Tissue damage is commonest cause of surgical negligence suits

BMJ 1999; 318 doi: (Published 13 March 1999) Cite this as: BMJ 1999;318:692
  1. Mark Pownall
  1. London

    Damage to underlying structures is the commonest complication for which patients successfully sue surgeons, a UK survey suggests. The survey, by the Medical Defence Union, found that damage to veins, nerves, and other underlying structures accounted for nearly one third of 115 successful claims, with infection accounting for another 12%.

    Retained items and failed or delayed diagnosis accounted for 8%and 7%respectively of successful medical negligence claims. The retained items–which included a pair of forceps after a panproctocolectomy and a surgical pack after a haemorrhoidectomy–occurred despite formal written procedures for swab and needle counts in operating theatres.

    Patients also sued success-fully after they were burnt by diathermy, after spirit based skin preparations ignited, and after adverse reactions to iodine.

    The Medical Defence Union, the largest professional indemnity organisation in the United Kingdom, reviewed the claims that it had settled since 1990 (Journal of the MDU 1999;15:13-5). Most of the surgery had been carried out in private practice (litigation within the NHS operates under a separate system).

    Helen Goodwin, clinical risk manager for the union, was particularly critical of two cases in which surgeons had failed to gain consent to a procedure before surgery, a situation which she described as a “fundamental departure from accepted norms.” She warned: “Specific consent must be obtained for all procedures.”

    The top award was for £550000 ($880000) and was allocated to relatives of a patient with a history of deep vein thrombosis and pulmonary embolism who died of an embolism four weeks after elective surgery for varicose veins. The patient had received no anticoagulant treatment until two weeks after surgery.

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