Jc01 the coroner, p.3
JC01 The Coroner, page 3
'Three weeks?'
'We are talking about the National Health Service.'
Alison's phone rang. 'Excuse me.' She fished it out of her pocket and answered. 'Coroner's officer . . . Hello, Mr Kelso ... I see ... Of course. I'll let Mrs Cooper know straight away . . . Yes, she's just started. Will do.' She rang off and turned to Jenny. 'That was an A&E consultant from the Vale. Fifty-four-year-old homeless man dead on admission. Suspected liver failure. Post-mortem this afternoon.'
'And a report next month?'
'I'll give you the morgue's number if you like. You can give them a ring and introduce yourself.'
She reached for a scrap of paper and wrote down a Bristol number. 'That'll get you through to Dr Peterson's answer- phone - the consultant pathologist. He's usually pretty good at calling back.'
Jenny glanced again at the file and felt an uneasy stirring in the pit of her stomach. Whatever Marshall's motives may have been, his handling of the case was negligent at best and it was her responsibility to clear up his mess.
'No, I think I'd better pay him a personal visit, see if we can't speed things up a bit.'
'You can try,' Alison said. 'Do you still want the coffee?'
Jenny got up from her chair and grabbed her handbag. 'I'll wait till I get back.'
'Have you been to a mortuary before?'
'No.'
'Just to warn you - it might be a bit of a shock. Wild horses wouldn't drag Mr Marshall down there.'
Alison waited until she heard Jenny's footsteps disappear through the front door of the building, then sat quietly at her desk for a long moment before reaching into her briefcase and drawing out a thick, bound document. She turned through its pages, her eyes flicking anxiously towards the door as if fearing that at any moment she might be seen. At the sound of voices on the stairs she hurriedly closed it again and returned it to her case. Long after the voices had gone she remained in her chair, staring across reception into the office where Harry Marshall should have been, her eyes burning with tears that refused to come.
* * *
CHAPTER THREE
Jenny sipped the warm dregs of her Diet Sprite, one hand on the wheel, as she drove the four miles to the hospital in slow-moving traffic. Edging through road works at walking pace, sandwiched between a truck belching fumes and an impatient Mercedes, she felt her heartbeat begin to pick up, a tightness in her chest, her 'free-floating anxiety' as Dr Travis, her previous psychiatrist, had termed it, close to the surface.
Highly strung. Stressed. Nervous. Call it what you like. Ever since the day almost exactly a year ago that she dried in court, had to sit down midway through reading out a banal medical report to a bemused judge, the most mundane of anxiety- making situations could trigger symptoms of panic. Waiting in a supermarket queue, travelling in an elevator, sitting in the hairdresser's chair, crawling through traffic: any situation from which there was no immediate escape could make her heart pound and her diaphragm tighten.
She went through her relaxation routine, breathed slow and deep, felt the weight of her arms tug at her shoulders, her legs sink into the seat. The anxiety gradually subsided, retreating to its hiding place in her subconscious, but leaving the door open a chink. Just so she wouldn't forget it was there.
Arriving at traffic lights, Jenny tossed her empty can into the passenger footwell and rummaged in her bag for the temazepam. She shook out a single tablet and swallowed it dry, angry at her dependence. Other people survived traumas without living on pills, why couldn't she? She tried to console herself with the fact that in the three months since she decided to quit being a courtroom lawyer her symptoms had eased significantly. No dark unwanted thoughts. No full-blown panic attacks.
One day at a time . . .
Approaching the large, modern, brick-built hospital that looked like another of the anonymous business units that surrounded it, she endeavoured to be rational, to accept that the stress of a new job would temporarily cause her to be more anxious. She would use the pills while she adjusted to her new responsibilities, then, in a week or two, wean herself off them again.
But as she parked up and walked across the tarmac to the hospital building her mind refused to still. Disturbing, unformed images played under the surface. What if her psychiatrists were right? What if there was a secret horror in her childhood that would continue to haunt her like a malevolent ghost until she somehow summoned the strength to confront it?
Damn. She had thought she was over this.
She caught her reflection in the glass of the revolving door: a smart, confident woman in a business suit. A professional. A presence. Give it a little more time, she told herself, and it'll dissolve like a bad dream.
After ten minutes of wandering along crowded corridors, many doubling as wards, with grey-faced patients stranded on trolleys, Jenny realized there were no signs to the mortuary. She queued at the reception desk, too self-conscious to pull rank on the ragtag of enquirers ahead of her. Most looked poor, old or confused; a heavily pregnant young woman gripped her stomach in obvious pain. The receptionist, a tense woman with nicotine-stained teeth, dealt increasingly impatiently with each one, one hand fidgeting with a pack of cigarettes as she struggled to give complicated directions around the building with the aid of a faded plastic map no one could follow.
The mortuary was situated in a separate anonymous, single- storey building at the rear of the hospital complex. There was no reply when she pressed the buzzer. She tried again. Still no response. On her third attempt a young Filipina cleaner answered, wearily wiping her hands on grubby, sleeveless overalls. Jenny tentatively asked where she could find Dr Peterson. The girl shrugged and waved her in, saying, 'No speak English, sorry,' and went back to flopping her mop across the tiled floor.
Jenny stepped inside, proceeded along a short corridor and pushed through swing doors into an open lobby area, off which were two semi-glazed office doors and a set of slap doors. A water cooler and a snack vending machine stood in the corner. She glanced through into the offices but no one was home. Following the sound of voices, she nudged through into a wider corridor, at the side of which were parked half a dozen or more gurneys, each carrying a corpse wrapped in white plastic. Then the smell hit her: powerful disinfectant mixed with a heavy, sweet odour which caught the back of her throat.
A tall, wiry, dark-featured man wearing stained surgical scrubs came through a door to her right. Pulling off a face mask, he gave her a look of pleasant surprise. 'Can I help you?'
Jenny straightened, tearing her eyes away from the row of dead bodies. 'Hello. Jenny Cooper, Severn Vale District Coroner. I'm looking for Dr Peterson.'
'That's me.' He smiled, tiny lines creasing around his eyes.
Jenny instinctively offered her hand. 'Pleased to meet you.'
'I wouldn't recommend it - best if I wash up first.' The smile again, almost boyish. 'Coroner, hey? Can't remember the last time I had one of you down here. Harry Marshall even managed to avoid it after he died. Shall we talk in my office?'
'Sure.'
Peterson led her along the corridor. As he walked, he pulled off his scrubs, revealing a neat-fitting polo shirt, and tossed them along with the mask into a laundry bin. He was slim for a man of his age, but vain, Jenny suspected. He arrived at a door with corpses parked either side of it and held it open. 'After you.' Jenny glanced uneasily at the bodies. Peterson said, 'Best patients in the NHS - been waiting for hours and not a cheep out of them.'
She managed a faint smile and stepped into his modest office. There was a window on to the hospital car park, shelves laden with textbooks, box files and several indistinct objects floating in jars of formaldehyde. Peterson stepped over to a stainless-steel wash-hand basin and proceeded to scrub his hands vigorously with strong-smelling liquid soap.
'Have a seat.' He nodded towards a single chair next to the desk. 'Just taken over the reins?'
'First day at the office.' She glanced around the room, her eye caught by the only picture on the wall: a framed postcard picturing a dead weasel slumped over a tiny desk, a miniature revolver in his paw, 'if you can call it that. I get the impression my predecessor had let things slide a little.'
Peterson rinsed the suds from his skin and shut off the tap. 'I don't know, Harry Marshall seemed a capable sort to me - not that I saw him very often.' He tugged a paper towel out of a dispenser. 'Always found him a pleasure to deal with.'
'Not one to get hung up on formalities.'
He balled up the wet paper towel and tossed it into the bin, a vaguely amused look on his face. 'That sounded a little loaded.'
'Merely an observation. At the beginning of last month you conducted a post-mortem on a fifteen-year-old girl, Katy Taylor. We're well into June and my office hasn't received a report from you.'
'You'll have to jog my memory.'
'Small blonde girl. Suspected heroin overdose.'
'I remember. Yes - partially decomposed. What we call a stinker.'
'Really.'
'I informed Marshall of my findings over the phone.'
'Which were?'
'She mainlined some close-to-pure heroin. I must get a couple like it every month.'
'Was there any possibility of suicide?'
'You can never rule it out.'
'Then Marshall was obliged by law to conduct an inquest. Any idea why he didn't?'
'I'm just a pathologist. I tell the coroner the cause of death and that's where my responsibility ends.'
'My officer says you seldom produce a report within three weeks of post-mortem.'
Peterson smiled patiently. 'Mrs Cooper, Jenny - I share a secretary with five other consultants, all of whose patients are still drawing breath. I'd love to get reports out to your office more quickly, but there's a better chance of one of those stiffs out there getting a hard-on.'
Jenny fixed him with the look she would give an evasive witness. 'Why don't you type them yourself?'
'Find me another three hours in the day and I'd be glad to.'
'In future I won't be signing death certificates without sight of a written report.'
'Then I suggest you take it up with the managers of this place. God knows, I've tried.' He glanced at his watch. 'Talking of which, I've got a meeting with the bastards any minute. I'm going to have to leave you.'
'I'm serious, Dr Peterson. That means bodies won't be released to undertakers for burial.'
'What?' Peterson let out a laugh. 'Do you want to see my fridges? They're stuffed in three deep as it is.'
Jenny rose from her chair. 'Then why don't you try storing them out in the car park?' She gave him a disarming smile. 'My guess is you'll have a secretary in no time. I look forward to reading the report.'
Alison had left a note saying, 'Gone to fetch more stuff from the station', and four death report forms, all of them patients at the Vale. Jenny ate a take-out salad at her desk and studied the new cases. The first was the homeless man who had died from suspected liver failure in a cubicle in A&E. She didn't know much medicine yet, but she knew enough to realize he would have left this world in agonizing pain, probably on a trolley waiting for overstretched junior doctors to decide which one of them would draw the short straw. The second was a woman in her seventies who had been admitted with emphysema and promptly contracted a hospital infection. The third was a male, sixty, dead on arrival having suffered a suspected heart attack, and the fourth an unmarried Pakistani girl of nineteen who had haemorrhaged while giving birth in a public park.
She imagined them all stacked up on top of one another in Peterson's fridge and felt a momentary sense of dread.
Her desk phone rang, a welcome interruption.
'Jenny Cooper.'
A confident young woman said, 'Tara Collins, Bristol Evening Post. Are you the new coroner for Severn Vale?'
'Yes?'
'Hi. I wrote a piece a few weeks back about a boy who died in custody, Danny Wills. Your predecessor handled the inquest.'
'Uh-huh.' Jenny tried to sound noncommittal, wary of reporters even though in family law she had had few dealings with them.
'Marshall died three days after the jury returned a verdict of suicide.'
'So I understand.'
There was a brief pause on the line. 'His GP wrote out a death certificate stating cause of death as a coronary, but as far as I can make out no post-mortem was performed.'
Jenny sensed she was being drawn into something. 'I'm afraid I don't know any more than you do, but if the GP was satisfied as to his cause of death—'
'How could he have been? Marshall only had mild angina. He had an ECG in February.'
'What exactly is it that you want, Ms Collins?'
'Don't you think it strange that only three days after conducting an inquest into the death of a fourteen-year-old prisoner in a privately run prison, the coroner died suddenly and didn't even undergo a post-mortem?'
'I've just taken over here. I don't know much about the Wills case - only what I read in your paper, which wasn't exactly sympathetic to the boy, as I recall.'
'My copy got subbed ...' Tara Collins trailed off.
Jenny waited for her to continue.
'Marshall was a busy man before the inquest. He was taking statements from the staff at Portshead, the prison escort service, the Youth Offending Team, and then he pushed the whole thing through in a day. He only called four live witnesses and went back on his promise to let the boy's mother give evidence.'
It was Jenny's turn to pause for thought, acutely aware that anything she said was in danger of appearing in this evening's paper. She tried to change the subject. 'How do you know about his ECG?'
'A source. I can't tell you who.'
'And his discussions with the family?'
'I've been in close contact with Mrs Wills since Danny died. Marshall promised her no stone would be left unturned. He was giving her regular updates until three days before the full hearing. Then he went silent. Never spoke to her again.'
'Well, I suppose there could be any number of explanations. I'd have to look at the file before forming a view, but if the family are dissatisfied with the inquest the normal course is to seek legal advice.'
'There's no legal aid for inquests and bugger all chance of getting any to challenge the outcome of one.'
'Mr Marshall's death was very unfortunate,' Jenny said, straining to remain patient. 'I'm sorry for his family and even more so for the family of Danny Wills, but my job is to make sure that as of now this office is run in a modern, efficient and open manner. I want to make sure that in future families feel fully satisfied by the inquest process.'
'Did you read that from a script, Mrs Cooper? It sounded like it.'
Jenny bristled. 'Do you want me to respond, Ms Collins, or are you simply trying to make a point?'
The journalist was quiet for a moment. When she spoke again she had her emotions back under control. 'I apologize . . . But having covered Danny's case, it seems to me that the truth never made it into the open. Not by a long way. And then there's Marshall's death . . .'
'What about it?'
'Doesn't it strike you as rather more than coincidental?'
'Given that it was due to natural causes, no.'
'His behaviour leading up to the inquest was pretty peculiar.'
'Never having met him, I couldn't possibly comment.'
'So you won't be looking at the Wills case again?'
'It's been dealt with. I have no power to do so.'
'What about Section 13 of the Coroner's Act 1988? You can ask the High Court for permission to let you hold a fresh inquest.'
Jenny felt the muscles in her throat tighten. She swallowed, resisting a powerful urge to slam down the receiver. 'Since you've been researching the law, you'll know that only happens where there's compelling new evidence.'
'If you look for it, you might find it. Goodbye, Mrs Cooper.'
Jenny slowly lowered the receiver on to the cradle, adrenalin coursing through her veins. Half a day into the job and a journalist was already trying to catch her out. Family lawyers had to cope with weeping mothers and violent fathers in court, but the press were excluded. No case she'd conducted had ever attracted an inch of newsprint. Dealing with the media was another thing she'd have to learn on the job. Tara Collins was obviously working an angle, so she'd have to be ready for her and on top of the facts. She found the Danny Wills file and started to read.
The Form of Inquisition recorded the jury's verdict of suicide. In the narrative section, the foreman had written: 'Between 2 and 4 a.m. the deceased tore a strip from his bed sheet, tied one end to the bars of the window and, standing on a chair, tied the other end around his neck, then kicked the chair away, causing death by strangulation.'
There were statements from the maintenance man who discovered the body, the two secure care officers who were on duty in the house unit that night, a security guard who testified to the continuing malfunction of the CCTV system in the unit, the medical staff who examined Danny on his admission, the director of Portshead Farm and the case worker from the Youth Offending Team who had dealt with him before he was sentenced. A copy of the staff rosters for the week leading up to Danny's death had been carefully gone through: there were personal phone numbers next to each name and ticks, she assumed, Marshall had made as he worked through them.
Near the back of the file was an aerial photograph and detailed plan of the secure training centre which Marshall had annotated. It was a small prison in an exposed field on the South Gloucestershire side of the Severn estuary, midway between the Severn Bridge and Oldbury nuclear power station, four miles to the east.
Portshead Farm consisted of five buildings positioned around a central yard area and a playing field. The entire complex was surrounded by a twelve-foot concrete wall topped with razor wire and surveillance cameras. At the entrance were the reception and medical centre in which new inmates were examined and, if necessary, housed in one of several observation cells before being certified fit for transfer to one of the two single-sex house units. The fourth building contained classrooms in which trainees underwent a crude form of education. The fifth, nearest the playing field, was the canteen, which doubled as a gymnasium.









