MEDICO – LEGAL CASEBOOK

JOHN MEADNHS LITIGATION AUTHORITY

What is NHSLA?

- Created in 1995

- Part of the NHS

- Not an insurance company

- Covers England only

- Administers various schemes on behalf of the Secretary of State

- Clinical negligence/public

liability/employers’ liability/

defamation etc.

- Will run Redress

- Risk Management initiatives (e.g. CNST Maternity Standards)

- Human Rights Act Information Service

- Pooling of resources and expertise

Percentage of Open Claims by Speciality

Obstetrics - 23.1%Orthopaedics - 12.9%General Surgery - 9.2%Paediatrics - 9.2%Casualty/A&E - 8.5%

Gynaecology - 5.0%General Medicine - 4.7%Psychiatry - 2.5%Others - 24.9%

Value of Open Claims by SpecialityObstetrics - 65.4%Paediatrics - 10.9%Casualty/A&E - 3.3%Orthopaedic Surgery - 2.8%General Surgery - 2.1%General Medicine - 1.6%Neurology - 1.4%Anaesthesia - 1.0%Gynaecology - 1.0%Others - 11.5%

Value of Open Claims by Speciality £m

Obstetrics - 4,445Paediatrics - 738Casualty/A&E - 225Orthopaedic Surgery - 191General Surgery - 145General Medicine - 95Anaesthesia - 70Gynaecology - 67

Number of Obstetric Claims by Cause (% of Total)

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

11%

12%

13%

14%

15%

Failure / Delay

Diagnosis

Fail To Monitor 1st

Stg Labour

Fail To Make Resp

To Abnrm FHR

Fail To Recog.

Complications

I ntra-Op Problems Fail To Monitor

2nd Stg Labour

Delay I n

Perf orming

Operation

I napp Use Of

Forceps / Ventouse

Cause

Perc

enta

ge

Breakdown of Obstetric Claims (by value)

53%36%

10%1%

Cerebral Palsy

Others

Brain Damage

Erb's Palsy

Gynaecology – Most Frequent Causes of Claims

Intra-operative problems - 27.6%

Failure/Delayed diagnosis - 16.0%

Failure to recognise complication - 8.5%

Delayed treatment - 6.0%

Lack of consent - 5.7%

Failed sterilisation - 5.7%

Other causes - 30.5%

INDIVUDUAL CASES

1) Laboratory Mix-up- Ultrasound: one twin with? Down’s Syndrome- Double amniocentesis- FISH analysis- Selective feticide- Birth of live child with Down’s- Test-tubes had been wrongly labelled

2) Multiple Sites and Poor Layout

- On-call registrar at another site

- Failure of handover on change of shift at 17.00

- 58 minutes from decision to perform C/S to delivery

- Theatre on different level to labour ward

- Inadequate lifts

3) Uterine Rupture

- Term + 13 days

- Trial of scar

- Excessive use of Syntocinon

- Failure to warn

- Baby in peritoneal cavity

- Quadriplegic cerebral palsy

4) Breakdown of Communication with Ambulance Service

- Hospital with two areas to receive emergencies

- Mother delivered to A/E, not Maternity Suite

- Lack of preparation by obstetric SHO

- Delay in delivery of 28 minutes

- Birth of child with cerebral palsy

5) Mother Seriously Brain-Damaged

- Labour ward locked

- Mother suffered seizure

- Crash team not informed of change of

code

- Inexperienced doctor on duty “froze”

- Largest claim in NHSLA’s history

6) ERPC Errors

- Miscarriage

- Doctor inexperienced

- Ethical opposition to termination

- Failure to review

- Failure to check

- Mother passed body parts in shower

7) Diathermy Burns

- Hysterocopy/sample/cautery

- Surgeon stepped on foot pedal

- Burns to knee

- Alleged remark by SHO

8) McGeehan-v-Stockport Health Authority (High Court, 2004)

- Persisting bradycardia

- Urgent forceps delivery

- V/E at 12.19; scalp electrode

- Local anaesthetic

- Born at 12.35 – cerebral palsy

- Should anaesthetic have been dispensed with, saving ten minutes?