Trust pays over £30m to 7 year old boy who was severely brain damaged at birth
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2927 (Published 21 July 2020) Cite this as: BMJ 2020;370:m2927
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Dear Editor
A maternity delivery unit is a very small part of a hospital's footprint. Ill managed events in this domain represent a vastly disproportionate amount of NHS monies paid in compensation. In addition, a maternity delivery unit is dealing with the birth of babies - something that is held dear to our psyche. It has never ceased to amaze me there is no constant presence of a senior obstetrician and midwife on delivery suites. Their role being to supervise and oversee events and undertake the difficult procedures – and nothing else. After all, no Airbus 380 would ever leave the ground without an experienced captain on board – usually with a minimum of 3000 flying hours under their belt.
Litigation related to poor obstetric outcomes currently costs £13m per week (1) There are approximately 200 maternity units in the UK, so each unit is in effect paying £65K per week on obstetric litigation. Were but a small portion of that money used to pay for ensuring a constant level of experienced supervision, it would seem likely the reduced litigation costs would more than pay for the increased cost from paying for the extra staffing.
There have been all sorts of initiatives to help reduce damaged babies – and the resultant costs. None seem to have worked. I wonder were Her Majesty’s Treasury to look into the matter, this might well deem extra expenditure is cost saving in the longer run. And reduce the tragedy of babies being needlessly damaged.
References:
1 BMJ 2020;368:m552
Competing interests: No competing interests
Dear Editor,
The ongoing conversation around medical tort law and if it is a sustainable and useful method for both compensating the patient and ensuring the highest quality of care is an immense yet delicate one.
The acknowledgement of wrongdoing and demonstration of measures taken to ensure the same event does not happen again is undoubtedly a key part in the process and has been shown to be of high satisfaction for patients and also to lower the number of lawsuits filed (1). In many cases, however, this is not enough and the monetary value of compensation must be assessed and awarded due to lifestyle difficulties caused by the wrongdoing.
One of the current issues with this is that there are many other, not immediately apparent, costs that the litigation culture of the U.S and increasingly so of the U.K indirectly causes to increase. U.S evidence shows that due to the “fear” of litigation many doctors admit to carrying out further tests or screening that have little to no added value to the patient, for fear of being sued (2). This is often referred to as defensive medicine. Defensive medicine thus causes the knock-on effect of increased waiting times for all patients requiring those services and in the case of the NHS, increased costs. A comparable example of this can be seen in the motor insurance industry, where due to an increase in compensation claims, the price for everyone had to increase.
Defensive medicine practices can also make healthcare professionals warier of doing typically riskier procedures, again, for fear of legal action (3). It is clear then that some aspects of the current legal system do not fully promote the highest standard of medical care.
NHS Wales' “Put Things Right” scheme which deals with complaints and can assess the severity of them has some positive ideas. It both analyses what went wrong and looks into how it can be fixed; but maybe most importantly, keeps in contact with the patient. By keeping the dialogue open with the patient in this way it can help prevent some of the anxiety and stress caused by the long wait times between an event and its eventual settlement/admission of wrongdoing (one of the largest downsides to the current system) for both patient and healthcare practitioner. In doing so it may be able to help reduce the negative impact of defensive medicine whilst still enabling patients the ability to complain, and where appropriate, receive compensation.
It is in striking the balance between having an open dialogue and still having the option of monetary compensation that we will hopefully see a system that is best for both the patient and the healthcare professional.
1. Ackerman B, You Had Me as “I’m Sorry”: The Impact of Physicians’ Apologies on Medical Malpractice Litigation, 2018 Nov, The National Law Review, Vol. VIII, No. 310
2. Reisch LM, Carney PA, Oster NV, Weaver DL, Nelson HD, Frederick PD, Elmore JG. Medical malpractice concerns and defensive medicine: a nationwide survey of breast pathologists. American journal of clinical pathology. 2015 Dec 1;144(6):916-22.
3. Tancredi LR, Barondess JA. The problem of defensive medicine. Science. 1978 May 26;200(4344):879-82.
Competing interests: No competing interests
Re: Trust pays over £30m to 7 year old boy who was severely brain damaged at birth. Response to Mr Dickson and Mr Perry
Dear Editor
Before we jump to new “solutions”, we ought to see why we have progressively landed in this ever deepening hole.
Presumably the perinatal damage to the mother and child is assessed by two Royal Colleges? Or, three Royal Colleges - including the Royal College of Anaesthetists?
Do we still have a Regional Assessor in Obstetrics, looking at Maternal Deaths (Confidential Inquiry it was)? In the dead past, there used to be a Principal Medical Officer (at the Department of Health) who would look at every report complied by the Regional Assessor.
The Medical Officer of Health (pre-1974) and the District Community Physician (until 1982) would poke his nose into every case and record the clinical events relating to the general practice and district midwifery care plus any gaps. He did read all the reports written by everyone in the district.
We should be told how the inquiries are conducted, completed and recorded these days.
There ought to be similar inquiries in every paediatric untoward event.
We the public need to know.
Competing interests: No competing interests