An alternative to the clinical negligence system
BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39050.696192.94 (Published 22 February 2007) Cite this as: BMJ 2007;334:400
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I have followed the progress of the NHS Redress Act and most recently
the comments by Richard Furniss and Sarah Ormond-Walshe (An alternative to
the clinical negligence system BMJ 2007;334;400-402) including their
predictions of the likely outcome. The act is a courageous and proper
response to the medical malpractice problem and is something that the
citizens of the UK should be proud of. I know from my own experience how
this process works and what to expect. In 1987, I helped start and manage
a program in a US hospital that used early disclosure and compensation
(but, unlike the NHS Redress Act, without any compensation ceiling). That
program is now in its 20th consecutive year of operation and its record
has been made public(1).
The disclosure of error and offer of compensation is not a risk
management scheme intended to benefit the institution. It is a common
sense method to help redress the damage done to a patient who has been
harmed by a medical error or negligence. Any benefit to the institution
derives from that. If such a course is pursued competently and
confidently, the NHS Redress Act probably will result in more paid claims
than is now the case. However, the diminished anger resulting from the
proper treatment of injured patients should mitigate monetary demands
aimed mainly at punishing the NHS. This, and the decline in litigation and
its costs, should result in lower total liability expenses at the same
time that it benefits deserving patients. It is true that some persons
with undeserving claims may attempt to profit from the scheme. This can be
prevented by performing complete investigations (to defend the NHS in the
event of litigation) and steadfastly declining to compensate such
plaintiffs. With time, this will discourage undeserved claims.
1) S.S. Kraman and G. Hamm, “Risk Management: Extreme Honesty May Be
the Best Policy,” Annals of Internal Medicine 131, no. 12 (1999): 963–967.
Competing interests:
None declared
Competing interests: No competing interests
In response to the author's analysis of the NHS Redress act 2003, I
certainly agree that the current system of patient complaint procedure is
blatantly complicated and slow, leaving patient discontended and staff
dissatisfied and longer the claim takes to conclude, the rising costs on
patients behalf could lead to a distasteful patient for future
appointments or treatments. -I feel that the upward rise in the
compensation bill for the NHS is probably the impetus for enaction of the
redress act which is evident from the figures of the national audit office
however, the scheme may open doors to exploitation of the system, seeing
increasing number of minor claims against clinicians and hospital staff
with a pure intention to get a hand to some compensation, promoting
further blame culture and crippling the already burdened financial crisis
in the NHS. - On the other hand this act will encourage the healthy
process of apology and explanation as argued by LLoyd-Bostock and Mulcahy
that complaints in hospital services are different from claims and tend to
be 'non-instrumental'with an aim to acieve a 'social outcome'eg. an
apology rather than material outcome. If the savings are evident by the
new proposals, funding could be diverted to implementing and strenghening
quality governance to improve patient quality of care.
References
Lloyd-Bostock S. & Mulcahy L. (1996) Social psychology of making and
responding to hospital complaints. An account model of complaint
processes. In: D. Galligan (Ed.) A Reader on Administrative Law, pp.
438–465. Oxford University Press, Oxford
Competing interests:
None declared
Competing interests: No competing interests
Medical Negligence in Trinidad and Tobago
In Trinidad and Tobago it is very hard to bring a case of medical negligence since doctors are usually unwilling to provide expert testimony against a fellow practitioner.It is scary since it could leave open a system not accountable to the courts
Competing interests: No competing interests