Medical negligence

Question 1

Who regulates the GMC?

Answer 1

Professional Standards Authority

Question 2

What is the GMC responsible for?

Answer 2

Overseeing and certifying the appropriateness of medical education

Also for ensuring that doctors are fit to practice – by publishing its ethical and professional guidance – Good Medical Practice

Question 3

What sorts of things does the GMC guidance include?

Answer 3

Ethics

Professionalism

Professional Governance

The Law as it affects and governs medical practice

Confidentiality

Consent

Negligence

Record Keeping

Risk management, audit, peer review

Clinical governance

Referral of patients

Dealing with criticism and complaints

Working with colleagues, team working

The duty to report

The duty of candour

Continued professional development

Self appraisal and staying healthy

Question 4

What is a disciplinary action?

Answer 4

When an employer raises a concern about employee performance or behavior.

It may come in the form of a verbal or written reprimand or the loss of employee privileges

Question 5

What is a local complaint?

Answer 5

The least severe/ lowest level of complaint

It might be a complaint to local management (i.e GP practice management) or a ward complaint.

Question 6

Why might a patient make a local complaint?

Answer 6

Error - treatment or results etc

Grief - drives a lot of complaints. Some need to assert blame somewhere

Poor understanding / explanation

Unrealistic expectations - doctor should understand patient’s expectations + respect them. Effective communication to make sure the patient doesn’t have unrealistic ones though

Failure to appreciate needs/wishes of patient - not listening

Question 7

What must you do if a complaint is made about you?

Answer 7

You must reply to it and deal with it using the complaints procedure.

It is important to respond rationally as this could be quite crucial as to what happens next.

Engage with line managers etc early on about how to manage the complaint.

Question 8

What are the most common reasons a doctor might face disciplinary action?

Answer 8

Breaking terms and conditions of service - breaching your contract

Job planning - not being on top of your work

Poor time keeping

Absence - not showing up for shifts etc

Question 9

What is the appraisal system?

Answer 9

Appraisals measure your performance against previously-agreed goals, set future objectives and give staff guidance on their developmental and training needs.

You have an appraisal every year and a lot of issues are usually raised and dealt with during it. You must declare any complaints that have been made against you and discuss them.

Question 10

If a complaint is made about you to the GMC who hears your case?

Answer 10

The Medical Practitioners Tribunal Service (MPTS) - this is separate to the GMC

Question 11

If you are found to have been negligent by the GMC what sanctions may they impose?

Answer 11

Sanctions may be that you are more heavily supervised, restrictions on you (prescribing medication etc), suspension and maybe removed from the register.

Question 12

Give some examples of misconduct that the GMC may investigate

Answer 12

Manner and attitude

Dishonesty

Sexual impropriety/misconduct

Criminal convictions

Health issues – drink driving/abuse of drugs/mental health

Significant Performance issues

Question 13

What are some types of criminal allegations made against doctors? (5)

Answer 13

Indecent assault

Prescription fraud – prescribing to yourself or family members

Manslaughter – culpable homicide. Didn’t intent to kill someone but you did like a Road traffic accident

Murder

Deception offences – not declaring private incomes etc, fraud

Question 14

Examples of civil law cases

Answer 14

Family disputes, such as divorce, dissolution of civil partnerships, children’s issues and childcare arrangements

Personal injury cases, such as RTA’s, medical and clinical negligence and slips, trips and falls

Breach of contract or promise, such as cases where money is unpaid or a contract isn’t honoured

Employment law, for example where an employee suffers discrimination

Question 15

Where will criminal cases be heard?

Answer 15

Magistrates’ court or the crown court (England)

High court of Justiciary (Scotland)

Question 16

Define medical negligence

Answer 16

A lack of reasonable care and skill as a result of which the patient suffers

Question 17

In medical negligence, the monetary reward will reflect what?

Answer 17

The financial loss suffered by the patient and not the degree of negligence exhibited

Question 18

What is the first thing a solicitor will look at to work out whether a doctor has been negligent?

Answer 18

The solicitor will question whether that doctor has a duty of care for the other person.

The answer to this is yes

Question 19

What is the 2nd thing a solicitor will look at to work out whether someone has been negligent?

Answer 19

The idea of whether the doctor acted in reasonable care and skill.

Has the doctor breached their duty of care?

To find this out, a solicitor would explore whether any other competent doctor of ordinary skill in that field would act in the same way? (This comes from the Hunter v Hanley case)

Question 20

Bolam test

Answer 20

Assesses what the appropriate standard of care should have been in cases of medical negligence

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.

Question 21

Look

Answer 21

It is not sufficient to raise a claim due to negligence alone, if the outcome would have been the same in any event (e.g. the administration of the wrong dose of a drug which fortunately has no ill effects).

ie if drug had been administered at correct dosage - no ill effects

administered at wrong dosage - no ill effects

Question 22

Examples of losses leading to compensation in a civil case?

Answer 22

Loss of earnings

Expenses incurred – may have to reequip house – disability friendly etc

Impaired enjoyment of life – difficult to prove

Permanent incapacity

Procreative incapacity

Pain and suffering endured

Death

Question 23

What happens when an aggrieved patient states his complaint to his solicitor?

Answer 23

If the solicitor believes the allegations to have substance, represents the complaint to the doctor (and co-defenders) in writing, demanding financial reward for damages.

The doctor immediately puts the affair in the hands of their legal representatives (Defence Organisation, Health Authority etc)

Question 24

What are the possible outcomes of a legal battle regarding a medical negligence claim?

Answer 24

It can be settled ‘out of court’ - both parties come to an agreement.

Proceed through the Civil Courts before a judge (sheriff court)

Question 25

What are some lines of defence in a medical negligence case?

Answer 25

Deny the charge

True facts but not the pursued doctor’s fault, or vicarious liability

Patient took a risk – consented procedure is important. If you explain fully the risk factors and patient understands them + gives consent then you can’t be held liable.

Contributory Negligence - claimant’s own negligence contributed to their loss or damage

Question 26

Define vicarious liability

Answer 26

Where a person can be heldliablefor the actions of another person (e.g. Health Board can be held responsible for the actions of the doctor)