CHRISLAND UNIVERSITY, ABEOKUTA.

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IRIEL NATHANIEL CSS/2023/002
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BADMUS BAMIDELE SHAKIRUDEEN CSS/2023/004
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DEPARTMENT: CRIMINOLOGY AND SECURITY STUDIES

COURSE CODE: CSS 102

COURSE TITLE: INTRODUCTION TO CRIMINAL JUSTICE

LECTURER: BARRISTER ADEYANJU FUNMILAYO

QUESTION: WITH THE USE OF DECIDED AUTHORITY EXPLAIN THE ROLE OF THE
CORONER INQUEST IN THE CRIMINAL JUSTICE SYSTEM WITH CASES.
INTRODUCTION
The coroner's court is a legal body established to investigate certain types of deaths, including
those that are sudden, unexpected, unexplained, or involve violence. The court operates under
specific legal frameworks that vary by jurisdiction but generally share common functions and
procedures. Here are more detailed aspects of the coroner’s court:
-Jurisdiction: The coroner’s court has the authority to investigate deaths that fall within certain
categories, such as:
- Violent or unnatural deaths
- Sudden deaths of unknown cause
- Deaths occurring in custody or state detention
- Deaths where the deceased had not been seen by a doctor during their final illness
-Coroner: A coroner is a public official, often with a background in law or medicine, responsible
for overseeing investigations into deaths within the court’s jurisdiction. They ensure that the
inquest is conducted fairly and thoroughly.
-Inquest: An inquest is a judicial inquiry conducted by the coroner to establish the facts
surrounding a death. It is not a trial but an investigation. The inquest aims to determine:
- The identity of the deceased
- The place and time of death
- The manner and cause of death
-Verdicts: At the conclusion of an inquest, the coroner or a jury (if present) delivers a verdict or
finding. Common verdicts include:
- Natural causes
- Accident or misadventure
- Suicide
- Unlawful killing
- Open verdict (when evidence is insufficient to determine the cause of death)
-Autopsies: An autopsy, or post-mortem examination, may be ordered by the coroner to
determine the cause of death. This is conducted by a pathologist and can provide crucial medical
evidence.
-Witnesses and Evidence: The coroner’s court can summon witnesses, including medical
professionals, family members, and others with relevant information. It can also compel the
production of documents and other evidence.
- Public Health and Safety: The findings of the coroner’s court can lead to recommendations
aimed at preventing future deaths. These recommendations can influence public policy,
workplace safety standards, and healthcare practices.
- Independence: The coroner’s court operates independently of other legal bodies and
government agencies to ensure impartiality in its investigations.

Key Functions
-Fact-Finding: The primary function of the coroner’s court is to ascertain the facts surrounding a
death. This involves gathering and evaluating evidence from various sources.
-Legal Clarification: The court clarifies the legal status of the death, which can affect issues such
as inheritance, insurance claims, and criminal investigations.
-Preventive Role: By identifying hazards and risks that contributed to deaths, the coroner’s court
can make recommendations to prevent similar incidents in the future.

Examples of Inquest Outcomes

-High-Profile Cases: Inquests into the deaths of public figures or deaths involving significant
public interest (e.g., deaths in police custody) often receive widespread media coverage and can
lead to broader societal changes.
-Workplace Incidents: Inquests into workplace fatalities can result in improved safety regulations
and practices.
- Medical Cases: Inquests into deaths resulting from medical procedures or hospital care can lead
to changes in medical protocols and better patient safety measures.

Legal Framework
The operation of the coroner’s court is governed by statutes and regulations specific to each
jurisdiction. These laws define the scope of the court’s authority, procedures for conducting
inquests, and the rights of the deceased's family and other interested parties.

HISTORICAL BACKGROUND
It is in the general interests of the community that any sudden, unnatural or unexplained deaths
should be investigated and, to reflect this, the role of the Coroner has adapted over the eight
centuries since the office was formally established in 1194, from being a form of medieval tax
gatherer to an independent judicial officer charged with the investigation of sudden, violent or
unnatural death. The duties of the early coroners were varied, and included the investigation of
almost any aspect of medieval life that had the potential benefit of revenue for the Crown.
Suicides were investigated, on the grounds that the goods and chattels of those found guilty of
the crime of 'felo de se' or 'self murder' would then be forfeit to the crown, as were wrecks of the
sea, fires, both fatal and non-fatal, and any discovery of buried treasure in the community which,
as 'treasure trove', remains one of the coroner’s duties today, although it is likely that this
particular medieval duty will finally be removed. Sudden death in the community had always
been considered important since the early days of the office and was also investigated by
coroners, although for reasons far different to those of today. After the Norman Conquest, to
deter the local communities from a continuing habit of killing Normans, a heavy fine was levied
on any village where a dead body was discovered, on the assumption that it was presumed to be
Norman, unless it could be proved to be English. The fine was known as the 'Murdrum', from
which the word 'murder' is derived and, as the system developed, many of the early coroners'
inquests dealt with the 'Presumption of Normanry' which could only be rebutted by the local
community, and a fine thus avoided, by the 'Presentment of Englishry'.

The Coroner system continued to adapt over the centuries, but in the nineteenth century major
changes relating to the investigation of death in the community occurred. In 1836, the first Births
and Deaths Registration Act was passed, prompted by the public concern and panic caused by
inaccurate 'parochial' recording of the actual numbers of deaths arising from epidemics such as
cholera. There was also growing concern that given the easy and uncontrolled access to numerous
poisons, and inadequate medical investigation of the actual cause of death, many homicides were
going undetected.

The Coroner and Justice Act 2009 was implemented on the 25th July 2013.

The Coroners and Justice Bill was introduced into Parliament in January 2009, following extensive
consultation, and became an Act on 12 November 2009. However the current law relating to
coroners remains the Coroners Act 1988 (which is based upon the 1887 legislation) as the
2009 legislative provisions await implementation.

ROLES AND FUNCTIONS OF CORONER’S COURT

Here are the primary roles and functions of a coroner's court in the context of criminal justice:

Roles of the Coroner's Court

1. Investigative Role:
- Death Investigations: The primary role is to investigate deaths that are sudden,
unexplained, or suspicious. This includes deaths due to violence, accidents, suicides, and
deaths in custody or state detention.
- Establishing Identity: The court works to establish the identity of the deceased, the
circumstances surrounding the death, and the cause and manner of death.
 2. Judicial Role:
- Conducting Inquests: The coroner conducts inquests, which are judicial inquiries into
the circumstances of a death. These inquests are not trials but fact-finding missions to
determine the who, what, when, where, and how of the death.

- Issuing Verdicts: Based on the evidence presented during the inquest, the coroner or a
jury delivers a verdict on the cause and manner of death.

3. Preventive Role:
- Public Health and Safety Recommendations: The findings from inquests can lead to
recommendations aimed at preventing future deaths. These can influence public policy,
healthcare practices, and workplace safety regulations.

- Identifying Systemic Issues: By uncovering patterns or systemic issues that contribute

to deaths, the coroner's court can prompt reforms in various sectors, including healthcare,
law enforcement, and industry.
4. Advisory Role:
- Guiding Law Enforcement: The coroner's findings can inform police investigations
and guide decisions about whether criminal charges should be pursued. The evidence uncovered
can be crucial in building a case for prosecution.

- Informing the Public and Stakeholders: The court’s proceedings and findings are often made
public, providing transparency and informing the public and relevant stakeholders about
potential risks and safety concerns.

Functions of the Coroner's Court

1. Conducting Post-Mortem Examinations:
- Ordering Autopsies: To determine the cause of death, the coroner can order an
autopsy, conducted by a pathologist. The results can provide critical medical evidence
about how the death occurred.

- Reviewing Medical Records: The coroner examines the deceased's medical history
and any relevant healthcare records to understand underlying conditions or treatments
that may have contributed to the death.

2. Gathering and Evaluating Evidence:

 - Collecting Witness Testimonies: The coroner’s court can summon witnesses,
including family members, friends, medical professionals, and law enforcement officers,
to provide testimonies and evidence.

- Examining Physical Evidence: The court may review physical evidence from the
scene of the death, including forensic evidence, photographs, and any relevant
documents.

3. Holding Public Hearings:

- Inquests: Public hearings are held where evidence is presented, and witnesses testify.
These hearings are often open to the public and media, ensuring transparency and
accountability.

- Jury Involvement: In some jurisdictions, inquests may be conducted with a jury,

particularly in cases of public interest or where the death occurred in state custody.

4. Issuing Findings and Recommendations:

- Verdicts on Cause of Death: The court issues formal findings on the cause and manner
of death, which can range from natural causes to unlawful killing.

- Safety Recommendations: Based on the inquest findings, the coroner can issue
recommendations to prevent similar deaths in the future, addressing issues like workplace
safety, public health policies, and medical practices.

5. Facilitating Legal Processes:

- Referring Cases for Prosecution: If evidence of criminal activity is uncovered, the
coroner can refer the case to law enforcement or the public prosecutor for further
investigation and potential prosecution.

- Supporting Civil Litigation: The findings of the coroner's court can be used in civil
litigation, such as wrongful death lawsuits, by providing a clear, official determination of
the cause of death.

Types Of Coroner’s Court:

Here are some common types of coroner's courts:
1. Standard Coroner's Court

Purpose:
- Investigates routine cases of sudden, unexplained, or suspicious deaths.

Characteristics:
 - Handles a wide range of deaths, including those due to natural causes, accidents,
suicides, and homicides.
- May involve straightforward inquests without complex legal or medical issues.

2. Special Inquest Coroner's Court

Purpose:
- Deals with high-profile or particularly complex cases that may have significant public
interest or require specialized knowledge.

Characteristics:
- Involves deaths in police custody, prison, or other forms of state detention.
- Handles cases involving multiple deaths, such as mass casualty incidents or natural
disasters.
- Often involves a jury to assist the coroner in reaching a verdict.
- Typically receives more media attention and public scrutiny.

3. Coroner’s Court for Deaths in Custody

Purpose:
- Specifically investigates deaths that occur while a person is in police custody, prison, or
other forms of state detention.

Characteristics:
- Focuses on ensuring that the death was not due to unlawful actions or neglect by state
officials.
- Often mandated to include a jury.
- Emphasizes transparency and accountability in the investigation.

4. Medical Inquest Coroner's Court

Purpose:
- Specializes in investigating deaths related to medical treatment or procedures.

Characteristics:
- Involves detailed examination of medical records, treatments, and healthcare practices.
- Often requires expert medical testimony to determine whether the death was due to
medical malpractice, negligence, or natural progression of a disease.
- Can lead to recommendations for changes in medical protocols and patient safety
measures.

5. Workplace Death Coroner's Court

 Purpose:
- Focuses on deaths that occur in the workplace or as a result of occupational activities.

Characteristics:
- Investigates whether proper safety regulations and protocols were followed.
- Involves coordination with workplace safety agencies and may lead to
recommendations for improved safety standards.
- Examines potential employer liability and regulatory compliance.

6. Mass Fatality Coroner's Court

Purpose:
- Handles cases involving multiple deaths from a single incident, such as natural
disasters, terrorist attacks, or major accidents.

Characteristics
- Requires coordination with multiple agencies, including emergency services, law
enforcement, and forensic teams.
- Often involves complex logistics in identifying victims and determining causes of death
for each individual.
- May include recommendations for emergency preparedness and response
improvements.

7. Human Rights Inquest Coroner's Court

Purpose:
- Investigates deaths that may involve violations of human rights, such as deaths resulting
from police actions, military operations, or other state-related activities.

Characteristics:
- Focuses on ensuring that the death was not due to excessive use of force, torture, or
other human rights abuses.
- May involve international legal standards and cooperation with human rights
organizations.
- Often includes a jury and is conducted with a high degree of transparency.

CASES
1. The Case of the Ibadan Building Collapse (2019):

The Coroner's Court investigated the collapse of a building in Ibadan, Oyo State, which
resulted in the deaths of five people. The court found that the building collapse was
 caused by structural failure due to inadequate design and construction and recommended
that the government improve building regulations and enforcement.

2. Case of the Oyinbo Oladele Rape and Murder (2019):

The Coroner's Court investigated the rape and murder of a 19-year-old student, Oyinbo
Oladele, in Ogun State. The court found that the perpetrator was a serial rapist and
murderer and recommended that the police improve their response to reported cases of
sexual assault and murder.

3. The Case of the Apo Killings (2013):

The Coroner's Court investigated the killing of eight people, including a pregnant
woman, by police officers in Abuja. The court found that the police officers acted
unlawfully and recommended that they be prosecuted for murder.

4. The Case of the Lagos Plane Crash (2012):

The Coroner's Court investigated the crash of a Dana Air plane in Lagos, which resulted
in the deaths of 163 people. The court found that the crash was caused by pilot error and
mechanical failure and recommended that the aviation authorities improve their safety
regulations and enforcement.

5. The Case of the Abuja Bomb Blast (2011):

The Coroner's Court investigated the bombing of the United Nations Headquarters in
Abuja, which resulted in the deaths of 25 people. The court found that the bombing was
carried out by the terrorist group Boko Haram and recommended that the government
improve its counter-terrorism measures.

6. The Case of the Nigerian Immigration Service Recruitment Stampede (2014):

The Coroner's Court investigated the stampede during the Nigerian Immigration Service
recruitment exercise, which resulted in the deaths of 16 job seekers. The court found that
the stampede was caused by poor planning and crowd control and recommended that the
government improve its recruitment processes and provide adequate security measures.

7. The Case of the Lagos State University (LASU) Student Killing (2018):

The Coroner's Court investigated the killing of a final-year student of LASU, who was
shot by a police officer during a protest. The court found that the police officer acted
unlawfully and recommended that he be prosecuted for murder.
8. The Case of the Port Harcourt Serial Killings (2019):

The Coroner's Court investigated a series of serial killings in Port Harcourt, Rivers State.
The court found that the killings were committed by a single perpetrator and
recommended that the police improve their investigative techniques and response to
reported missing persons cases.

9. The Case of the Apo Six (2013):

The Coroner's Court investigated the killing of six young men by police officers in
Abuja. The court found that the police officers acted unlawfully and recommended that
they be prosecuted for murder.

10. The Case of the Synagogue Church of All Nations Building Collapse (2014):

The Coroner's Court investigated the collapse of a building belonging to the Synagogue
Church of All Nations, which resulted in the deaths of 116 people. The court found that
the building collapsed due to structural failure caused by inadequate design and
construction. The court recommended that the church be prosecuted for criminal
negligence and that the government improve building regulations and enforcement.

CONCLUSION

The coroner’s court plays a critical role in the criminal justice system by investigating
unexplained deaths and making recommendations to prevent future occurrences.
Addressing current issues such as case backlogs, transparency, training, and
technological integration is essential for improving the effectiveness and public
confidence in the system. Relevant sections of governing legislation, like the Coroners
and Justice Act 2009 in the UK, provide the legal framework for these investigations and
outline the duties and responsibilities of coroners. By focusing on these reforms and
adhering to legal guidelines, coroner’s courts can continue to fulfill their vital role in
society. The coroner's court serves as a crucial mechanism for understanding and
addressing the causes of death, promoting justice, and enhancing public safety. By
focusing on necessary reforms and leveraging the legal framework, the coroner’s court
can continue to fulfill its essential role effectively. Addressing current challenges and
implementing targeted reforms will ensure that coroner's courts remain a cornerstone of
the criminal justice system, contributing to a safer and more just society.