Pub Date : 2015-09-01DOI: 10.1177/1356262215618047a
J. Mead
Prior to the relevant procedure on 26 October 2009, X had given birth to four children by way of Caesarean section. In addition, she had undergone three terminations, two miscarriages and an ectopic pregnancy. In September 2009, X discovered that she was 12 weeks pregnant. She wished to have a termination and was initially referred to the British Pregnancy Advisory Service. However, they were unable to assist her with a termination because they considered she needed to see a specialist. Consequently, she was referred to the defendant trust. She came under the care of Mr Ohizua, a consultant gynaecologist. She did not dispute the assessment undertaken by Mr Ohizua in which he advised her as to options, the risks associated with each method of termination and the steps which would be involved. During his assessment, the consultant gave careful consideration to X’s medical history. He concluded that she could be at high risk of abnormal adherence of the placenta, which would carry a high risk of additional bleeding. As a consequence, he undertook an ultrasound scan before deciding whether surgery was feasible. This indicated that X had a posterior placenta, which meant a lower risk than an anterior placenta. He therefore devised a plan which included a first stage of administration of drugs with a view to termination. Unfortunately, this proved unsuccessful and therefore Mr Ohizua proceeded to the second stage of his plan, namely surgical termination. This operation occurred on 26 October 2009. Amongst the advice he gave prior to obtaining consent was that surgery might be ‘incomplete’ to the extent that there could be retained products of conception. X agreed to proceed to surgery. In his witness statement Mr Ohizua described how, following removal of the foetus, he undertook suction to ensure removal of any parts which might have remained. He also employed ultrasound as a visual aid. Once he had completed the operation he performed three checks, in keeping with his usual practice, to ensure that most of the products of conception had been removed:
{"title":"Gynaecology – Surgeon not liable for failing to remove all retained products of conception: X v Walsall Healthcare NHS Trust (Coventry County Court, 21/5/2015 – Judge Mithani QC)","authors":"J. Mead","doi":"10.1177/1356262215618047a","DOIUrl":"https://doi.org/10.1177/1356262215618047a","url":null,"abstract":"Prior to the relevant procedure on 26 October 2009, X had given birth to four children by way of Caesarean section. In addition, she had undergone three terminations, two miscarriages and an ectopic pregnancy. In September 2009, X discovered that she was 12 weeks pregnant. She wished to have a termination and was initially referred to the British Pregnancy Advisory Service. However, they were unable to assist her with a termination because they considered she needed to see a specialist. Consequently, she was referred to the defendant trust. She came under the care of Mr Ohizua, a consultant gynaecologist. She did not dispute the assessment undertaken by Mr Ohizua in which he advised her as to options, the risks associated with each method of termination and the steps which would be involved. During his assessment, the consultant gave careful consideration to X’s medical history. He concluded that she could be at high risk of abnormal adherence of the placenta, which would carry a high risk of additional bleeding. As a consequence, he undertook an ultrasound scan before deciding whether surgery was feasible. This indicated that X had a posterior placenta, which meant a lower risk than an anterior placenta. He therefore devised a plan which included a first stage of administration of drugs with a view to termination. Unfortunately, this proved unsuccessful and therefore Mr Ohizua proceeded to the second stage of his plan, namely surgical termination. This operation occurred on 26 October 2009. Amongst the advice he gave prior to obtaining consent was that surgery might be ‘incomplete’ to the extent that there could be retained products of conception. X agreed to proceed to surgery. In his witness statement Mr Ohizua described how, following removal of the foetus, he undertook suction to ensure removal of any parts which might have remained. He also employed ultrasound as a visual aid. Once he had completed the operation he performed three checks, in keeping with his usual practice, to ensure that most of the products of conception had been removed:","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"100 - 101"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262215618047a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-01DOI: 10.1177/1356262215616307
C. Feeny, Ana Samuel, C. Austin
The article examines the law surrounding causation in situations when a death could be said to have been accelerated with particular reference to the case of Davies v Countess of Chester Hospital [2014] EWHC 4294 (QB). In doing so, the authors will argue that there are two options available to the courts, one that is an arbitrary time limit and the second which focuses on materiality.
{"title":"She should have died hereafter? When is death caused in law by breach of duty?","authors":"C. Feeny, Ana Samuel, C. Austin","doi":"10.1177/1356262215616307","DOIUrl":"https://doi.org/10.1177/1356262215616307","url":null,"abstract":"The article examines the law surrounding causation in situations when a death could be said to have been accelerated with particular reference to the case of Davies v Countess of Chester Hospital [2014] EWHC 4294 (QB). In doing so, the authors will argue that there are two options available to the courts, one that is an arbitrary time limit and the second which focuses on materiality.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"87 - 91"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262215616307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-01DOI: 10.1177/1356262215604991
J. Whyman
Hospital policies and procedures are designed to help prevent patients being harmed during the course of their treatment. The same principles apply as they do in business: by implementing a process-driven approach to ensuring that every component of the product is manufactured to the highest possible specification, customer satisfaction and safety can be secured. The more safety conscious the business, such as aerospace engineering, the tighter the procedures and controls. Hospitals should be no different; they are dealing with life and death and, as such, straightforward, fully tested procedures that are put in place to eliminate medical negligence mistakes should not be ignored. So why, as medical negligence lawyers, do we still see failures by both hospitals and health professionals to follow well-established procedures resulting in serious harm to patients? And particularly when such failures can and do lead to legal sanctions resulting not only in the loss of reputation and livelihood but also, in extreme cases, to liberty? In this article, which is a personal view, I explore some of the reasons why some medical practitioners fail to follow procedures and policies and outline the sanctions, both civil and criminal, for that failure.
{"title":"What are the legal implications of ignoring hospital policies and procedures?","authors":"J. Whyman","doi":"10.1177/1356262215604991","DOIUrl":"https://doi.org/10.1177/1356262215604991","url":null,"abstract":"Hospital policies and procedures are designed to help prevent patients being harmed during the course of their treatment. The same principles apply as they do in business: by implementing a process-driven approach to ensuring that every component of the product is manufactured to the highest possible specification, customer satisfaction and safety can be secured. The more safety conscious the business, such as aerospace engineering, the tighter the procedures and controls. Hospitals should be no different; they are dealing with life and death and, as such, straightforward, fully tested procedures that are put in place to eliminate medical negligence mistakes should not be ignored. So why, as medical negligence lawyers, do we still see failures by both hospitals and health professionals to follow well-established procedures resulting in serious harm to patients? And particularly when such failures can and do lead to legal sanctions resulting not only in the loss of reputation and livelihood but also, in extreme cases, to liberty? In this article, which is a personal view, I explore some of the reasons why some medical practitioners fail to follow procedures and policies and outline the sanctions, both civil and criminal, for that failure.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"83 - 86"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262215604991","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-01DOI: 10.1177/1356262215618047
J. Mead
{"title":"Hospital receptionist under no duty to give accurate waiting time information: Darnley v Croydon Health Services NHS Trust (High Court, 31 July 2015 – Judge Robinson)","authors":"J. Mead","doi":"10.1177/1356262215618047","DOIUrl":"https://doi.org/10.1177/1356262215618047","url":null,"abstract":"","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"98 - 99"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262215618047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-01DOI: 10.1177/1356262215618316
H. Merrett
I was struck by an item on the radio recently reporting on the world of ‘preppers’, perhaps better known as survivalists. Usually associated with America, these are people who prepare for a major disaster, whether a collapse of government, failure of banking or information technology systems or a natural catastrophic event. There are now many people in Britain preparing (or ‘prepping’) for man-made, or natural, Armageddon. The more extreme envisage a need for knives and crossbows to defend their families against marauding looters and other competitors for dwindling resources. Perhaps, the more realistic ones stock up on food and other supplies in the event that they will need to be self-sufficient. The aftermath of Hurricane Katrina in the southern states of America has been cited by some as a very real example of the necessity of such an approach. While I would not suggest that we face total shut down in the NHS at the moment, the concept of improving self-sufficiency is an interesting one in the current financial climate. One of the fundamental recommendations from the Francis inquiry into care at Mid Staffordshire NHS Foundation Trust was to set mandatory safe staffing levels at a national level. The attempts to implement this have foundered due to a combination of complexity and expedience. In June this year, the government suspended NICE (the National Institute for Clinical Excellence) from working further on issuing safe staffing guidance, announcing that it would instead incorporate nurse workforce planning into its forward plans. Now, the alarm over the high level of deficits in trusts seems to have forced the pendulum away from a focus on improving staffing ratios and filling posts (with a concomitant rise in agency and other costs) back towards the need to balance the books at all costs. If not a catastrophe for patient safety, this is surely a crisis. The analogy with ‘preppers’ and their self-reliance becomes particularly interesting if we interpret the ‘self’ for the NHS as our staff. The NHS has a range of armory to reduce the threats posed to good clinical care by suboptimal or unsafe conditions. Examples include early warning system; professional codes of conduct; guidelines; protocols; patient safety metrics; training; audit; communications; whistleblowing. However, I would argue that each of these depends on the quality, health and well-being of their much vaunted biggest asset: staff. In my experience of talking to a range of NHS staff about their organisations, there is a palpable feeling of optimism only in those where the senior clinicians and managers have truly managed to prove that they wish to engage with front-line staff. Even when people are under-staffed and working in difficult, pressurised circumstances, they will be heartened and inspired by leaders who are visible to them, who communicate personally with them and who make the effort to find out what they can do to make front-line working lives more comfortable. Lu
{"title":"Preparing for hard times: Safer staff","authors":"H. Merrett","doi":"10.1177/1356262215618316","DOIUrl":"https://doi.org/10.1177/1356262215618316","url":null,"abstract":"I was struck by an item on the radio recently reporting on the world of ‘preppers’, perhaps better known as survivalists. Usually associated with America, these are people who prepare for a major disaster, whether a collapse of government, failure of banking or information technology systems or a natural catastrophic event. There are now many people in Britain preparing (or ‘prepping’) for man-made, or natural, Armageddon. The more extreme envisage a need for knives and crossbows to defend their families against marauding looters and other competitors for dwindling resources. Perhaps, the more realistic ones stock up on food and other supplies in the event that they will need to be self-sufficient. The aftermath of Hurricane Katrina in the southern states of America has been cited by some as a very real example of the necessity of such an approach. While I would not suggest that we face total shut down in the NHS at the moment, the concept of improving self-sufficiency is an interesting one in the current financial climate. One of the fundamental recommendations from the Francis inquiry into care at Mid Staffordshire NHS Foundation Trust was to set mandatory safe staffing levels at a national level. The attempts to implement this have foundered due to a combination of complexity and expedience. In June this year, the government suspended NICE (the National Institute for Clinical Excellence) from working further on issuing safe staffing guidance, announcing that it would instead incorporate nurse workforce planning into its forward plans. Now, the alarm over the high level of deficits in trusts seems to have forced the pendulum away from a focus on improving staffing ratios and filling posts (with a concomitant rise in agency and other costs) back towards the need to balance the books at all costs. If not a catastrophe for patient safety, this is surely a crisis. The analogy with ‘preppers’ and their self-reliance becomes particularly interesting if we interpret the ‘self’ for the NHS as our staff. The NHS has a range of armory to reduce the threats posed to good clinical care by suboptimal or unsafe conditions. Examples include early warning system; professional codes of conduct; guidelines; protocols; patient safety metrics; training; audit; communications; whistleblowing. However, I would argue that each of these depends on the quality, health and well-being of their much vaunted biggest asset: staff. In my experience of talking to a range of NHS staff about their organisations, there is a palpable feeling of optimism only in those where the senior clinicians and managers have truly managed to prove that they wish to engage with front-line staff. Even when people are under-staffed and working in difficult, pressurised circumstances, they will be heartened and inspired by leaders who are visible to them, who communicate personally with them and who make the effort to find out what they can do to make front-line working lives more comfortable. Lu","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"73 - 74"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262215618316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-01DOI: 10.1177/1356262215618353
P. Walsh
{"title":"Will the independent patient safety investigation service make a difference?","authors":"P. Walsh","doi":"10.1177/1356262215618353","DOIUrl":"https://doi.org/10.1177/1356262215618353","url":null,"abstract":"","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"75 - 76"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262215618353","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-01DOI: 10.1177/1356262215602582
J. Mead
{"title":"No Evidence of negligent acquisition of MRSA: Billington (deceased) v South Tees Hospital NHS Foundation Trust (Bristol County Court, 6 January 2015—Judge Denyer QC)","authors":"J. Mead","doi":"10.1177/1356262215602582","DOIUrl":"https://doi.org/10.1177/1356262215602582","url":null,"abstract":"","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"41 1","pages":"67 - 69"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262215602582","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-01DOI: 10.1177/1356262215602582a
J. Mead
On 16th March 2010 the claimant, then aged 42, suffered an ischaemic stroke. He developed ‘‘locked-in syndrome’’ due to infarction in the brain stem and cerebellum, secondary to basilar artery thrombosis. He is now virtually totally paralysed, doubly incontinent, and is fed through a PEG (Percutaneous Endoscopic Gastrostomy) tube. His ability to communicate is extremely limited and he is dependent on 24 hour nursing care. His life expectancy is markedly reduced. On his behalf it was alleged that delays in taking him to hospital and in diagnosing his condition while there and providing the necessary treatment gave rise to the development of locked-in syndrome. In particular, it was maintained that failure promptly to start the claimant on Aspirin caused his deterioration. The trusts denied that such treatment would have resulted in a better outcome, although they admitted various breaches of duty as noted below.
{"title":"Causation in stroke case not demonstrated: Choudhury v South Central Ambulance Service NHS Trust and Portsmouth Hospitals NHS Trust (High Court, 13 May 2015—Cox J)","authors":"J. Mead","doi":"10.1177/1356262215602582a","DOIUrl":"https://doi.org/10.1177/1356262215602582a","url":null,"abstract":"On 16th March 2010 the claimant, then aged 42, suffered an ischaemic stroke. He developed ‘‘locked-in syndrome’’ due to infarction in the brain stem and cerebellum, secondary to basilar artery thrombosis. He is now virtually totally paralysed, doubly incontinent, and is fed through a PEG (Percutaneous Endoscopic Gastrostomy) tube. His ability to communicate is extremely limited and he is dependent on 24 hour nursing care. His life expectancy is markedly reduced. On his behalf it was alleged that delays in taking him to hospital and in diagnosing his condition while there and providing the necessary treatment gave rise to the development of locked-in syndrome. In particular, it was maintained that failure promptly to start the claimant on Aspirin caused his deterioration. The trusts denied that such treatment would have resulted in a better outcome, although they admitted various breaches of duty as noted below.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"143 1","pages":"69 - 72"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262215602582a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-01DOI: 10.1177/1356262215603266
P. Walsh
{"title":"Could ‘cost-capping’ be the final straw for access to justice in clinical negligence cases?","authors":"P. Walsh","doi":"10.1177/1356262215603266","DOIUrl":"https://doi.org/10.1177/1356262215603266","url":null,"abstract":"","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"59 - 60"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262215603266","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：