Medical error - failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim

Negligence

• Doctor-patient relationship = duty of care
• Doctor has to deviate from the duty of reasonable care
• Harm or damage must have occurred
• Causal link must be demonstrated between the deviation from the duty of care and the injury

Bolam

• Case where ECT given without anaesthetic or muscle relaxant - serious fractures
• Common practice to give ECT in this way
• "Not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art"

Bolitho

• Two year suffered brain damage and cardiac arrest
• Doctor sued for failure to intubate
• Five expert witnesses would not have intubated vs one that would
• Court could reject expert opinion where it was "logically indefensible"

Barnett vs Chelsea and Kensington Hospital

• Three men feeling unwell were sent away unseen because doctor was unwell
• Advised to see own doctors
• One of three died - arsenic poisoning
• Court held that there was negligence but there was no evidence that this caused the death

Duty of Candour

• Health and social care act 2008
• "Notifiable safety incident" duty to:
  • Notify the patient face to face
  • Provide reasonable support
  • Provide a full account of all known facts
  • Advise what inquiries will be undertaken
  • Include an apology
    
  • Record above in writing
• Criminal offence to not do this
• "Any unintended or unexpected incident that occurred in respect of a service user during the provision of a regulated activity that appears to have resulted in":
  • Death
  • Sensory/motor/intellectual impairment
  • Change to body structure
  • Prolonged pain or psychological harm
  • Shortened life expectancy
  • Requires treatment to prevent above
• GMC: Must inform, apologise, remedy and fully explain

Dealing with errors

• Acknowledgement of distress
• Apology/statement of regret
• Information
• Continuing commitment
• Not defensive/avoidant/very formal/unhelpful letter
• Face to face

How to apologise

• Acknowledge harm
• Explain what happened
• Show remorse
• Reparation (make amends and commit not to repeat)