Coroner John Gittins said he wrote to members of the Welsh government's cabinet to express concerns.
Senior coroner for north east and central Wales, Mr Gittins is looking at the deaths of four vascular patients who died in 2021 after being treated at Ysbyty Glan Clwyd, Denbighshire.
At a pre-inquest hearing in Ruthin on Friday, Mr Gittins read out the letter he emailed to nine Welsh government ministers on 12 May 2023. "In view of all the above circumstances, I feel duty bound to bring these matters to the attention of ministers so that they may give their consideration as to whether the provisions of Section 29 of the Inquiries Act 2005 now require there to be a public inquiry.
The coroner also said in his letter he would be happy to provide more detailed information for such consideration.
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