PPD - Clinical negligence Flashcards
3 duties of a doctor and how to fulfil them
- Knowledge, skills and performance: make the care of your patient the first concern
- Safety and quality: take prompt action if you think patient safety, dignity or comport is
being compromised - Maintaining trust: be honest open and act with integrity
4 ways in which duties of doctor may go wrong/negligence may occur
Human error
Neglect
Poor performance
Misconduct
Relationship between error and harm
Error does not always cause harm (learning from these may prevent harm)
Harm is not always caused by error
3 types of human error
Communication
Judgement errors
Omissions, lapses, violations
What are the consequences of medical error
A medical error leads to either an adverse event or a near miss.
Define adverse event
An incident which results in harm to a patient, which is not a direct result of their illness or some other change event
Define near miss event
An event which arises during care and has the potential to cause harm but fails to develop further thereby avoiding harm
Define neglect.
And how does this differ from error
Neglect: falling below the acceptable standard of care.
Error: an unintended outcome.
Define medical negligence and outline what it is
Breach of legal duty of care owed which results in harm to that patient.
Medical negligence is:
- A legal entity: the outcome of a court case
- A civil claim for damages (not imprisonment; NHS pays damages)
- On the balance of probabilities
- You can be found liable; you cant be found guilty
What are the 4 questions to demonstrate medical negligence, ie what are the criterion for a doctor to be found liable (IN EXAM)
- Was there a duty of care?
- Was that duty of care breached?
- Did the patient come to harm?
- Was the harm due to the breach in duty of care?
was there a breach in duty of care - 2 specific tests (2/4 negligence)
Bolam: would a group of reasonable doctors have done the same?
(ie. the medical professional must demonstrate that they acted in a way that a responsible body of medical professionals in the same field would regard as acceptable or reasonable.)
Bolitho: would it have been reasonable of them to do so?
(ie. a defence in Bolam must be reasonable both in terms of its logic and in demonstrating the the risks and benefits of a particular course of action have been properly considered)
Example case of human error and explain
Wayne Jowett
Wayne (19) due to have IV vincristine and intrathecal cytosine as he went into remission from ALL
Missed first appt so decision made to give both drugs on the same day
SHO assumed new registrar knew how to give chemo
Registrar assume SHO know local policies and procedures
IV and I-T syringes were similar in appearance
Who developed swiss cheese model and what is it.
Explain how Wayne Jowett case happened using swiss cheese model - including safety measures and errors
Jim Reason
Each layer represents processes which have been put in place to prevent errors happening (e.g. Wayne Jowett: 2 appts, 2 pharmacists, 2 fridges, 2 doctors to help ensure IV vincristine and I-T cytosine were delivered, stored and injected separately without confusion)
Holes are where processes can fail.
When the holes in the cheese line up an error can occur.
Latent errors: first 3 layers
- Latent errors: errors in the system (Eg: not having two people to check a drug chart)
Active error: unsafe act.
- Latent conditions may lie dormant within the system for many years before they combine with active failures and local triggers to create an accident opportunity
- Active failures are often hard to foresee but latent conditions can be identified and remedied before an adverse event occur
Define neglect and give a couple characteristics
Definition: falling below accepted standard
Often involves repeated minor mistakes, and occurs in cultures of not caring
What are the possible effects of neglect re patient care
Necessary care is withheld
Safeguarding is often overlooked
Nutrition and Personal care often disregarded
Medical care can suffer
Example of neglect
Mid-Staffordshire between 2005-09
What are the features of poor performance
Individual
Problem of attitude of doctor, which often comes across as rudeness, tardiness, scruffiness, laziness.
- Failure to learn from mistakes and listens to advice
- Affects patient care
- Usually evident from student days
Misconduct examples x4
Deliberate harm,
Lack of candour,
Fraud/theft,
Improper relationships
Deliberate harm examples (serious, minor)
Serious - shipman
Minor - rough handling, carelessness
Lack of candour examples x4
Hiding own or other’s mistakes
Ignoring mistakes, hoping they will go away
Altering medical records
GMC duties of a doctor: to report a concern
Fraud/theft examples x3
False expense claims
Time: sickness
Drug and alcohol problems
Improper relationships examples x3
Patients
Relatives
Colleagues - students/juniors with supervisors
When does a doctor hold a duty of care (1/4 negligence)
- usually very clear
- includes all patient
- probably includes relatives if they are with patient
- may include fellow passengers/passers-by
- if you offer medical advice you are accepting a duty of care
did the patient come to harm? (3/4 negligence)
Patient has to prove they came to some harm and that it arose from the injury
Harm usually limited to brief periods of discomfort
Recognised complications are not usually negligent eg wound infection
did the breach cause the harm? (4/4 negligence)
onus is on patient to prove harm resulted from breach of care
standard of proof = balance of probabilities (>50%). NB. this is lower than criminal standard of proof beyond reasonable doubt
4 things patient has to prove in order to charge with medical negligence
- Dr owed them a duty of care
- Dr breached the duty
- They came to harm
- The harm was caused by Dr’s breach
4 things courts consider when deciding costs to award (quantum) x4
If they win, court awards costs based on:
- Loss of income
- Costs of care - obstetrics cases are expensive
- Pain and suffering
- Punitive damages to punish Dr (USA only)
Define error of omission and error of commission
- Errors of omission – when a required action is delayed or not taken
- Errors of commission – where the wrong action is taken
