Negligence Flashcards
What is the pathways for complaints being made to the NHS from patients?
From most lenient to stringent, what are the sanctions that can be imposed upon a physician following an investigation by the GMC?
- Take no action
- To accept undertakings by doctor
- Place conditions on doctor’s registration
- Suspend registration
- Erase doctors name from medical register
What is the GMC definition of ‘Duty of Candour’?
By statutory regulation, every healthcare professional must be open and honest with patients when something that goes wrong with their treatment or care causes, or has the potential to cause, harm or distress.
This means that healthcare professionals must:
- Tell the patient (or, where appropriate, the patient’s advocate, carer or family) when something has gone wrong
- Apologise to the patient (or, where appropriate, the patient’s advocate, carer or family)
- Offer an appropriate remedy or support to put matters right (if possible)
- Explain fully to the patient (or, where appropriate, the patient’s advocate, carer or family) the short and long term effects of what has happened.
What does NPSI stand for? And what are its ramifications?
After a Notifiable Patient Safety Incident (NPSI) occurs, the organisation must tell the patient (or their representative) about it in person.
A NPSI has a specific statutory meaning: it applies to incidents where a patient suffered (or could have suffered) unintended harm that results in death, severe or moderate harm, or prolonged psychological harm
In a civil suit, what three things must the patient prove to ellicit a charge of clinical negligence?
In order to prove negligence in a civil suit the plaintiff must prove three things (on the balance of probabilities):
- The doctor had a duty of care
- The duty of care was breached
- The breach of the duty of care caused harm
How did the 1996 Bolitho case ammend the legal power of the ‘Bolam Test’?
The Bolitho Test, which resulted from the 1996 court case of Bolitho v City and Hackney HA, is an amendment to the Bolam Test.
The Bolam Test (1957) had stipulated that no doctor can be found guilty of negligence if they are deemed to have acted “in accordance with a responsible body of medical opinion.” The Bolitho Test helped to clarify what was meant by “a responsible body,” defining it as one whose opinion had a “logical basis.”
Combined together, they provide a practitioner with the same protection as Bolam, provided that the Court finds such an opinion to be logical.
Why is proving that a trust/physician HAS a duty of care over someone easy?
Doctors have a duty of care towards anyone with whom they have a doctor-patient relationship
NHS trusts have a duty of care to provide a comprehensive service to their service users and can be sued if such care is not forthcoming
The NHS also has vicarious liability for the errors that doctors employed by the NHS make
Why is proving that a trust/physician’s duty of care HAS BEEN BREACHED difficult?
Because in order to know whether the duty of care was breached, we need to know what the duty of care amounts to:
eg the Expected Standard of Duty of Care
Establishing causation can be simple, but proving – on the balance of probabilities – that the doctor’s negligent action was the cause (or a substantial cause) is very difficult
What is the test for establishing causation over an adverse outcome, in the context of establishing negligence?
The basic test of causation is the “but for” test:
“But for the defendant’s negligence, would the patients have suffered an injury?”
Outline the four-fold duty a physician has upon signing any prescription:
Correct patient name and drug name
No comparative or absolute contraindications
Correct dose and directions are given
Provision for appropriate monitoring/follow up
What is the contrast between Lack of Expertise and Lack of Experience in terms of a legal defence over negligence?
Lack of expertise IS taken into account when determining negligence, whereas Lack of Experience IS NOT.
- Whilst doctors do not have to be experts in all things medical, they DO have a duty to refer to someone who does have the relevant expertise.
- If doctors are not competent to proceed they should seek senior advice and assistance. Do NOT “go it alone”.
What may you be required to do if you are to ignore/disregard a guideline (eg. NICE, GMC etc)?
Justify your departure
What is meant by the allegation of Defensive Medicine?
“The practice of performing tests as a safeguard against possible malpractice liability rather than to ensure the health of patients”
True or False?
An apology is NOT a legal admission of guilt/liability
True
Can an omission of care be considered causative in an adverse health outcome?
Generally the law would not regard an omission as a cause
However…the law does seek to ensure that health care professionals who allow harm to befall their patients due to a failure to act can be found liable.
