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MEDICO – LEGAL CASEBOOK

MEDICO – LEGAL CASEBOOK. JOHN MEAD NHS 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

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MEDICO – LEGAL CASEBOOK

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  1. MEDICO – LEGAL CASEBOOK JOHN MEAD NHS LITIGATION AUTHORITY

  2. What is NHSLA? • Created in 1995 • Part of the NHS • Not an insurance company • Covers England only

  3. Administers various schemes on behalf of the Secretary of State • Clinical negligence/public liability/employers’ liability/ defamation etc. • Will run Redress

  4. Risk Management initiatives (e.g. CNST Maternity Standards) • Human Rights Act Information Service • Pooling of resources and expertise

  5. 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%

  6. Value of Open Claims by Speciality Obstetrics - 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%

  7. Value of Open Claims by Speciality £m Obstetrics - 4,445 Paediatrics - 738 Casualty/A&E - 225 Orthopaedic Surgery - 191 General Surgery - 145 General Medicine - 95 Anaesthesia - 70 Gynaecology - 67

  8. Breakdown of Obstetric Claims (by value)

  9. 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%

  10. INDIVUDUAL CASES • 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

  11. 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

  12. Uterine Rupture • Term + 13 days • Trial of scar • Excessive use of Syntocinon • Failure to warn • Baby in peritoneal cavity • Quadriplegic cerebral palsy

  13. 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

  14. 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

  15. ERPC Errors • Miscarriage • Doctor inexperienced • Ethical opposition to termination • Failure to review • Failure to check • Mother passed body parts in shower

  16. Diathermy Burns • Hysterocopy/sample/cautery • Surgeon stepped on foot pedal • Burns to knee • Alleged remark by SHO

  17. 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?

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