Secondly, if the medical referee is concerned about a particular certificate or cause of death which does not fall within the remit of the coroner, there is no source of funding for the medical referee to order a post mortem which he is empowered to do.

There is no way that a medical referee can discern that a doctor has lied about a cause of death if all other circumstances appear to be in order.

DR PATRICIA HENSHALL
Cheadle, Cheshire

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