Medical Negligence

Question 1

What is the role of the GMC?

Answer 1

• Oversee and certify medical education
• Produce the medical register
• Ensure doctors are fit to practice

Question 2

What is the relevance of legislation on the work of a doctor?

Answer 2

• Working legally and lawfully
• Duty of care to the patient
• Working with proper skill and attention
• Risk versus benefit analysis
• Working in a patient’s best interests
• Working within one’s own capabilities
• Achieving expected outcomes

Question 3

What are the 5 levels of patient complaint?

Answer 3

1. Local Complaints
2. Disciplinary action - employer
3. Civil claim
4. Medical Council
5. Criminal Prosecution

Question 4

Why might a patient make a complaint?

Answer 4

• Error
• Grief
• Poor understanding/explanation
• Unrealistic expectations
• Failure to appreciate needs/wishes

Question 5

What is a doctors professional responsibility towards local complaints?

Answer 5

Must reply - deal with complaints constructively and honestly

Cooperate with any complaints procedure

Do not allow the complaint to prejudice care provided to the patient

When appropriate, offer apology

Question 6

What are the disciplinary procedures of employers?

Answer 6

• Terms and conditions of service
• Appraisal
• Job planning
• Time keeping
• Absence

Question 7

What factors explain the differences in litigation between the UK and the USA?

Answer 7

• Socialised healthcare
• Jury involved
• Contingency fee for lawyers
• Public expectation
• NHS UK complaints procedures permit interaction and explanation for patients without the need to sue

Question 8

What is the largest cause of medical litigation in the USA?

Answer 8

Lack of communication between the doctor and the patient

Question 9

What cases may be covered by the GMC?

Answer 9

• Manner and attitude
• Dishonesty
• Sexual impropriety
• Criminal convictions
• Health issues – drink driving/abuse of drugs/mental health
• Significant Performance issues

Question 10

What types of criminal allegations are made against doctors?

Answer 10

• Indecent assault
• Prescription fraud
• Manslaughter
• Murder
• Deception offences

Question 11

What is civil law?

Answer 11

Concerned with rights and property of individual people/organisations - may not always be criminal

Often involved compensation

Question 12

Civil law cases depend on what?

Answer 12

Establishing whether or not the accused person or organisation (defendant) had a duty of care towards the claimant

Question 13

What is criminal law?

Answer 13

Relation to offenses that negatively affect society as a whole

Brought by the Crown Prosecution Service

• Burglary/theft/arson
• Assault
• Murder
• Fraud

Question 14

How is medical negligence defined?

Answer 14

A lack of reasonable care and skill as a result of which, the patient suffers

Question 15

What must be demonstrated, in legal terms, to fulfil the definition of medical negligence?

Answer 15

1. A legal duty to provide care - contract (express or implied)
2. Reasonable care and skill - accepted medical practic
3. Actual damage as a result of lapse

Question 16

Hunter v Hanley 1955 determined what?

Answer 16

Mistake made by the practitioner must be an error which no competent doctor in that field would have made

Question 17

Bolam v Friern Hospital Management Committee 1957 determined what?

Answer 17

A doctor who acted in accordance with a practice accepted at the time as proper by a responsible body of medical opinion, is not guilty of negligence merely because a body of competent professional opinion might adopt a different technique

Question 18

Which losses may lead to a compensation?

Answer 18

• Loss of earnings
• Expenses incurred
• Impaired enjoyment of life
• Permanent incapacity
• Procreative incapacity
• Pain and suffering endured
• Death

Question 19

What are the lines of defence in medical negligence?

Answer 19

• Deny the charge
• True facts but not the persued doctor’s fault/vicarious liability
• Patient took a risk-consented procedure
• Contributory negligence (claimants own negligence led to their loss)

Question 20

What is vicarious liability?

Answer 20

Where a person can be held liable for the actions of another person

Question 21

What is Gross Negligence manslaughter?

Answer 21

Accused breached duty of care with foreseeable risk of death/actions causing or significantly contributing to the death of the victim

Question 22

What were the outcomes of the Bawa-Garba Case 2011?

Answer 22

Policy review of gross negligence manslaughter

Investigating the understanding of the processes and law in gross negligence manslaughter, and its relationship with reflective practice

• Clarify the law
• Improve the use of experts
• Exclusion of reflective material from documentation recoverable by professional regulations
• Removal of GMC right to appeal MPTS decisions

Question 23

What strategies can a physician undertake to minimalise the risks of complaints of negligence?

Answer 23

Join a medical defence organisation

Seek advice early

Maintain good records

Delegation

Comments about colleagues

Courtesy/hostility

Report early