Written evidence from Debra McFall
Questions 1-5 are not applicable in our experiences with my son’s murder/ manslaughter in Tenerife after being viciously attacked and dying the early hours of the next morning in hospital.
6. Improvements in service for bereaved:
During our initial contact with the Coroner’s office in London we were told that an autopsy would be carried out in this country once his body had been repatriated. When we informed the Coroner’s office that my son’s organs had been removed they advised this would prove more difficult but that they would do what they could and requested we send them any information we received from Tenerife from investigation/post mortem that was carried out over there.
We didn’t have any contact with the Coroner’s office except to check that they had the information that was necessary. The initial report we received from the Coroner in London after the repatriation of my son’s body was quite vague due to the fact they only had an organ-less body and the paperwork from Tenerife to go by. We finally received my son’s organs back almost a year later and asked the Coroner’s office in London if they would be of any help, were told that they would no longer be of any use due to the timescale and deterioration that would have occurred.
We were not given a time of when the inquest would be but had been made aware by a third party that my son’s inquest was shown online and that it had been scheduled to take place. This was subsequently removed and when we queried it we were told this was due to the fact that they were waiting for further information from abroad. There was a later date that this was scheduled for and again due to the same reasons as before we were advised this too had been deferred.
We finally receive a letter from the Coroner to say that they were going ahead with the inquest to save us further grief, this letter also stated that the Coroner agreed with the medical expert in Tenerife and that it appeared the hospital had overdosed my son which therefore resulted in his death.
7. Failures in the Coroners system;
I would say that there is no fairness whatsoever in our experience. We turned up on the day and did not know what to expect, with no representation. The whole experience from start to finish was appalling.
The Coroner advised that when someone dies abroad this proves very difficult for them; I found this to be quite insulting considering everything we had already been through.
The Coroner was looking through the paperwork to ascertain the date that the inquest had been opened, then realised that it had not been.
We have since been informed that we could have had a pre-inquest where we could have seen all the evidence and asked questions.
The Coroner then continued to advise that we would be shocked by his findings as he had changed his initial opinion due to some paperwork that he had seen. He then proceeded to read through the reports and repeated things as though he had not read them before, continually repeating and apologising if his translation from Spanish to English was a bit rusty though he would do his best. I don’t understand why this was not done previously and professionally.
When we wanted to ask questions we were met with the hand so we patiently waited until the Coroner had finished before attempting again. The Coroners final words were to say he believed my son’s death was not down to the hospital but down to his head injuries. To say we were shocked was an understatement. We still to this day do not understand the verdict. I can understand if the Coroner thought my son’s death was due to a combination of both his injuries and an overdose from the hospital but I cannot understand why the hospital would be ruled out of the Coroner’s statement because of the head injuries? Either my son received an overdose or he didn’t? The final cause of death would not have changed the fact that he was overdosed? Due to this sudden change, understandably as family we had questions, however the Coroner stood up and walked out. We were not able to ask questions or why he changed his mind. We were left so shocked and with so many unanswered questions.
We since contacted the Coroner’s office to try to ascertain the reason for his change in opinion however have yet to receive the answers. We were told we could obtain a recording of the inquest which we requested and paid for. Obviously this did not answer any queries we had as it was just an audio recording of the proceeding that we attended. We then requested all of the paperwork relating to the Coroners findings but were only sent the same paperwork we had supplied prior to the inquest. We feel we are still left without answers to our queries, and these queries are not minor.
We feel completely let down by all sides of this investigation, not one part of it has been correctly carried out but we thought perhaps at least the coroner here would shed some light but he only confused matters further.
It’s too late for my son to receive adequate justice. I just pray that lessons are learned and another family never have to go through what we have.