Markham v HM Coroner Greater London (Western District)

JUDGE THORNTON: This is the judgment of the court.

This is an application by Jeffrey Markham which is brought with the Attorney General's fiat. Mr Markham, the applicant, who appears today in person, seeks an order under section 13(1)(b) of the Coroners Act 1988 to quash the inquest concerning the death of his son, James Ross Markham, and to direct a fresh inquest.

James Markham died on 20 November 2001. He collapsed in the street near his home in Ruislip, west London, and was pronounced dead at Hillingdon Hospital only a few hours later. His death was all the more tragic because of his age. He was only 21 years old, having been born on 18 August 1980. He was a music student living at home and was seemingly fit and healthy at the time.

Unfortunately, the investigation commenced by the West London Coroner was inconclusive. The post-mortem examination on 23 November found no obvious causes of death. The experienced pathologist, Dr RC Chapman, concluded in his report: "No gross acute natural disease was visible ... Sudden deaths in young people may occur with no obvious pathology for the pathologist to see. Such deaths probably relate to a sudden heart arrhythmia." He recorded the medical cause of death as "unascertained".

Since there was, at the time, no further explanation for James's sudden and unexpected death, the coroner at the inquest on 1 March 2002 had no option but to pronounce a verdict of "unknown natural causes", the injury or disease causing death remaining "unascertained". As a result, the entry in the death certificate of 4 March 2002 for the purposes of the Births and Deaths Registration Act 1953 also recorded the cause of death as "unascertained" and the inquest verdict as "unknown natural causes".

But matters did not rest there. The applicant had blood samples of James's DNA tested. In due course those tests showed unequivocally that James had died as a result of a genetic fault known as Long QT Syndrome. This fault had caused the unexpected cardiac arrest and James's sudden death. A so-called "mutation report" to this effect, dated 20 December 2006, was obtained by the University College London Hospital's Cardiac Genetic Counselling Clinic from the Department of Clinical Biochemistry at the Statens Serum Institut in Denmark. The UCL Clinic, in a letter of 20 December 2006, explained that "A novel mutation has been identified in KCNQ1 which has been proposed as being pathogenic."

This conclusion of a genetic fault was further described by Dr Elisabeth Rosser, Consultant Clinical Geneticist at the North East Thames Genetics Service. In her report of 1 May 2012 she confirmed that the particular genetic mutation had been found in James but not in either of his parents, a significant finding as James was the only member of the family to have suffered a cardiac problem. Unfortunately, as Dr Rosser pointed out, this condition is not diagnosed in life in many people.

Following on from the conclusions of the genetic testing, both the applicant and indeed the coroner, who helpfully supported him and does not oppose this application, tried to have the death certificate amended. The applicant believes that the record should be accurate, not just for the sake of his son but for other families who suffer similar tragic deaths caused by genetic faults.

The coroner indicated to the General Registry Office that the cause of death, previously unascertained, was now known. Had she had the genetic information at the time of the inquest, she stated, the verdict would have been "natural causes" and the cause of death would have been recorded as "Long QT Syndrome leading to cardiac arrhythmia".

The General Register Office, however, was unable to make the requested alteration without a fresh inquest, because it would be an alteration of substance relating to the cause of death: see section 29(4) of the Births and Deaths Registration Act 1953. Hence this application today, brought with the Attorney General's consent which was given on 18 September 2012. The only way forward is for a fresh inquest to be held: see for example Attorney General v Harte (1987) 151 JP 819.

Having read the new medical evidence and the genetic testing reports we are satisfied that it is necessary and desirable in the interests of justice, under section 13(1)(b) of the Coroners Act 1988, that another inquest should be held. Thanks to the applicant's persistence, the mystery of his son's death has been solved. The fresh evidence allows us therefore, as we now so order, to quash the inquest and the inquisition and to order another inquest to be held. We leave it to the local coroner to decide who shall conduct the inquest, but we hope it shall be soon; the applicant has waited long enough for the record to be put straight.

Mr Markham, would you like a copy of that document which I have just read out?

MR MARKHAM: Yes please, sir.

JUDGE THORNTON: There is one for you here. It is not the official judgment in official judgment form, but it is all the words that I have read out.

MR MARKHAM: Thank you, sir.

JUDGE THORNTON: In any event, can I tell you that I will be sending a copy to the West London Coroner today.

MR MARKHAM: Thank you, sir.

JUDGE THORNTON: Can I also say something else. Thank you very much for your submissions and the way your case was put. Can I say that, quite separately from this case, I have consulted with the British Heart Foundation and we shall be issuing joint guidance in due course with the Department of Health so that coroners and coroners' officers will be more aware of this kind of death in young people, and so that they can warn extended members of the family that they should be genetically tested and, if necessary, treated through the various clinics that are available to avoid similar deaths in the future. I thought you might like to know that.

MR MARKHAM: Thank you, sir.

JUDGE THORNTON: Thank you very much for coming today.