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A phrase used by many junior doctors everyday to put their patients
at
ease. But what’s in a prick? We do it to patients and occasionally to
ourselves in what is commonly termed “a needle stick injury”. A hazard
of being a doctor especially surgeons who use needle of all sorts in
their trade. Soldiers have guns and occasionally one will accidentally
shoot themselves in the foot. Whose fault is it? Is it a risk they
accept when they join the army?
Two cases have come to prominence of late, namely those of Dr Celia
Battley and Jane Robinson; a nurse who took blood from HIV infected
patients and accidentally stabbed herself with grave consequences. Her
case is tragic and the issues involved are different from those raised
by Dr Battley’s case. To quote her father “It was a job for doctors and
senior staff but somehow she was asked to do it and did it. She was like
that”. In so far as his statement is accurate I would perhaps qualify it
by saying it was a job for experienced doctors and experienced
laboratory staff. She presumably wished to learn how to take blood, in
so doing she was accepting an element of risk but that risk had to be
reduced to a minimum. Learning on HIV patients was poor risk management.
Junior doctors are generally not formally trained in phlebotomy and tend
to learn on the job. Similarly, a junior doctor should not be expected
to take blood from highly infectious patients, but this is expected of
them. Not by the public, as demonstrated by Jane Robinson’s father’s
sentiments, but by their senior colleagues most of who can not recall
the last time they provided a phlebotomy service. The fear from most
junior doctors is not of needlestick injuries but of obtaining a poor
reference at the end of the post. Such sacrifices are considered a rite
of passage in medicine. The tragedy is they will cost health care
workers their lives and the NHS a lot of money.
Dr Battley’s case is not comparable. She was performing a job, which
most judges would expect her to have been qualified to do, when she
suffered a needlestick injury. She came to no physical harm but claims
to have suffered psychologically. She allegedly developed a needle
phobia and as a result is unable to continue work as a doctor and cannot
even leave her own house. A phobia is defined as an abnormal or morbid,
often irrational fear or aversion. The link between needle phobia and
agoraphobia is not immediately obvious from the information we are privy
to. It is not inconceivable for a doctor with a needle phobia to
continue practising. There are many branches of medicine where needles
are not in regular use and therefore where it could have been possible
to compensate for her psychological deficiency. Treatment is also
possible. However, it is clear that Dr Battley has multiple phobias the
main one of which presently restricts her from being employed in any
field including those outside medicine. She has developed
psychological/psychiatric illness, the origin of which is difficult to
trace to a needlestick injury.
The role of the British Medical Association in Dr Battley’s case may
appear suprising to some, but as a trade union they have to protect
there members’ employment conditions, including safety at work. The
question therefore is whether the employing Trust failed to provide a
safe working environment. If the answer is yes, they should not have
even considered paying. If the answer is no they are liable. The next
question should then be whether in this unsafe environment an ordinary
doctor would have behaved similarly. In legal terms the answer is
unknown because the matter has never been argued before a judge. The
Health and Safety Act provides an answer to the former question but
common law will be relied upon to answer the latter.
Commentators, health service employees and the general public have
debated the precedent that this case establishes. The settlement was
made without arguing the issues before a court and does not therefore
constitute a legal precedent and has no authority. It can only be cited
in a similar test case as being persuasive. How persuasive depends on
the arguments made to justify the settlement and their relevance to the
future case in question. Such arguments are likely to carry very little
weight. Until such time as a court decides a similar case, NHS trusts
can sleep easily as long as they comply with the 1974 Health and Safety
act and aim to improve health and safety at work.
My feeling, in common with that of many doctors, is that the award
was
unfortunate and a matter of poor judgement. It does not set a precedent
and judging from the universal repulsion of the profession and the
public is unlikely to be repeated, at least without reference to a
court.
JUST A LITTLE PRICK WITH A NEEDLE?
A phrase used by many junior doctors everyday to put their patients
at
ease. But what’s in a prick? We do it to patients and occasionally to
ourselves in what is commonly termed “a needle stick injury”. A hazard
of being a doctor especially surgeons who use needle of all sorts in
their trade. Soldiers have guns and occasionally one will accidentally
shoot themselves in the foot. Whose fault is it? Is it a risk they
accept when they join the army?
Two cases have come to prominence of late, namely those of Dr Celia
Battley and Jane Robinson; a nurse who took blood from HIV infected
patients and accidentally stabbed herself with grave consequences. Her
case is tragic and the issues involved are different from those raised
by Dr Battley’s case. To quote her father “It was a job for doctors and
senior staff but somehow she was asked to do it and did it. She was like
that”. In so far as his statement is accurate I would perhaps qualify it
by saying it was a job for experienced doctors and experienced
laboratory staff. She presumably wished to learn how to take blood, in
so doing she was accepting an element of risk but that risk had to be
reduced to a minimum. Learning on HIV patients was poor risk management.
Junior doctors are generally not formally trained in phlebotomy and tend
to learn on the job. Similarly, a junior doctor should not be expected
to take blood from highly infectious patients, but this is expected of
them. Not by the public, as demonstrated by Jane Robinson’s father’s
sentiments, but by their senior colleagues most of who can not recall
the last time they provided a phlebotomy service. The fear from most
junior doctors is not of needlestick injuries but of obtaining a poor
reference at the end of the post. Such sacrifices are considered a rite
of passage in medicine. The tragedy is they will cost health care
workers their lives and the NHS a lot of money.
Dr Battley’s case is not comparable. She was performing a job, which
most judges would expect her to have been qualified to do, when she
suffered a needlestick injury. She came to no physical harm but claims
to have suffered psychologically. She allegedly developed a needle
phobia and as a result is unable to continue work as a doctor and cannot
even leave her own house. A phobia is defined as an abnormal or morbid,
often irrational fear or aversion. The link between needle phobia and
agoraphobia is not immediately obvious from the information we are privy
to. It is not inconceivable for a doctor with a needle phobia to
continue practising. There are many branches of medicine where needles
are not in regular use and therefore where it could have been possible
to compensate for her psychological deficiency. Treatment is also
possible. However, it is clear that Dr Battley has multiple phobias the
main one of which presently restricts her from being employed in any
field including those outside medicine. She has developed
psychological/psychiatric illness, the origin of which is difficult to
trace to a needlestick injury.
The role of the British Medical Association in Dr Battley’s case may
appear suprising to some, but as a trade union they have to protect
there members’ employment conditions, including safety at work. The
question therefore is whether the employing Trust failed to provide a
safe working environment. If the answer is yes, they should not have
even considered paying. If the answer is no they are liable. The next
question should then be whether in this unsafe environment an ordinary
doctor would have behaved similarly. In legal terms the answer is
unknown because the matter has never been argued before a judge. The
Health and Safety Act provides an answer to the former question but
common law will be relied upon to answer the latter.
Commentators, health service employees and the general public have
debated the precedent that this case establishes. The settlement was
made without arguing the issues before a court and does not therefore
constitute a legal precedent and has no authority. It can only be cited
in a similar test case as being persuasive. How persuasive depends on
the arguments made to justify the settlement and their relevance to the
future case in question. Such arguments are likely to carry very little
weight. Until such time as a court decides a similar case, NHS trusts
can sleep easily as long as they comply with the 1974 Health and Safety
act and aim to improve health and safety at work.
My feeling, in common with that of many doctors, is that the award
was
unfortunate and a matter of poor judgement. It does not set a precedent
and judging from the universal repulsion of the profession and the
public is unlikely to be repeated, at least without reference to a
court.
Competing interests: No competing interests