Clinical Indemnity Scheme St James s Hospital 25 January 2011 Catherine Tarrant Solicitor/Clinical Claims Manager Clinical Indemnity Scheme Specialist Division of State Claims Agency Aims (1) Management of clinical claims from 1st July 2002 (2) Clinical Risk Management Advisory Services 2 Reasons for Clinical Indemnity Scheme Enterprise Liability Provision of obstetrics and gynaecology insurance 3 Relevance of CIS to you If a patient sues for personal injuries arising out of clinical treatment received at a public hospital, CIS will:- 1. Represent you 2. Investigate and defend the claim 3. Appoint and liaise with legal team 4. Instruct and liaise with experts 5. Cover all legal costs of the case 6. Pay Court award or settlement, if applicable. 4 CIS Cover Inclusions:- Professional medical services Good Samaritan acts within Ireland Representation at Coroners Inquests C.I.S Cover C Exclusions: - Private Hospitals Disciplinary Hearings Medical Council Criminal cases Must be acting within scope of employment as doctor (c.f. inappropriate examinations) * NB: Supplementary Insurance 5 6
Coroner s s Inquest Coroner s s Inquests Inquiry into the circumstances surrounding death Purpose to establish facts surrounding death -who, when, where, HOW liability not considered Inquest is not a trial it is a fact finding inquiry 7 8 Procedure Submit written statement Full factual account, in chronological order of involvement Evidence on oath or affirmation Entitled to be legally represented Verdicts : accidental death misadventure medical misadventure suicide natural causes open verdict narrative verdict General recommendation (rider) Reported in the newspapers Litigation 9 10 How will you know if there is a claim? Contacted by hospital Risk Manager/Claims Co-ordinator Contacted by Clinical Indemnity Scheme Personally served with solicitors letter of claim What do you do? Contact Clinical Indemnity Scheme Review your involvement with the patient, with reference to the clinical records Prepare a statement Privileged - Prepared in Contemplation of Litigation at the request of CIS Stay in touch with CIS notify us of change in contact details 11 12
Importance of statement Assists us in interpreting the clinical records Instruct relevant experts to provide their opinion on clinical care Share statements with own legal team Assists us in assessing liability Claims Investigation Expert evidence is taken up by CIS Meeting/Conference call Consultation with legal team and experts Pre-trial consultation with full defence team if case is proceeding to hearing 13 14 Case Conclusion Plaintiff discontinues the claim Claim settles Trial - either (a) full fight on liability if no negligence or (b) quantum only judge to decide amount of compensation (where settlement talks have failed) Why claims are settled Negligence Poor records - absent/inadequate entries - Illegible handwriting/inability to identify signatures - unclear abbreviations No records or missing records 15 16 Medical Records as a Legal Document Should give a factual picture of past events Considered to be an accurate reflection of care provided to the patient at the time Only evidence available years later Scrutinised by the plaintiff and defence lawyers, medical experts and the court Consent 17 18
Consent Consent is a process not a single event Begins when clinician decides that a procedure would be in patient s best interests Ends when procedure/treatment is concluded Can be withdrawn at any time during procedure/treatment Informed consent Patient should understand nature and purpose of procedure/treatment What is actually involved in the procedure/treatment Anticipated outcome, benefits, risks and alternatives Consequences of refusal 19 20 Timing of consent Process should begin at an early stage Consent form time to read and ask questions Ensure form is valid no more than 3 months If any material changes occur in clinical/personal circumstances, re-consent the patient Where consent is taken Environment where patient has time to reflect on information and consider issues without duress Best practise: do not take consent while patient is on the way to/actually in theatre Do not take consent after patient has been sedated/pre-medicated 21 22 How consent is obtained Detailed discussion Allow time for the process Information leaflets, handouts, DVDs No substitute for conversation Consent Form Note in records that contents of consent form discussed patient signs form Speak clearly and in language patient understands Do not assume patient is familiar with process even if long term patient 23 24
Emergency Medico-Legal Helpline Most frequent queries Consent Confidentiality Records Aftermath of adverse event Advice re communication with relatives of patients. Genuine emergency calls-5% Contact Details Clinical Indemnity Scheme (01) 6640900 Emergency Medico-Legal Helpline (01) 6640909 Website: www.stateclaims.ie 25 26 Thank You! 27