Including Facts Which Did Not Directly Cause The Death On The Record Of Inquest

R (Paul Worthington) v HM Senior Coroner for Cumbria [2018] EWHC 3386 Admin

The High Court has recently considered what findings are permitted to be included by a coroner in a Record of Inquest.

The case arose from the high-profile (second) inquest into the death of 13 month-old Poppi Worthington. The coroner made a finding that the deceased had been sexually assaulted in her father's bed prior to her death. However he found that this assault did not cause her death, which was from asphyxiation due to the position of the bedclothes, or her position within the bed or overlaying, or a combination of all three. The fact of the sexual assault was included in the Record of Inquest, for the purpose of explaining how Poppi came to be lying in the unsafe sleeping environment. The coroner explained his findings and reasoning in a lengthy document.

Poppi's father challenged the inclusion of the sexual assault in the Record of Inquest, on the basis that because it was not medically causative of the death, it was not relevant to recording 'how she came by her death'.

The High Court dismissed his challenge and concluded that it was lawful for the coroner to record the sexual assault as it was an integral part of the factual matrix. This formed the immediate circumstances of the death, because it was the reason that Poppi had been moved from her cot into the bed where she died. The court also re-iterated (at paragraph 43) that one function of an inquest is to seek out and record as many of the facts concerning a death as the public interest requires, and that a coroner is at least entitled to record their finding in relation to a main issue, even if that is to explain why they did not find that it directly caused the death.

This judgment is...