In a case described as "of widespread importance" for the powers of coroners to investigate the causes of deaths, the Dublin City Coroner has appealed to the Supreme Court against a decision prohibiting him from investigating any indirect role the Pertussis, or three-in-one vaccine, may have played in the death of a Dublin man.
Mr Gerard Hogan SC, for the coroner, Dr Brian Farrell, yesterday argued that the High Court had erred when it upheld a challenge by the Northern Area Health Board to the coroner's decision to investigate any role the vaccine may have played in the death in 1995 of Mr Alan Duffy (22), of Howth Road, Clontarf.
If the High Court was right, the power of the coroner to investigate is "highly confined" to the immediate or proximate cause of death as against the "true cause" of death, Mr Hogan said.
Mr Duffy died on December 31st, 1995 after contracting pneumonia. He had received the three-in-one vaccine between October 17th, 1973 and February 16th, 1974.
After his death, the consultant who had treated him had proposed to state on the death certificate that he died of aspirational pneumonia due to cerebral palsy.
Mr Duffy's parents objected to such an entry and alleged that the aspirational pneumonia was due to Alan's mental handicap which, in turn, they alleged, was caused by an encephalopathic reaction to the Pertussis vaccine when he was a child.
Because of the dispute, the death certificate was not completed and the matter was referred to the coroner, who directed that an inquest be held. The inquest has stood adjourned since December 1997 in order to conduct medical investigations into the cause of death. These have included investigation into any role the Pertussis vaccine may have played.
Dr Farrell had proposed to reconvene the inquest in April 1999, when he planned to recount the evidence given up to then and to call another medical witness. The health board took a legal challenge to prevent any investigation into any alleged link between the vaccine and Mr Duffy's death. In December 1999, the High Court upheld that challenge.
Giving the High Court decision, Mr Justice Geoghegan said Section 30 of the Coroner's Act, 1962 required a coroner to investigate "how", "when" and "where" the death occurred. While he stressed that it would be unwise to set down any hard and fast rule, the judge said it was his view that a coroner should be investigating what is the real and actual cause of a death. He believed any conceivable link between Mr Duffy's death and the Pertussis vaccine was "too nebulous and indirect" to make it appropriate for an investigation by the coroner.
In the Supreme Court yesterday, Mr Hogan said the primary issue in the appeal was the construction of the word "how" in Section 30 of the 1962 Act.
He argued that the High Court had constructed "how" in a manner at variance with the structure of the 1962 Act and which usurped the function of the coroner and the coroner's jury.
There was no dispute in this case that Mr Duffy died of aspirational pneumonia, counsel added. But aspirational pneumonia was a proximate cause of death and was always caused by another condition. There was a dispute over why the pneumonia happened. Mr Hogan said the High Court decision was predicated on the assumption that, because Mr Duffy had received the vaccine 22 years earlier, it could not be the underlying cause of his death.
If Mr Duffy had died on December 31st, 1973, two months after receiving the vaccine, no one would argue that the coroner was not entitled to look beyond the pneumonia.
Mr Paul Gardiner SC, for Mr Duffy's parents, said the purpose of inquests was to allay rumours or suspicions or to draw attention to circumstances which, if not addressed, could lead to further deaths. Another purpose was to advance medical knowledge. How could this be achieved if analysis of the cause of death had to stop at aspirational pneumonia? he asked.
The appeal continues today.
