Other key organisations

State Forensic Pathologist

The State Forensic Pathologist assists the coroner by co-ordinating and providing the medical expertise requested by the coroner in order to conduct a thorough investigation. The most important function of the State Forensic Pathologist is to conduct post mortem examinations of deceased persons (including autopsies, which are governed by section 36 of the Act). After their examinations are complete, the State Forensic Pathologist writes a post mortem report, which becomes a key part of the coronial record. The post mortem report aids the coroner to determine the cause of death. Other pathologists can also conduct post mortem examinations as and when required.

The role and powers of the State Forensic Pathologist are set out in Part 3 of the Act. The Macquarie Dictionary defines pathology as ‘the branch of medical science dealing with the origin, nature, and course of diseases’. It also covers ‘the study of diseased body organs, tissues, or cells using laboratory tests’. Forensic pathology goes beyond the traditional confines of this definition, also covering areas such as identification of deceased persons through medical means, and the interpretation and review of medical reports and records.

The State Forensic Pathologist is responsible for ensuring that forensic medical services are provided to the coroner’s court in an efficient and effective manner (ss 17 & 18). The State Forensic Pathologist supervises and co-ordinates pathology across the state, issuing guidelines and ensuring that pathology services are well administered. They also attend scenes of death at the request of coroners, provide expert evidence in court and delegate their functions to approved pathologists when required. Having a State Forensic Pathologist to organise all the services in the state ensures a cohesive approach and strong strategic management of these important services.

Forensic Science Service Tasmania

Forensic Science Service Tasmania (FSST) provides forensic science services to coroners, and to the State Forensic Pathologist. They provide scientific analysis of samples such as fibres taken from clothing, paint flakes, dirt removed from shoes and DNA from under fingernails (or other appropriate biological specimens). FSST also conduct toxicological analyses. Toxicology involves testing blood and other biological samples (when required) for the presence of substances such as alcohol, drugs or medications, and poisons.

Many commonly prescribed medications and illicit drugs, which are potentially significant or important in terms of possible toxicity, are included in routine toxicological screening at FSST. Not all drugs and poisons can be detected during routine toxicology testing. If a substance is not routinely detected during toxicological analyses, sometimes it is possible to outsource forensic toxicology testing to an interstate forensic toxicology laboratory.

Toxicology tests provide information on the specific substances detected and at what concentrations. Identifying specific substances such as alcohol, drugs or poisons is vital in many coronial investigations and supplements the evidence obtained by the forensic pathologist in their post mortem examinations.

FSST also assists in the investigation of fires and explosions. Its staff can provide chemical analysis of explosive compounds and can identify trace accelerants used to initiate fires.

Tasmania Fire Service

The Tasmania Fire Service (TFS) plays a vital role in the investigation of fires and explosions, regardless of whether a death also occurs. TFS personnel are the first responders to the scene of such incidents, and contain any fire and ensure that any explosion site is safe for the public and TFS staff. They also gather evidence at the scene, and identify the cause and origin of the fire or explosion if possible. TFS does not have a dedicated coronial unit.

TFS officers attend all fires and explosions, and additional staff attend and provide support as required. TFS also has access to a network of specialists, such as qualified electrical inspectors and wildfire-qualified investigators, upon whom they can call whenever needed. Once the TFS has completed its investigations, personnel produce a Fire Investigation Report, which is forwarded to the coroner’s court if a coroner is investigating the matter.

It is rare for a coroner to investigate a fire or explosion without a related death. At all fires and explosions, the TFS conducts its own investigations according to its own procedures and may transfer the scene to Tasmania Police if appropriate (as in the case of a suspected crime, such as arson).

Religious, cultural and other support groups

Religious, cultural and other support groups play a vital role in assisting the families and friends of deceased persons to negotiate the coroner’s court. People from religious and cultural minorities can sometimes feel uncomfortable expressing their views to public officials. Past experiences, both personal and historical, can cause fear and anxiety and prevent people freely communicating their feelings. Support groups include any group that provides individual or social support to a particular group in society based on ethnic background, sexuality, gender identity, disability or any other attribute.

A religious, cultural or other support group whose members understand the needs and beliefs of affected families and friends can help bridge the gap between the coroner’s court and those individuals. Anyone can contact such a group and they can talk to the court on that person’s behalf, explaining their views. If you are a member of a particular social group with diverse needs, then the use of a support group as an intermediary may assist them to express their views and concerns in a clear manner.

Religious, cultural and other support groups can also help coroners to understand how a deceased person may have felt about certain issues or in certain situations, giving them a deeper understanding of the deceased person and their life. Understanding the viewpoints of the families and friends of the deceased person can also help the coroner and the coroners’ office to communicate in an appropriate, respectful manner when dealing with the bereaved.

The National Coronial Information System (NCIS)

The National Coronial Information System (NCIS) is the national data repository for coronial information. The NCIS holds information about deaths reported to a Coroner in Australia and New Zealand. The function of the NCIS is to develop and maintain a high quality information service for coroners, policy makers and researchers to benefit the community by contributing to a reduction in preventable death and injury.

The NCIS provides national case information to assist in coronial investigations, as well as statistical data to agencies including the Australian Bureau of Statistics and the Commonwealth Department of Health. The data is used to inform community health and safety strategies. Data reports may be provided, subject to coronial approval, and access to the database may be available for ethically approved research. To find out more, visit ncis

Registry of Births, Deaths and Marriages

The Registry of Births, Deaths and Marriages (BDM) maintains the Register of all deaths in Tasmania. It also issues Death Certificates and provides statistical data to government departments and some approved private organisations. Once the coroner’s court receives the initial police Report of Death, a Registration of Death Statement is generated and sent to BDM. The death is then registered and an interim death certificate can be issued.  The certificate will have an endorsement stating ‘incomplete registration – cause of death subject to coronial inquiry’. Once the cause of death has been determined, the coroner’s court notifies BDM.  BDM then finalise the death registration and the endorsement is removed. After this, anyone who received an interim death certificate can return it to BDM in exchange for a standard Death Certificate.  If you require a copy of a Death Certificate, you may apply to Service Tasmania.

The coroner is required to state the particulars needed to register the death under the Births, Deaths and Marriages Registration Act 1999 in their findings if possible (s 28(1)(e)). At this point, there is no legislation stating which particulars are required to register a death. The practice of coroners is to only record the personal particulars which may be appropriate in the circumstances of each case.

Funeral Directors

Funeral directors help families and friends of deceased persons to lay their loved ones to rest in a respectful and dignified manner. Family members are welcome to contact a funeral director to arrange care for their loved one at any time. Once the coroner has gathered all the information they require from the deceased person’s body, they will sign a certificate authorising release of the body. If the coroner’s court is aware that family members have contacted a funeral director, then the mortuary staff will call the funeral director when the deceased person is ready to be collected. The coroner’s court will call the senior next of kin and let them know, so the funeral director may also be contacted by families to request that the deceased person be collected. If a family contacts a funeral director, they will liaise with the mortuary to transfer the deceased person into their care as soon as practicable.

Information for funeral directors

• The deceased person cannot be collected from the mortuary until the coroner signs a certificate authorising their release.
• If the coroner is notified that you have been contracted to care for the deceased person, then mortuary staff will contact you as soon as the body is ready to be collected.
• The senior next of kin will be notified by the court once the certificate authorising release is signed, so they may also choose to notify you.
• The coroners’ office will be able to provide guidance on when the deceased person is likely to be released for burial or cremation.
• The coroner will have named the senior next of kin at various stages in the investigation. The coroner’s decision on who is the senior next of kin has no bearing on any legal proceedings outside the coroner’s court. If there is a disagreement about to whom the body should be released, parties should apply to the Supreme Court under probate law.
• All medical procedures are undertaken with the aim of returning deceased persons to families for cremation or burial as soon as is reasonably possible.
• Once a deceased person is released by the coroner, there are no additional restrictions placed on cremation, manner of burial or location of burial by the coroner (over and above the usual Tasmanian laws surrounding burial and cremation).
• Police will take all the personal effects belonging to the deceased person. If any family member or close friend is seeking return of these items, advise them to contact the coroner’s court.

Insurance companies

Insurance companies may be involved in coronial proceedings for a number of reasons. These include matters where there has been motor vehicle damage due to a fatal crash, matters involving superannuation and matters where insurance claims are made relating to deceased persons (such as payouts for life insurance). Insurance companies may be granted access to a particular coronial document if they have a ‘sufficient interest’ in that document. For example, if an insurance company genuinely needs to know the cause of death they can notify the coroners’ associates of their interest in the matter. Once the coroner’s findings are ready, they will release a copy to the insurance company. It is not possible for the coroner to issue a ‘preliminary’ or ‘draft’ finding before the investigation is complete.

It is common for an insurance company to have a sufficient interest in one document to receive a copy. Insurance companies rarely have an interest in relation to an entire investigation. Although their interest in a matter is enough to allow access to some documents, it will not usually give them the right to question witnesses in court and exercise other rights of an ‘interested person’. In some cases, the coroner will take custody of an item (such as a motor vehicle) as evidence during an investigation. All items held as evidence remain in the custody of the coroner until they make an order as to care and control, or until the findings are handed down, whichever occurs first. If a coroner does make a care and control order (s 60) the item can be returned, however it remains in the custody of the coroner and so it must not be altered or disposed of until the findings are handed down. For example, if an order is made returning a laptop, the laptop cannot be sold or any files deleted.

Insurance company representatives are asked to note that the coroner does not issue Death Certificates. A coroner will make findings as to cause of death, but Death Certificates can only be sourced from Births, Deaths and Marriages (via Service Tasmania). If a bank or other institution requests a ‘death certificate from the coroner’ you should clarify whether they are requesting a copy of the ‘coroner’s findings certifying cause of death’, or whether they are requesting the ‘Death Certificate’ from Births, Deaths and Marriages.

Media

The media play an important role in coronial proceedings, conveying the coroner’s findings into the public arena. It is through media reports that most people become aware of coronial findings and therefore, it is through the media that inquests and findings can make their most significant impact on the public. One of the coroners’ most important roles is to protect the public, and therefore the coroners’ office works with the media so that the public is made aware of coroners’ comments, warnings and recommendations, and their knowledge and wellbeing are increased.

The media can also play an important role for families. If the families and friends of a deceased person feel that the death of their loved one could have been avoided, the public naming of any authorities that may have contributed to the death can have a positive emotional effect. People feel that their voice has been heard and this can help them to cope. The death of a loved one is a tragic event and the knowledge that others have been saved this pain can be a comfort in difficult times.

Information for the media

• All coronial inquests are open to the public and the media, unless the coroner orders otherwise. The coroner has the power to exclude a person from court for a part or all of the proceedings, although this does not often occur.
• You are welcome to make notes during inquests including direct quotes; however, you may not record sound or images anywhere in the court building.
• The staff at the coroners’ office are always pleased to assist by providing court dates and information on the status of an investigation where appropriate.
• You may apply to access documents on the court file using the ‘Application to Access Coronial Records’  form on the Magistrates Court web site, under Forms. Access may be granted where you, or the organisation you work for, has a ‘sufficient interest’ in the document in question.
• All information disclosed during an inquest can be published unless a coroner makes an order restricting the publication of proceedings (or evidence tendered at an inquest) in whole or in part. There are penalties for publishing materials restricted in this manner.
• The factors which a coroner will take into account when determining any application to restrict or prohibit publication are, whether publication would:
  • be likely to prejudice the fair trial of a person
  • be contrary to the administration of justice, national security or personal security
  • involve the disclosure of details of sensitive personal matters including, if the senior next of kin of the deceased has so requested, the name of the deceased.
• Some coronial cases are highly sensitive and care must be taken in reporting these matters in a suitable manner. In particular, when reporting on cases where suicide and mental illness are factors, the following document should be consulted: Reporting Suicide and Mental Illness: a Mindframe resource for media professionals. This resource is available free on the Mindframe web site under ‘For media’.
• Coronial findings are often published, and when this occurs they are made available for public viewing on the coroner’s court section of the Magistrates Court web site, under Findings | Coroners Court (magistratescourt.tas.gov.au) Findings made after an inquest are always published online.

In January 2024 Media Guidelines for the Coronial Division were developed to assist the media around what information the coronial division can and can't provide, attending court, requesting documents and non-publication orders.  The document can be accessed here Media Guidelines for the Coronial Division.

Suppression Orders

Journalists reporting from court must ensure that any publication does not contravene any suppression order or any applicable legislation, and does not otherwise prejudice the inquest.  A list is provided below which pertains to which relevant matters and the order made.

Forensic Cleaners

The purpose of forensic cleaning is to remove any biological material from a crime or trauma scene and restore it to a livable condition. Doing so safely often requires specialized equipment and knowledge that the average population does not possess.

For further information refer to yellow pages.