How they affect YOU! Dr Mark Corcoran 13 th Jan 2015
ACCOUNTABILITY Civil Liability Negligence Criminal Liability Assault and Battery Manslaughter Professional Accountability Disciplinary Hearings Complaints Procedure Inquests
THE NEW NHS General Trends Clinical Governance NICE Guidelines QuOF Harold Shipman; Colin Norris Practice Based Commissioning Laws of Consent Living Wills Fraser Guidelines Chaperone Policies Victoria Climbie; Baby P Information Technology Revalidation
LEGAL REFORM The Adversarial System Lord Woolf Out of Court Settlements No Win No Fee Lord Jackson No Fault Compensation
GENERAL TRENDS THE RULE OF FIVES
FROM 1989 to 1999 General Practitioners were 13 times more likely to be sued successfully General Practitioners were 33 times more likely to be involved in a spurious medico - legal claim
GMC Figures 2010-7,153 2011-8,781 2012-10,347 2013-9,866 (5% Increase from the public) No evidence that this points to falling standards of practice NHS OMBUDSMAN upholds only a quarter of cases brought against GPs
NHS COMPLAINTS 16,337 in 2012-13 17,964 in 2013-14 18% Against GPs 45% Against Hospital Trusts 14% Against PCTs
COST OF LITIGATION NHS Litigation Authority 9,143 claims in 2011/12 10,129 in 2012/3 increase of 10.8% Total payments 633m in 2007/8 Rising to 1.117bn in 2012/13 And to 1.192bn in 2013/14 Increase of 12% per annum
COST OF LITIGATION MDU New Claims increased by 20% for the second year in a row (had been increasing by 8%) Legal costs 28.5m MPS New Claims increasing by 10.4% annually over five years Legal costs 251.9m GMC 5% increase in complaints from the general public 31% increase in complaints to GDC
COST OF LITIGATION TIME STRESS
HOW NOT TO GET SUED Don t be a Doctor Don t be a Lawyer Don t be an Accountant DON T DO ANYTHING THAT INVOLVES TAKING RESPONSIBILITY FOR ANY ASPECT OF OTHER PEOPLE S LIVES
PUBLICITY Brain implants let paralyzed woman move robot arm New cancer drug 'shows promise Hospital hails new arthritis drug
PUBLICITY Rotten Apples Underperforming NHS
WHY ARE PATIENTS UNHAPPY? Publicity Awareness of Health Issues / Rights Raised Expectations IN ADDITION To Establish The Facts To Prevent Recurrence To Receive Compensation
WHY DO PATIENTS TAKE ACTION? Publicity Awareness of Health Issues / Rights Raised Expectations IN ADDITION To Establish The Facts To Prevent Recurrence To Receive Compensation
I have very strong views on the lawyers involvement in health care. Their proper place is on the operating table and certainly keeping doctors and nurses out of court and lawyers out of hospital seems to me to be the best working principle. Frank Dobson
Are Healthcare Professionals Blameless Or just misunderstood?
THE TEST OF NEGLIGENCE The Patient is owed a DUTY OF CARE The Duty of care is BREACHED As a direct result, the Patient suffers DAMAGE
THE DUTY OF CARE IN THE NHS This duty will usually exist without question
THE DUTY OF CARE Reasonable Foreseeability The NEIGHBOUR PRINCIPLE Donaghue -v- Stevenson (1932) Bourhill -v- Young (1942) Applied in a Medical Case :- Goodwill -v- BPAS (1996)
WHO DECIDES?? BREACH OF DUTY Bolam -v- Friern Barnet Hospital (1957) A Doctor is not negligent if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art...
BOLAM UNDER ATTACK A judge would be entitled to reject a unanimous medical view if he were satisfied that it was manifestly wrong. (Bolam, High Court ruling) Hucks -v- Cole (1993) CLINICAL GOVERNANCE NICE
DAMAGE IS CAUSED AS A RESULT OF THE BREACH Examples :- Kay -v- Ayrshire & Arran Health Board (1987) Barnett -v-chelsea & Kensington Hospital (1968) Hotson -v- East Berkshire Area HA (1987)
CAN WE AVOID LITIGATION? Are Healthcare Professionals Blameless Or just misunderstood?
Are Healthcare Professionals Blameless? MDU Analysis Failure or delay in diagnosis 51% Prescribing errors 23% Minor Surgery 7% Failure or delay in referral 4.5% Clinical Management 2%
Are Healthcare Professionals Blameless? MPS Analysis 60% of claims are due to System Failures Communication Problems Misunderstandings Data Management Referrals Monitoring of side-effects etc
ORAL COMMUNICATION Rudeness Lack of Explanation Uninformed Consent Communication Between Teams Breach of Confidentiality
WRITTEN COMMUINICATION Lack of Written Records is the Number One Problem
MDU ADVICE Good medical and nursing records are an indication of good practice. If you are sued it will be difficult to convince a Judge that you are a good Clinician or Nurse if your records are poor. Accurate, legible, comprehensive and contemporaneous notes are often the key to successful Defence of a medical negligence claim
WRITTEN COMMUINICATION Testicular atrophy - an uncommon but recognised complication of herniorrhaphy and as such there might have been a case which could be defended. However, the general level of care as indicated by the case records is of such a poor standard that I feel it would cast a shadow over any subsequent Court Proceeding. if they are unable to write adequate and accurate notes, can we trust them to perform a proper operation?
10 TOP TIPS Comprehensive and contemporaneous Accurate and legible Do not insult the patient Record all significant events Facts and not fiction Entries should clearly identify personnel State timing when it is relevant Declare post dated or corrected entries Indicate when advice of colleagues is sought Record complaints of patient or family
COMPLAINTS Local Resolution Practice PCT. Now what? PALS NHS Ombudsman GMC
Talk to someone In practice Friend / mentor LMC (Safehouse) MDO What To Do? Respond promptly Don t be afraid to apologise
CONTROVERSIAL ABBREVIATIONS GOK FLK FLP VGLM LOLIAD PTOB NFD TTFO
That s How they affect YOU!