Providing this material would allow you and your team to consider the extent to which you are satisfied that the public statements made in 2018 do provide an accurate representation of the underlying intelligence and assessment.. Local authority set-up, resource, facilities and socio-economic make up mean this will not be comparing like with like. To quash the original inquest and order a fresh investigation, s.13 of the Act provides that the High Court must be satisfied that it is necessary or desirable in the interests of justice that an investigation, or another investigation, be held, whether because of fraud, rejection of evidence, irregularity or proceedings, insufficiency of inquiry, the discovery of new facts or evidence or otherwise. To take the body of a deceased person out of England and Wales, notice must be given to the coroner within whose area the body is lying. The office is open 9am to 5pm Monday to Friday. It will take only 2 minutes to fill in. ) or https:// means youve safely connected to the official website. For the time being Halletts office declines to say when she will resume hearing the case. Mr Hoskins was found dead on July 14 2022, the The table below provides information about future hearings. The Appeals Court considers all types of civil cases and all types of criminal cases except first degree murder appeals, which go directly to the Supreme Judicial Court. Inquest conclusions of killed unlawfully, road traffic collision and open conclusions were down 55%, 22% and 20% on 2019 to 61, 774 and 1,207 respectively. Until now, the press record which the family members made at the time was not viewed by the coroner or the government as threatening to contradict the official Novichok narrative. If a medical practitioner (who does not have to be the same medical practitioner who signed the MCCD) attended the deceased within 28 days before death (a new, longer timescale) or after death, then the registrar can register the death in the normal way. An inquest heard that Steven James Purchase, also known as Steven James Harrod, had attempted to get out of the way when crossing a railway track last year. But even though I have experienced perhaps more of the harshness of modern politics than most, there are no regrets.". The British government has selected a new team trusted with state secrets to run the inquest into the alleged Novichok death of Dawn Sturgess three years ago. The Coroners Courts Support Service provides support to people when they attend an inquest at a coroners court. Coroners appointments, contacts and areas Coroners appointments, contact details and information about the merger of coroner areas. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. Mr Porter had vowed to fight on and contest the next election and had already been pre-selected, but announced in December of that year that he would not recontest the seat of Pearce in Western Australia. Share sensitive information only on official, secure websites. For a list of all historical amalgamations and changes to coroner areas, please refer to the supporting guidance document. "We remain disappointed the NSW Police did not conduct a similarly thorough investigation into the crime Kate alleged had been perpetrated against her," the statement said. Unclassified conclusions made up 21% of all conclusions in 2020, one percentage point more than in 2019. She feels that Dawn is not getting the same quality of treatment as the Skripals because of her background and the fact shes an alcoholic. Ewan Hope, Dawns son, told a London newspaper that he had been alerted to his mums illness in a call from his gran [Caroline Sturgess] last Saturday [June 30]. These secret reports, Hallett was told, are assessments [which] draw together the complex intelligence jigsaw puzzle that was put together during the very large-scale investigation that took place into the Salisbury and Amesbury poisonings. Click or tap to ask a general question about $agentSubject. Gavin George William Baker died on December 14, 2020 and was . They are seeking a multi-million pound compensation from the British government. To help us improve GOV.UK, wed like to know more about your visit today. myanmar cigarette brands. Some page levels are currently hidden. 3: INVESTIGATION and INQUEST An inquest into the death of Miss Amy Henderson was opened on the 26th April 2022 and resumed Within the Key Findings sections, figures greater than 1,000 are rounded to the nearest 100. However, the proportion of reported deaths requiring a post-mortem has. Instead of the earlier bedside vigil, the newspaper reported Dawns sister Claire as changing her story: all the visitors have to look at them through glass. Registered in England & Wales | 01676637 |. Future inquest hearings Inquest hearings scheduled at the City of London. Accidental, unexpected, unexplained, sudden or suspicious deaths are investigated privately for. New research into statements reported by the press from Sturgesss sister, mother, son, and other family members, speaking at the time of her hospitalisation, reveals that if they are called to testify in Halletts court, their evidence may contradict the governments Novichok allegations. Please let us know how we can improve this page. Deaths should be reported to the coroner's officers. Pearl Morris died 16 October 1936 in Wilson. The Wiltshire and Swindon Coroner What a Tel: 01392 383636. WebThe SJC is the Commonwealth's highest appellate court responsible for the general superintendence of the judiciary and of the bar, makes or approves rules for the On 1stJuly 2018 I was informed that my sister Dawn Kelly Sturgess had been taken ill and was in hospital. There is no reference in this court statement to what Claire and the family had observed in the days immediately following July 1. "This is in accordance with the wishes of Kate's family, who have requested that their privacy be respected. Hallett and the lawyers advising her inadvertently allowed secret medical evidence to slip into the public record on March 30. Lancashire and Blackburn with Darwen, Leicester City and South Leicestershire, Stoke-on-Trent and North Staffordshire, and Black Country conducted over a half (86%, 57%, 52% and 63% respectively) of all their post-mortems using only less-invasive techniques. Of the 205,438 deaths reported to coroners in 2020, less than 1% (771) were reports of deaths that had occurred outside England and Wales, a slight decrease compared to 2019. Fire Safety Act 2021; Products & Services . A lock icon ( Medical practitioners: Refer a death to the coroner. Caroline is in really bad shock. The Devon Registration Service for helpful information during bereavement. Administration The estimated[footnote 17] average time taken to process an inquest in 2020 (defined as being from the date the death was reported until the conclusion of the inquest) was 27 weeks (see Table 13)[footnote 18], so no change compared to 2019. After replacing the Salisbury coroner in January of this year, and after a single hearing on March 30 by secret service advisor and ex-judge Baroness Heather Hallett, briefings by the Cabinet Office and the security services have led to the decision that the only way of preserving the governments narrative of a Russian nerve agent attack, first against Sergei and Yulia Skripal, then against Sturgess, is to introduce Defence Ministry and MI6 evidence in secret session. Please limit your input to 500 characters. It also includes a glossary with brief definitions for some commonly used terms. Administration Email: coroner@devon.gov.uk Tel: 01392 Charlie [Rowley] called her when Dawn fell ill hours before he did, Ewan said: The paramedics gave mum CPR for 30 minutes as her heart wasnt beating. Email: coroner@devon.gov.uk There are also the coroner's courts, investigating causes of (b)An application under s.13 of the Coroners Act 1988. WebJudge-led inquests The circumstances in which judges can lead inquests and details of notable inquests overseen by a judge. Websalisbury coroners court inquests 2020 salisbury coroners court inquests 2020. salisbury coroners court inquests 2020. what can you not bring on a carnival cruise; The day before, on July 5, the patient medical notes were changed, according to Halletts March 30 record Novichok had been introduced. All deaths in England and Wales must be registered with the Registrar of Births and Deaths and statistics on all deaths are published by the ONS. List of upcoming hearings. In 2021, questions were raised by the NSW parliament about NSW Police's handling of the investigation, including around statement processes and communications. WebShould you have any questions about the impact of COVID-19 please contact the Coroners Office by email to coroner@devon.gov.uk or by telephone on 01392 383636. This is evidence that the ambulance crew, which first responded to Dawn on the morning of June 30, have recorded in their logs that she had no heart beat or pulse, and was not breathing. Senior coroner David Ridley said Mr Hoskins died of heroin/morphine and alcohol toxicity. Type a question or click on a popular topic below. WebThe Coroner can issue a Coroner's Certificate to the Registrar of Births and Deaths who will then register the death and issue the death certificate. Travel and tourism have been significantly impeded by the Coronavirus pandemic. Where a death is from natural causes (for example, from a naturally occurring disease) in most cases that death will not need to be reported to the coroner. WebSTATE CORONERS COURT . If the cause of death is The doctors said that its not looking good and that she might not survive. A non-standard post-mortem is defined as a post-mortem which requires special skills. She[Claire] added: [Caroline] is annoyed because for days the police told her that Dawn had a heart attack. The number of finds reported has historically been steadily increasing since the commencement of the 1996 Act in September 1997, from 54 finds in 1997 to 1,059 in 2017, before decreasing to 999 in 2018, then rising to 1,061 in 2019. Industrial disease had the highest proportion of inquests relating to males, at 90%, and accident/misadventure had the highest proportion of inquests relating to females[footnote 14], at 46%. , Killed lawfully was excluded from above, as there was only 5 such inquest conclusions in 2020. The wayback machine has made possible the recovery of this police website notice. Mr Porter declined to comment on today'sstatement by the SA coroner. Further information about attending court. A video shown to the court revealed Steven walking out on to the crossing, then attempting at the last moment to get out of the way of an incoming train. An inquest is a court hearing conducted by the coroner to gather information about the cause and circumstances of a death. 205,438 deaths were reported to coroners in 2020, the lowest level since 1995. court tv mystery schedule today; possessions series ending explained. Shes on the brink of death, basically. . In Halletts court the family members and Rowley are represented by London lawyers Michael Mansfield QC and Irene Nembhard. The family member, who asked not to be named [sister Claire Sturgess], spoke in detail how Dawns mother,Caroline Sturgess, has visited her daughter several times and is distressed at the level of care she has been given. (ABC News: Lincoln Rothall) In early 2021, the former Attorney-General became "There are few, if any, constants left in modern politics. Editors' Code of Practice. | Website Designed by: family guy peter dies in car crash, Wow! Use this button to show and access all levels. Superior Court has jurisdiction over all felony matters, civil actions over $50,000, labor disputes where injunctive relief is sought, and medical malpractice tribunals. Someones getting a brand new unit, Alex is one of Our SAM (Safety & Maintenance) Tech, Thanks again to all who have voted for us! A Binghamton man will The coronial investigation into the death of former attorney general Christian Porters accuser has concluded, with the South Australian coroner deciding against The feedback will only be used for improving the website. The ONS mortality statistics, based on death registrations, report the number of deaths registered in England and Wales in a particular year irrespective of whether a coroner has investigated the death. WebIt is the duty of coroners to investigate deaths which are reported to them. Not sure how this unit was still working but, Ill just put this right here! We will use this information to improve this page. Three young men died when the driver of their car lost control while drunk and crashed into a house, a coroner ruled. Assistant coroner Ian Singleton said Mr Chaney was discovered at 3.58pm by members of the public in a public toilet with drug paraphernalia The inquest, held on December 13 at Wiltshire and Swindon Coroners Court in Salisbury, heard that Mr Chaney had a history of substance abuse, namely crack cocaine, benzodiazepine, and heroin. The woman "Kate" contacted police in 2019, but withdrew her complaint in the days before she took her own life in 2020. You can also view a table of past hearings. After Mr Morrison said his minister had been "unable to conclusively rule out a perceived conflict of interest", Mr Porter quit the frontbench, saying he would not pressure the donors to reveal their identities. Left to right: Dawn Sturgesss father Stan; mother Caroline; son Ewan Hope. WebInquest: Inquest into the death of Emiliana Obusan Hearing dates: 1 to 3 November 2021 Date of findings: 19 November 2021 Place of findings: Coroners Court of New South Wales at Lidcombe Findings of: Magistrate Derek Lee, Deputy State Coroner Catchwords: CORONIAL LAW cause and manner of death, endotracheal tube, unrecognised This page is located more than 3 levels deep within a topic. "I have entered a finding as to the cause of Kate's death and determined that an inquest will not be held," the coroner said. These were described in court by the lawyer for the Home Secretary as some high-level assessments that were written in 2018 on the cases of Sergei and Yulia Skripal, allegedly attacked by Russian agents with Novichok in Salisbury on March 4, 2018; and the cases of Sturgess and Rowley, allegedly struck by a vial of Novichok left behind by the Russian agents, picked up inadvertently by Rowley, and opened at his apartment in Amesbury on June 30. In early 2021, the former Attorney-General became embroiled in controversy after the ABC reported an "unnamed cabinet minister" had been accused of raping a woman in 1988, in a letter sent to then-Prime Minister Scott Morrison. pros and cons of civil service system in policing. However, Hallett has exposed the interval between June 30 and July 5, 2018, when this contradictory evidence was accumulating. The Land Court has statewide jurisdiction over most real property matters, including registration of title as well as zoning and real estate tax lien cases. Inquests are taking place and where possible attendees are being asked to participate remotely. Web[2021] WACOR 36 Page 2 Coroners Act 1996 (Section 26(1)) RECORD OF INVESTIGATION INTO DEATH I, Philip John Urquhart, Coroner, having investigated the deaths of Trisjack Preston SIMPSON and Christopher Mervyn DRAGE with an inquest held at Perth Coroners Court, Central Law Courts, Court 51, 501 Hay Street, PERTH, on 15 A statement provided today to the ABC by former Adelaide Writers Week director and federal independent candidate Jo Dyer, issued on "on behalf of a group of Kate's friends", said they were "grateful for the South Australian Coroner's exhaustive and respectful investigation into Kate's death". District Court hears criminal, civil, housing, juvenile, mental health, and other types of cases. On July 2 and 3, 2018, the Wiltshire police issued warnings by twitter and official website confirming that their search of the Sturgess-Rowley flat in Amesbury, together with interviews of others who were in the flat at a party the evening before Dawns collapse, confirmed that Sturgess and Rowley had fallen ill after using a contaminated batch of drugs. Websalisbury coroners court inquests 2020 stephen stills gold hill, colorado. In September 2021, Mr Porter was again under pressure to quit the ministry, after he declared he had accepted funds from anonymous donors to cover some of the legal fees in his defamation action against the ABC. (Pre Inquest Review). This means that between June 30 and July 5, there is evidence from the Sturgess family and the medical personnel who briefed them that Dawn was not suffering from nerve agent symptoms. Figure 4: Number of conclusions recorded at inquests, England and Wales, 2010-2020 (Source: Table 7). Heard during a statement from the driver of the train, a Salisbury to Exeter service, the train was travelling at 40mph and had attempted to stop after. The following table summarises the coroner area amalgamation that have occurred during 2020. However, in the same year, deaths reported to coroners, which form only a proportion of all registered deaths, decreased to their lowest level - 205,438, since 1995. World United States United Kingdom Canada Australia South Africa Israel India France Belgium Switzerland. Coroner's inquests are held in cases of sudden, unexplained or suspicious deaths. A leading British expert on organophosphate poisoning and other toxicologists have commented that paralysis of the lungs leading to asphyxiation is the usual trigger for death by nerve agents; and that the hospital triage when Dawn was admitted would have detected lung fluid accumulation, if Novichok had been present. I have no doubt whatsoever, Hallett declared in court, that the provisional scope [of the inquest] should include the source of the Novichok and Russian state responsibility. Making that stick now requires replacing the coroners court testing witnesses and documents in public with a public inquiry accepting secret evidence behind closed doors, where it cannot be tested. "As such, we have nothing further to add at this stage," a spokesperson said. Web[2021] WACOR 12 Page 2 Coroners Act 1996 (Section 26(1)) RECORD OF INVESTIGATION INTO DEATH I, Sarah Helen Linton, Deputy State Coroner, having investigated the death of Child LDW with an inquest held at Perth Coroners Court, Central Law Courts, Court 85, 501 Hay Street, PERTH, on 12 January 2021 - 13 January 2021, find When expanded it provides a list of search options that will switch the search inputs to match the current selection. This is the lowest level since 2014. Coroners are independent judicial officers who investigate deaths reported to them. All official statistics should comply with all aspects of the Code of Practice for Official Statistics. who sells culver's gift cards; funeral gloria gaither; andrea king jesse lacey; terry mcdermott Time indicates the start of court session and we are unable to guarantee timings of individual inquest hearings. Halletts disclosure that Lumbs cause of death report was added to, months later, by the notation from Rutty, the second pathologist, of Novichok toxicity exposes the same process occurring post-mortem, as had happened at the hospital before death. "Our ongoing relationship with them is cherished.". She cant believe it,the family member said. shakespeare astrology quotes; florida medicaid provider master list; opposite of normocephalic; salisbury coroners court inquests 2020. speorg note iceland myth April 14, 2023 0 Comments 9:40 am. , A direct average of the time taken to process an inquest cannot be calculated from the summary data collected; an estimate has therefore been made instead. The lawyers refuse to answer questions; the family members are forbidden to speak to the press without their lawyers clearance. The SJC is the Commonwealth's highest appellate court responsible for the general superintendence of the judiciary and of the bar, makes or approves rules for the operations of all the courts, and in certain instances, provides advisory opinions, upon request, to the Governor and Legislature on various legal issues. Inquest jury No findings have been made against Mr Porter. Until then the information provided to the family by hospital staff and by the police had been accurate: no nerve agent symptom had been detected at the hospital, nor evidence of Novichok gathered by the police after their search of the Amesbury flat. The number of inquests opened in 2020 increased by 2,022 (up 7%) to 31,991. Perhaps the only certainty now is that there appears to be no limit to what some will say or allege or do to gain an advantage over a perceived enemy," he said in December 2021. For details of the police search, and for the late discovery of the poison bottle on July 11, read the book. She also announced a vague timetable to follow, with the next hearings to be listed in June or July 2021 and in September 2021., Asked this week to clarify when Hallett plans to resume this month, Halletts spokesman Bernadette Caffarey said: the Sturgess Inquest will be launching a website in the coming days and all the information on upcoming dates for further Pre Inquest Reviews will be posted on there.. They also sold their story to the BBC for a three-part dramatisation broadcast last year; click for details. Probate and Family Court has jurisdiction over a wide range of family matters, probate proceedings, and general equity. A coroner has recorded verdict that a Westbury man died from toxicity caused by drug and alcohol addiction. The London Daily Mailreported being told by Caroline that her daughter is being deprived of the quality of care given to Sergei and Yulia Skripal because she is a nobody alcoholic. Thank you for your website feedback! A .mass.gov website belongs to an official government organization in Massachusetts. A post-mortem examination will often be held before the coroner decides whether to open an inquest. From: Ministry of Justice The bulletin presents calendar year 01/05/2022 Inquests with juries and suspended investigations. WebA MAN in his 50s died after he was struck by a train running through Salisbury. Partially-redacted documents published by the Federal Court in June 2021 detailed the woman's allegation that she was raped three times by Mr Porter in Sydney when they were both teenagers in 1988, after a formal dinner for a debating championship. Thanks again to o, Voted BEST HEATING AND AIR COMPANY again this year, Up she goes. For "unclear reasons" he failed to see the incoming train. These are likely to have been reviewed in the first post-mortem conducted by Lumb, soon after Dawns death was recorded on July 8. Any such request can be submitted to: Wiltshire and Swindon Coroner's Office 26 Endless Street Salisbury Wiltshire SP1 1DP Complex Inquests . "The State Coroner is bound by confidentiality obligations and no further information will be released.". If you are planning to attend an Inquest listed below, could you please either phone 01823 359271 or email coroner@somerset.gov.uk It helps to have an for the Exeter and Greater Devon District, Further information about attending court, Benjamin Simpson - Inquest, no jury - POSTPONED, Harry George, William, WEBB, inquest, no jury, Stephen COLLOM - Inquest, no jury - POSTPONED, John Granville Couzens - Inquest, No Jury, William John Warren - Inquest, No Jury - POSTPONED, Elizabeth BRIGHT - Inquest, no Jury - POSTPONED, Luke Nightingale, Inquest, no jury POSTPONED, Richard Faulkner LLOYD - inquest, no jury, Christine Diane O'HAGAN - Inquest, No Jury, Cynthia Annie HELLEWELL - Inquest, No Jury, Shirley PARKER - Inquest, no jury - POSTPONED. This meant WebWiltshire & Swindon Coroners Court, Salisbury, where the inquest into the death of Dawn Sturgess is taking place. The large range of average time (41 weeks) may be due to the fact that the profile of coroner areas although there will be other factors including the resources provided to coroner services can vary greatly and a direct comparison between coroner areas is therefore not advised. This revealed that two leading English pathologists could not agree to sign their findings on the cause of Sturgesss death after holding two autopsies in July of 2018; they then delayed signing their final post-mortem report for almost five months. The decreases in time taken that occurred in 2015 and 2016 can largely be attributed to DoLS deaths where, in accordance with the Chief Coroners guidance, in uncontroversial cases, there could be a paper inquest, i.e. In March 2021, New South Wales Police said there was insufficient admissible evidence to proceed with an investigation in the matter. Shes seen as a nobody, really, the family member said. This service may include material from Agence France-Presse (AFP), APTN, Reuters, AAP, CNN and the BBC World Service which is copyright and cannot be reproduced. 2020 has been an unprecedented year; the covid-19 pandemic and corresponding restrictions have had a wide effect on all aspects of life in the United Kingdom. Please do not include personal or contact information. *Includes Killed unlawfully; Killed lawfully; Lack of care or self-neglect; Stillborn; Open; Industrial Disease; Drugs/Alcohol related[footnote 8]; and Road traffic collision. All English Franais. salisbury coroners court inquests 2020proforce senior vs safechoice senior. Cases requiring neither a post-mortem nor inquest. It is believed George Pattison, 39, murdered his spouse, Emma Pattison, 45, and their seven-year-old daughter Lettie, earlier than he took his personal life on 5 February. Crown Courts deal with the more serious cases including murder, rape, robberies, serious assaults. Shes done a lot of abuse to her body already. But despite the round-the-clock care that the two victims are receiving in the Radnor Ward intensive care unit in Salisbury hospital, Caroline believes that staff are treating them like second-class citizens because of their addictions. Catch up with The Loop, Jock Zonfrillo remembered as an 'incredible chef' and influential member of Australia's culinary landscape, 'Until we meet in heaven': Maryborough community comes to grips with triple fatality as loved ones remembered, Perfect storm brewing for housing market and it could make buying your own home a pipedream, Reserve Bank tipped to leave interest rates on hold for a second month, ASX to open lower, identified himself as the unnamed cabinet minister, but strenuously denied the allegation, said there was insufficient admissible evidence to proceed with an investigation in the matter, documents published by the Federal Court in June 2021 detailed the woman's allegation, questions were raised by the NSW parliament about NSW Police's handling of the investigation, including around statement processes and communications, Clare desperately wanted to stop drinking but she couldn't make it stick. Northeast Housing Court - Lawrence Session. The Coroner has a duty to investigate deaths: which are unnatural or violent where the cause of death is unknown where the person died in prison, police custody or state detention Following the. RUSSIA THROUGH THE LOOKING-GLASS OF ANGLO-AMERICAN WAR, THE BRITISH GOVERNMENT HAS TRAPPED ITSELF BETWEEN TWO CORONERS, TWO PATHOLOGISTS AS CREMATION FORM NUMBER 6 EXPOSES THE NOVICHOK LIE. It is the duty of coroners to investigate deaths which are reported to them. If we become concerned about whether these statistics are still meeting the appropriate standards, we will discuss any concerns with the Authority promptly. countries. She feels like she hasnt been given the whole story., On July 19, the London Sunand Daily Mail reported from a prepared statement by sister Claire, read out at the first coroners hearing that day. That report, dated November 29, 2018, the medical records of the first and second autopsies, along with ambulance paramedic logs, hospital admission records, and ward medical notes remain top secret. To see these again later, type ", {"type": "chips","options": [{"text": "More languages"},{"text": "COVID-19 safety"},{"text": "COVID-19 vaccine"},{"text": "Travel"},{"text": "COVID-19 testing"},{"text": "Self-isolation"},{"text": "COVID-19 data"},{"text": "Connect by phone"}]}, Birth, adoption, death, marriage and divorce, Employment, business and economic development, Employment standards and workplace safety, Environmental protection and sustainability, Tax verification, audits, rulings and appeals, Fraser Valley Highway 1 Corridor Improvement Program, Highway 1 - Lower Lynn Improvements Project, Belleville Terminal Redevelopment Project, Williams, Jovan Christopher & Williams, Shirley Beatrice, Butters, James Reginald (aka Hayward, James), Miles, Matthew Charles & Hanna, Kenneth Robert, Roche, Glenn Francis and Little, Alan Harvey, Robinson, Angela Elsie and Robinson, Robert Victor Able, Currier, Shawn Erickson, Doug Newcombe, Bob Weitzel, Kim, Understanding the role of Coroner's Inquests, Media information guide to Coroner's Inquests. Despite the small fall in the number of total conclusions, the number of verdicts of drug-alcohol related deaths increased by 12% to its highest level since 2014. Lance R. Johnson will serve at least 77 years in prison for the 2020 murder of Alison Salisbury and attempted murder of Shannon Brooks. Inquests are taking place and where possible attendees are being asked to participate remotely. Caroline also revealed that until the medical record was changed on July 5, she and other family visitors were not required to wear protective gear. Inquests are taking place and where possible attendees are being asked to participate remotely. In 2020, the number of deaths reported to coroners as a proportion of registered deaths varied widely across coroner areas, from 16% in North Yorkshire (Western) to 82% in Gateshead and South Tyneside. Caution should therefore be used when making comparisons to previous years. South AustraliaPolice prepared its own report into the death of the woman for the State Coroner, for the court to decide whether to launch an inquest.
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