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This article draws upon the international literature to focus on the investigation of prisoner deaths in England and Wales, concentrating on clinician involvement in this process.

This is a viewpoint paper regarding clinician involvement in coroner investigations of prisoner deaths in England and Wales.

Compared to colleagues practising in the community, the authors suggest that there is a higher burden of investigation upon clinicians practicing in secure environments and recommend improved training for prison clinicians regarding expectations of the coroner's inquest and also a system whereby questioning in coroners' courts is directed through the coroner.

This paper provides an updated perspective on the issue of coroner investigations following a death in prison custody, from the position of practising prison clinicians.

The aim of this paper was, principally, to look at the coroner's post-mortem report quality regarding adult medical patients admitted to an English hospital; and to compare results with Royal College of Pathologists guidelines.

Hospital clinical notes of adult medical patients dying in 2011 and who were referred to the coroner's office to determine the cause of death were scrutinised. Their clinical care was also reviewed.

There needs to be a comprehensive approach to coroner's post-mortems such as routinely taking histological and microbiological specimens. Acute adult medical patient care needs to improve.

Steps should be taken to ensure that comprehensive coroner's post-mortems are performed throughout the UK, including with routine histological and microbiological specimens examination. Additionally, closer collaboration between clinicians and pathologists needs to occur to improve emergency adult medical patient clinical care.

The study highlights inadequacies in coroner's pathology services.