Medical Accidents in Women

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Medical Accidents in Womens Healthcare the
Patients Perspective
PETER WALSH, CEO,
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WHAT IS AvMA?

• An independent charity established 1982
• Promotes patient safety and justice for those who
  suffer medical accidents
• Provides advice to individuals affected by a
  medical accident
• Accredits and monitors specialist solicitors
• Maintains / develops medical expert database
• Promotes good practice

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Some Common Myths

• Patients are Litigious
• Health Professionals will not report incidents if
  there are implications for them
• The health service can not afford to compensate
  injured patients

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Patients are litigious

• DoH estimates circa 1 million medical errors in
  English hospitals alone each year, about half of
  which are potentially negligent
• Number of new claims made to the NHS Litigation
  Authority last year under 6,000!
• Most patients turn to litigation as a last resort
  to get to the truth, or because it is the only
  way of getting the compensation they need

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Health professionals will not report incidents
if implications for them

• If true, all of our health professions are unfit
  to practice under current criteria! (see GMC,
  Good medical Practice)
• Will always be some who put own interests before
  injured patients but do not tarnish everyone
• Anonymous reporting systems a safety net, but no
  substitute for ethical behaviour

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The NHS can not afford compensation

• 500 million a year could buy a lot extra
  treatment, but
• At well under 1 of budget is much cheaper than
  insurance premiums would be
• Human cost is the real cost but extra bed days
  and treatment outweigh compensation
• Best way to reduce costs is to prevent errors
  not deny justice
• Would there be the current emphasis on safety if
  it were not for the added incentive of litigation
  costs?

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What patients want

• Patient Safety
• and Justice

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PATIENT SAFETY

• First do no harm
• Benefits outweigh risks
• Qualified, competent practitioners
• Evidence base
• Safe environment
• Checks
• Lessons learned

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Issues in Obs Gynae

• Obs 25 claims 65 cost of claims
• Most serious and emotive incidents children
• Not about illness deprived joy
• Shortage of midwives consultants when you need
  them
• Interface between midwives doctors
• Late intervention / analysis of monitoring
  equipment / tears

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Issues in Obs Gynae (cont)

• Still births
• Listening to parents and Involvement of parents
  in investigation when things go wrong parents
  make great witnesses!
• Adding insult to injury denial and putting
  blame on mother

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WHAT DO PATIENTS WANT WHEN THINGS DO GO WRONG?

• Latest evidence (DoH, Making Amends, 2003)
• Of those affected by medical injury
• - 34 wanted apology/explanation
• - 23 an enquiry into causes
• - 17 support in coping with result
• - 11 financial compensation
• - 6 disciplinary action

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JUSTICE

• Fairness
• Information
• Explanation
• Apology (if appropriate and real)
• Action to prevent re-occurrence
• Compensation

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Is there a better way to deliver patient safety
justice?

• So called no-fault compensation schemes
• No such thing as no-fault compensation and
  why should there be?
• Most schemes designed in response to no blame
  culture calls, and perceived need to limit
  compensation not justice
• CMOs proposals in Making Amends widely
  criticised and dropped
• Every child deserves high quality treatment
  compensation an entirely different issue

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Alternative Proposals

• Widen the definition of liability for example,
  Denmark. An avoidability test
• Join up patient safety issues with issues of
  redress
• Build independence and specialist representation
  into the proposals

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The NHS Redress Bill

• Claims under 20,000 in value
• NHS determines its own negligence
• No specialist representation for patients
• Missed opportunity for joining up processes
  improving safety
• Mounting pressure to address these weaknesses in
  the Bill watch this space!

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Patients and Doctors want the same thing

• A Charter of Understanding between Doctors and
  People affected by Medical Accidents

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Appreciation of Risk

• The practice of medicine and undergoing medical
  treatment carry with them risks. These risks
  should be fully explained..There will be
  occasions when an adverse outcome is unavoidable.
  

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Treatment should not be affected by a Dispute

• Patients physical and mental health should be
  the paramount concern of any treating doctor,
  whether or not there is a clinical dispute over
  treatment or a medical error is alleged to have
  been made

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Doctors are only human

• Committing an error is not in itself an
  indication of incompetence or negligence. A
  doctor should be supported in (indeed applauded
  for) reporting errors openly and honestly without
  fear of unreasonable consequences

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The Right to know

• Avoidable injury may also be caused by human
  error on the part of doctors, or others assisting
  doctors in the care of a patient. When it appears
  this has occurred, the patient..should be
  informed and have the circumstances fully
  explained
• See also, Being Open, NPSA
• Good Medical Practice, GMC

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Right to Redress

• Medical accidents have a real and deep impact on
  peoples lives. Patients who have been affected
  by a medical accident have a perfectly reasonable
  right to explanations and to seek apologies,
  assurances and/or financial compensation for
  injuries caused, where appropriate
• See also Making Amends

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THANK YOU! Any questions or comments?

• To sign up to the Charter or for further
  information visit
• www.avma.org.uk
• admin_at_avma.org.uk