When Judge Neil Maclean became New Zealand’s first Chief Coroner a little over eight years ago, he faced a major challenge. That was to move the coronial system from the “fragmented, low-morale, part-time nature that it was, with 70-odd coroners scattered around the country with really no oversight of them at all … into a consistent national bench,” he says.
Appointed Chief Coroner in February 2007, Judge Maclean retired from the role in February this year. He will continue serving as a District Court Judge, however, hearing ACC cases.
Before he took the role, coroners were theoretically resourced by the Ministry of Justice. In practice, however, the legal profession was heavily subsidising the system. “There were a whole lot of law firms around the country who were providing the office resources and all the back-up. There were getting little from the Ministry of Justice other than a payment, a sort of piece-work type payment, which had got completely out of touch with reality.”
All that changed with the new coronial system brought about by the Coroners Act 2006. New Zealand moved to a system where the ministry was directly providing the resources for a small number, eventually 16, full-time legally qualified coroners.
Following the change, most of the full-time coroners had come from the old structure and had their own systems and ways of doing things.
So the challenge was to mould the old coroners with the new coroners, who had no experience in the role, into a consistent national bench.
“That’s been the big challenge,” Judge Maclean says. “The job’s by no means over yet. Consistency of process and timeliness are two key factors that are among the prime functions of the Chief Coroner. We have still got a long way to go, but I think we’ve made a good beginning.
“The other interesting thing is that eight years ago, the majority of the coroners came from the old system. When we swore in Anna Tutton [in Christchurch in January], the new coroners are now in the majority.”
Gender balance on the coronial bench has also changed significantly under Judge Maclean’s watch.
Eight years ago, they began with a bench with a very small number of women coroners. “Now we are almost 50-50, and I think of all the judicial benches in the country, we are the nearest to gender equality.
“It wasn’t actually a deliberate policy, but what has emerged is that the suggestion [Judge Maclean made in an interview with LawTalk on his appointment] that it was a good option for women practitioners with five years under their belt has been taken up and has become the position.”
Three events, which came “completely out of left field” provided their own particular challenges for the service. One was the Pike River Mine tragedy, another the Christchurch earthquakes and a third the Carterton balloon crash.
As a coronial service “we are always conscious of this fact: let’s try and make sure that when a crisis like this happens – a major aircraft crash, or a cruise ship sinking, or a natural disaster – let’s make sure that we are able to deal with it.
“We had, prior to the Pike River and the Christchurch earthquakes, actually convened a meeting of those who I saw as the key players in the event of a major natural disaster – just fortuitously.”
That had been driven by him attending a conference of the England and Wales Coroners Society, where he sat in on briefing sessions for their planning on emergency and coronial emergency services.
“It got me thinking: ‘hang on, we’ve got nothing like that’.” So when he came back to New Zealand, Judge Maclean convened a meeting.
“There wasn’t quite the sense of urgency that, looking back, would have been good, but one of the good things was that we were able to put names to faces for some players, and that paid off. It meant we were in a better position to respond when the Christchurch earthquake happened.”
Although the coronial services were not involved in a recovery of bodies at Pike River, “we established on the ground an understanding and building up of relationships which paid off in spades when, a couple of months later, the Christchurch earthquakes happened.”
His role following the earthquake was to ensure that he was rotating coroners through Christchurch. A national internal investigation office was set up at Burnham Military Camp. There, a coroner would deal with formal identification hearings, ensuring that a positive identification was established as soon as possible so the body could be released, because it is the coroner alone who can authorise release of the bodies.
“We made sure that happened. Whether it was in the morning or the afternoon or the evening, we had a coroner ready to go.
“I’d also become aware, as had the other emergency services, that you can’t just leave a person in there to fend for themselves. You need to be watching, watching their welfare, rotating them through, making sure you have got the right people, because they are working in quite trying circumstances.
“So we learnt from that and we learnt from Pike River and we learnt from the Carterton balloon tragedy.
“That was a challenge and, I think, a success that we truly became a 24/7 system. We now have got 16 coroners and me and now the new chief, all taking their turn as the national duty coroner, working under considerable pressure sometimes – over the weekend, at night.”
During his time as Chief Coroner, the attitude towards information about suicides has moved from “let’s not talk about it; it’s just a dangerous thing to do” to gradually more and more people saying “we can’t just bury this and pretend it’s not happening.
“We just have to face up to the fact that we have 10 to 12 suicides per week, every week, and it’s just relentless. It seems a high number for our population and there are real pockets of concern, particularly with Māori, teenage and youth suicides.”
Suicide, Judge Maclean says, “is probably one of the biggest things on my watch of eight years and something that I think I will continue to maintain an interest in.
“Despite the fact that I have been a coroner continuously since 1978, the total picture regarding suicide as a phenomenon in New Zealand had really passed me by until the media actually asked me to comment one day. It was about the comments the South Australia State Coroner had made about the correlation between the road toll death in South Australia and the suicide death.
“They were saying ‘we worry about the road toll death every Christmas. Nobody talks about the fact that it’s actually significantly lower than the suicide toll, which we actually never talk about’.
“From that a lot has grown – including what I’ve done, the yearly August release of the breakdown of suicides to the 30th of June.
“That caused a lot of angst and resistance, particularly from those at the far end of the spectrum who said this was dangerous. But increasingly I sense there has been a public shift. People are saying: ‘we would like more information. Please tell us what is going on’.
“There is a lesson to be learnt here for the profession too. We tend to think that all lawyers are bullet proof, particularly criminal lawyers and we tend to forget that there is a real human being behind all that struggling with the stresses and strains.
“I think we need to remember there is a human being with normal emotions and they are doing their very best, but it takes its toll.
“It’s not just the legal profession. The hard-driven professional groups – the doctors, the dentists, the lawyers, police detectives, first aid responders – are at enhanced risk of suicide.
“It’s an interesting area and something I did not expect to happen when I started the job,” Judge Maclean says.
Another thing he did not expect was the “huge media interest” in the Chief Coroner. One of the reasons that happened, he thinks, is that for the first time there was a focal point with the office.
Judge Maclean took the view that the Coroners Act says that part of his job is public education about what coroners do. “It was not good just saying ‘no comment’ or ‘I can’t possibly comment’. Nor would he just say that a coroner could not comment on or be interviewed about a decision they had put out the day before.
Instead, he would put it to them that they would not ask a judge to appear on Morning Report, for example, and explain their bail decision. Coroners were, like judges, judicial officers. He would then ask the journalists “what is it that you would like to know, because I can probably make some comment”.
“In most cases what I was able to give them was what they wanted.
“My view has also been that the media play an important role in the job of coroner, because if we didn’t have the media to report what we are saying, then we’d just be talking to ourselves.”