Clinical risk最新文献

{"title":"Clinical negligence litigation – Is there a better way?","authors":"P. Walsh","doi":"10.1177/1356262216659205","DOIUrl":"https://doi.org/10.1177/1356262216659205","url":null,"abstract":"For decades, people have been decrying the huge financial cost – not to mention the far greater human cost – that clinical negligence litigation has for the NHS. As a charity that works both for patient safety as well as access to justice, AvMA has also long argued that there has been a long-standing failure to learn lessons for improving patient safety from litigation. There is precious little evidence of this happening on any significant scale. With ever-increasing financial pressures affecting the NHS, a number of new approaches to dealing with clinical negligence are being proposed across the United Kingdom. The Scottish Government have been consulting on how they plan to move forward following years of pontification over the recommendations of an expert advisory group for a ‘no-fault compensation’ scheme. What they have come up with are proposals for a so-called ‘no-blame redress scheme’. While on first sight the proposals are not as sweeping as the original, they are quite radical. The proposed scheme would apply to ‘claims’ of under £100,000 value, which is about 70% of existing claims in Scotland. Its most radical aspect is that, as well as not requiring litigation to gain compensation, the eligibility criteria are based on ‘avoidability’ and ‘reasonable’ treatment. The scheme would provide ‘compensation quickly and fairly where . . . the harm would have been avoided by the use of reasonable care’. So far, so good. There are many advantages to using the ‘avoidability test’. It should mean that more people qualify for redress than would do under the legal test of medical negligence. It means you don’t need to point the finger of blame and pin ‘negligence’ on an individual, and it is more in tune with patient safety – looking at root causes, system failures and how such incidents can be prevented. However, the consultation document is very lacking in detail. Depending on that detail, it could be a radically different approach which is better for patients and for patient safety or it could be a disaster. More certainly is needed over the meaning of ‘reasonable’ care. There is no mention of independent legal advice for patients. It is proposed that the scheme is not independent. In fact it is administered by the very organisation that currently defends claims against the NHS in Scotland – the Central Legal Office. Worse still, a nasty surprise with huge implications for medical negligence victims with larger claims nothing to do with the redress scheme is tucked away at the back of the consultation. It is proposed to repeal the legislation which allows successful claimants some choice over their care packages and the ability to purchase services from private providers. They would be at the mercy of what the NHS/local authorities decide to give them or can afford – just like anyone else. What will happen in Scotland remains to be seen but it will certainly be interesting. Whereas in England, we have the bizarre situation of Government policy o","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"105 - 105"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216659205","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477499","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}

{"title":"Novel genetic disease claim struck out: A and M v University Hospitals of Leicester NHS Trust (High Court, 15 April 2016 Judge McKenna)","authors":"J. Mead","doi":"10.1177/1356262216659423a","DOIUrl":"https://doi.org/10.1177/1356262216659423a","url":null,"abstract":"In the present case, there was no doubt that the claimant had suffered profound distress as a consequence of the sequence of events which unfolded after initial realisation that his wife was not recovering as expected from surgery. However, the circumstances with which Mr Ronayne was confronted ‘‘fall far short of those which have been recognised by the law as founding secondary victim liability.’’ The judge was wrong in his conclusion. The events were not, unlike those in Walters, ‘‘a seamless tale with an obvious beginning and an equally obvious end.’’ Rather, there was a series of events over a period of time and no inexorable progression. Mr Ronayne suffered nothing like the ‘‘assault upon the senses’’ to which Mrs Walters awoke. He knew before seeing his wife that she was due to go into theatre for immediate surgery, and knew that meant her condition was serious. It followed that this was not a case where there was a sudden appreciation of a shocking event. On the contrary, there was a series of events which gave rise to an accumulation of gradual assaults upon the claimant’s mind. At each stage in this sequence the claimant ‘‘was conditioned for what he was about to perceive.’’ There was nothing sudden or unexpected about being ushered in to see his wife and finding her connected to medical equipment. Overall, what the claimant saw was not horrifying by objective standards. On both the first and second occasions, what Mr Ronayne saw was such as would ordinarily be expected of a person in hospital in the circumstances in which Mrs Ronayne found herself. What was required in order to found liability was something exceptional in nature. The court could readily accept that the appearance of Mrs Ronayne on the second occasion must have been alarming and distressing. However, it was not in context exceptional. Furthermore, the fact that Mr Ronayne did not suffer intrusive recollection of events told against the visual images of his wife being the trigger for his psychological condition. For all these reasons, the ruling of the judge would be overturned and judgment would be entered for the trust. Amanda Yip QC and Simon Fox (instructed by Maxwell Hodge) appeared for Mr Ronayne. Charles Cory-Wright QC (instructed by Hill Dickinson) appeared for the trust.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"14 1","pages":"128 - 129"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216659423a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477563","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}

{"title":"M v Colchester Hospital University NHS Foundation Trust","authors":"Sandra Patton","doi":"10.1177/1356262216656966","DOIUrl":"https://doi.org/10.1177/1356262216656966","url":null,"abstract":"In 1984, M was diagnosed with a large sub-frontal meningioma and underwent removal of the tumour which, macroscopically, was complete. Immediately after the operation, her vision recovered save for a slight visual field defect in the left eye. In 1988, having moved to Essex, she underwent a CT scan at the Defendant hospital which showed no evidence of recurrence, and she was discharged from the neurosurgical clinic. In 1993, M was referred to the ophthalmic clinic as her optician was concerned about deterioration of vision in her left eye. Her visual acuity was measured at 6/5 in the right and 6/12 in the left. It was noted M was anxious about a recurrence, but she was reassured and sent for a CT scan. The hospital was to monitor her visual fields every two months to see if there is any serial change. The CT was reported in July 1993, and there was said to be no evidence of significant mass effect nor of abnormal contrast enhancement, with a normal ventricular system. The low-density changes in both frontal fields were presumed to be due to previous surgery. The scan had been lost or destroyed by the time of the claim and so could not be reviewed. M was reviewed by the Ophthalmic Consultant in September 1993. Visual acuity in the right eye was noted to be 6/5 and in the left 6/9, a slightly pale left disc and field defects in the left eye ‘of long-standing’. The Consultant advised her GP to ‘keep herself assessed about once a year and if there is any change on the situation we shall be happy to see her again’. He discharged M from clinic. Notwithstanding their own management plan, M was not kept under review by the clinic. In August 2000, M’s optician advised her GP that M had visual acuity of 6/9 in the right eye and less than 6/60 in the left with a widespread area of decreased sensitivity in the right and that, in view of her history, this should be investigated further. The GP duly referred M back to the hospital where she was seen in October 2000. On examination, her visual acuity was 6/5 in the right eye and 6/60 in the left eye. She was to be reviewed in nine months’ time. M received no appointment. By 2003, M was noticing deterioration in her functional vision. She required help at work and at home with reading and had given up night-driving. In January 2004, her optician recorded acuity in each eye as 6/12.M attended the hospital inMarch 2004 to review if she could continue driving and was recorded to have visual acuity in the right eye of 6/36 unaided, 6/36þ 1 with glasses, and in the left eye 6/18 unaided, 6/12-1 with glasses. There is no evidence that she saw a doctor in the clinic, or any note of a management plan or review. Her driving licence was revoked in April 2004.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"124 - 126"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216656966","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477395","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}

{"title":"A culture for safety: Can we find our way out of the woods?","authors":"H. Merrett","doi":"10.1177/1356262216659167","DOIUrl":"https://doi.org/10.1177/1356262216659167","url":null,"abstract":"","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"103 - 104"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216659167","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477457","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}

{"title":"Opening Pandora’s Box of innovations?","authors":"D. Conway","doi":"10.1177/1356262216631220","DOIUrl":"https://doi.org/10.1177/1356262216631220","url":null,"abstract":"The second part of my Bill, therefore, does one thing: essentially, it brings forward what the medical community knows as the Bolam test. Currently, the Bolam test is applied only when proceedings have gone to court. However, bringing it forward to an earlier stage would allow a responsible doctor to take a series of steps to prove that they are being exactly that—responsible when providing treatment. This does not change common law.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"106 - 112"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216631220","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477268","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}

{"title":"The futile mission of voluntary registers","authors":"Amanda Casey","doi":"10.1177/1356262216646895","DOIUrl":"https://doi.org/10.1177/1356262216646895","url":null,"abstract":"Clinical physiologists have a vital role to perform in the diagnosis and treatment of patients. They perform sensitive and invasive procedures such as assessments and adjustments of pacemakers, internal ultrasounds and endoscopies, and lung function tests. Despite the risky nature of their work, clinical physiologists fall outside the scope of statutory regulation and are currently only subject to regulation by a voluntary register held by the Registration Council for Clinical Physiologists. While the Registration Council for Clinical Physiologists strives to maintain a register which sets a high practicing standard and which can hold practitioners to account, the nature of voluntary registration means the Registration Council for Clinical Physiologists lacks the statutory power to ensure practitioners comply with the correct processes and requirements and has no authority to discipline clinicians who practice negligently. This means that incompetent practitioners remain practically unaccountable for their actions, leaving patients without much needed protection, and putting their safety at serious risk. Over the past decade, statutory regulation has been recommended on a number of separate occasions by experts including the Health and Care Professions Council, and yet today, the workforce still exists outside the umbrella of professional oversight and scrutiny.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"113 - 115"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216646895","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477326","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}

{"title":"Further important ruling on secondary victim claim: Ronayne v Liverpool Women’s Hospital NHS Foundation Trust (Court of Appeal, 17 June 2015)","authors":"J. Mead","doi":"10.1177/1356262216659423","DOIUrl":"https://doi.org/10.1177/1356262216659423","url":null,"abstract":"The claimant was the husband of Julie Ronayne who had been admitted to the defendant’s hospital for a hysterectomy. It was agreed that this procedure was performed negligently because a suture was misplaced in the patient’s colon, in consequence of which she developed septicaemia and peritonitis. Liability in her claim was admitted and the case successfully resolved. Mr Ronayne claimed to have suffered mental trauma as a consequence of what had happened to his wife in hospital following the trust’s negligence. This occurred in two episodes:","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"127 - 128"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216659423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477515","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}

{"title":"Court refuses to strike out claim founded on non-delegable duty —GB v Home Office (High Court, 31 March 2015 Coulson J)","authors":"J. Mead","doi":"10.1177/1356262216659423B","DOIUrl":"https://doi.org/10.1177/1356262216659423B","url":null,"abstract":"nosed with ALD. So far as B was concerned, his condition was too far advanced for a stem cell transplant to be of any benefit to him and he died in April 2012. Following the diagnosis of A and B, X was seen in clinic and it was at this point that the consultant noted that the VLCFA test had not been performed. This was reordered and in August 2006, X was informed that the result was consistent with AMN. Genetic testing confirmed that diagnosis.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"129 - 131"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216659423B","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477574","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}

{"title":"Negligent administration of steroids without bone protection resulting in glaucoma, cataracts, visual loss and osteoporosis","authors":"Nicola Bould","doi":"10.1177/1356262216641544","DOIUrl":"https://doi.org/10.1177/1356262216641544","url":null,"abstract":"","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"121 - 123"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216641544","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477281","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}

{"title":"Patients’ willingness to complete written incident report forms in one UK tertiary cancer hospital","authors":"C. Doherty, C. Stavropoulou, Lorie Dickinson","doi":"10.1177/1356262215616013","DOIUrl":"https://doi.org/10.1177/1356262215616013","url":null,"abstract":"This article examines patients’ willingness to complete incident report forms, providing a description of the event or concern. Differing from other studies, its design enabled patients to report incidents when and if they felt this necessary, rather than responding to researchers’ questions. A total of 145 patients receiving treatment for cancer in a UK hospital were invited to participate. Of the 100 patients who agreed to participate, only 13 completed a total of 22 forms. The form’s purpose was not easily understood, often perceived as complaining and patients tended to report relatively trivial matters. Contrary to previous studies, this study found little evidence that incident report forms are the right tool for enabling patients’ proactive involvement in safety improvement. Asking patients to monitor their safety by completing incident report forms may serve to undermine patients’ trust in their clinicians while duplicating resources.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"21 1","pages":"77 - 82"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262215616013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477587","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}