A coroner has been asked to look into the deaths of 13 people at a care home for vulnerable elderly patients.
The Maypole Nursing Home in Birmingham closed in March 2003 after officials raised "serious concerns" about standards after an inspection.
From 2002-2003, 28 residents died and the home failed to notify care standard officials of 15 of these deaths.
Following a mutli-agency review, 13 deaths have now been referred to the Birmingham Coroner, Aidan Cotter.
In a statement, South Birmingham Primary Care Trust (PCT) said they had "shared serious concerns" following the review which led them to contact the coroner.
It read: "The coroner, who has been kept informed during the progress of the investigation, will now consider whether he needs to investigate and we are unable to comment further on this particular matter."
The office of the Birmingham coroner, Aidan Cotter, confirmed on Wednesday they were "involved" but were unable to confirm any details.
Dr Jamalapuram Hari Gopal and his wife, Pratury Samrajya Lakshmi, ran the 36-bed home on Alcester Road South, Kings Heath.
Restrictions imposed
Following the inspection, the couple were subsequently suspended and South Birmingham PCT referred them to the General Medical Council (GMC).
The GMC said Dr Gopal was continuing to practise as a GP at Philip Clark Medical Centre in Birmingham, but was not allowed any involvement with care homes for 18 months.
His wife, Dr Lakshmi, had also been suspended from care homes for 18 months, the GMC said.
The couple have always maintained they did nothing wrong and there is no suggestion that any residents were deliberately harmed.
Seven nurses employed by the Maypole are also facing an investigation by their professional body, the Nursing and Midwifery Council.
'Minimum standards'
A multi-agency inquiry was opened after the five-day inspection in February 2003.
The report stated: "Inspectors found that the home was failing to meet many of the national minimum standards and regulations across all aspects of its operation..."
It said this included general management, nursing and general care, physical standards, staffing and recruitment, recording and reporting.
A spokeswoman for the Birmingham and Black Country Strategic Health Authority said lessons had been learned and procedures tightened up following the release of the findings in November last year.
"All the agencies concerned have taken this review very seriously, in the interests of public confidence and patient safety," she said.