MEDICAL AREAS OF VULNERABILITY

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MEDICAL AREAS OF VULNERABILITY

• Dr Jim Rodger
• Medical Adviser MDDUS

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AREAS OF VULNERABILITY

• In-house complaints
• Independent Review Panel
• Ombudsman
• Disciplinary Hearing
• National Clinical Assessment Agency
• Patient Safety Agency
• Annual Appraisal

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AREAS OF VULNERABILITY

• Coroners Inquest/FAI
• Mental Welfare/Health Commission
• Criminal Convictions
• Criminal Prosecutions
• Civil Action - damages

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AREAS OF VULNERABILITY

• General Medical Council
• Health
• Professional Conduct
• Professional Performance
• Revalidation

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MEDICAL LITIGATION

• Rise in numbers of Claims and Complaints
• Rise in Costs and Diversion of Resources
• Rise in Stress Levels
• Rise in Violent Incidents
• Difficulty in Coping
• Low Morale

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SOURCES OF COMPLAINTS

• Consumerism
• Patients Charter
• Patients Advocacy Groups
• AVMA
• No win no fee arrangements
• Accountability

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SOURCES OF COMPLAINTS

• Scientific Advances
• Unrealistic Expectations
• Breaking of the Mould
• Legal Aid
• Dripping Roast of legal fees
• MONEY!

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MEDICAL LITIGATION

• Duty of Care
• Breach of Duty of Care
• Damage or Harm Occurred
• Causatively linked

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CLINICAL NEGLIGENCE

• Duty of care exists implicitly in any and all
  dealings between doctors, patients and other
  members of the public in connection with their
  professional work.

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CLINICAL NEGLIGENCE

• Breach of duty of care
• Did a doctor fall below a standard of care
  regarded as reasonable by a relevant body of
  medical opinion.
• Hunter v Hanley
• Bolam v Friern
• Bolitho

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CLINICAL NEGLIGENCE

• To successfully claim for damages a claimant or
  pursuer has to show
• That the doctor owed that person a duty of care,
• That the doctor breached that duty of care,
• That the patient suffered harm as a direct result
  of that failure.

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CLINICAL NEGLIGENCE

• Hunter v Hanley
• To establish liability by a doctor where
  deviation from normal practice is alleged, three
  facts require to be established. First of all it
  must be proved that there is a usual and normal
  practice.

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CLINICAL NEGLIGENCE

• Hunter v Hanley
• Secondly, it must be proved that the defender has
  not adopted that practice, and thirdly (and this
  is of crucial importance) it must be established
  that the course the doctor adopted is one which
  no professional man of ordinary skill would have
  taken if he had been acting with ordinary care.

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CLINICAL NEGLIGENCE

• Bolam v Friern
• The test (of negligence) is the standard of the
  ordinary skilled man exercising and professing to
  have that special skill..
• A doctor is not guilty of negligence if he has
  acted in accordance with a practice accepted as
  proper by a responsible body of medical me
  skilled in that particular art..

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CLINICAL NEGLIGENCE

• Bolitho (House of Lords 1997)
• The use of these adjectives responsible,
  reasonable and respectable all show that the
  court has to be satisfied that the exponents of
  the body of medical opinion relied upon can
  demonstrate that such opinion has a logical
  basis.

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CLINICAL NEGLIGENCE

• Causation
• Was the patient harmed by the negligent action of
  the doctor?
• Did that harm result from the negligent act?
• Did any other action by another person intervene?

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CLINICAL NEGLIGENCE

• Limitation
• Three years from incident
• Date of knowledge of harm and its cause

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CASE MANAGEMENT

• 100 Cases
• 85 Go nowhere lapse
• 10-15 Settle with/out admission of liabilty
• 1-5 Go to Proof or Trial
• EnglandScotland
• 38 62 GP members
• 50 50 Claims

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ABBREVIATIONS

• LEGS
• TESTES
• T.A.L.O.I.A.
• T.T.F.O.
• HARPICS DISEASE
• S.F.A.

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ABBREVIATIONS

• N.T.B.R.
• N.F.N (N.F.C.)
• P.I.T.A.
• CAT in WIG.
• CRAFT CLASS