What should the consequences be to a GP practice

[SexyGreyFox]

Does it get taken into account at all?

Not that I've seen in 10 years because you have to treat people like idiots.
In the case of the wrong prescription you can't expect the patient to notice they are taking a higher dose than what was prescribed.

The number of times I've seen a gallbladder nicked during a cholecystectomy.... it's just then washed out and everything continues as normal.

If the surgeon made a true mistake, that cost someone their life, the GMC would be all over them and a public inquest would have been held. All GMC investigations are publicly accessible.

The trust accepted responsibility and he is still working, which suggests that it wasn't a case of lying and covering something up. My guess it just wasn't policy to document everything, such as what happened in this case. If you've ever read a surgeon's notes - they really don't comment on the small things at all.

100%, so the only explanation is that the newspaper story isn't revealing all the facts and sensationalising it.
I can't count how many cases I see ending up in the papers that I've worked on and I'm shouting at my screen "You've left a bit out there".
People like to go to the papers but always leave bits out that are very important then what follows are people only commenting on what they have read.
It is clear to me in the above case that if the Clinician is still employed it was a mistake that they didn't think would be harmful and during an investigation all came clear.
I'll also say that it takes a lot to get somebody struck off and I've only known 3 in 10 years but because they have ended up with a God complex.
All other cases are accidents/mistakes but one thing I've learned in 10 years is that Clinicians don't stick up for each other, if they know there has been a Breach of Duty they will point fingers.

 

[Dis86]

One case where we don't fully know all the details doesn't quite equate to us medical professionals going around killing everyone.

What do you do, out of curiosity?

I never stated it did equate to that hyperbole there. I stated that punishment seems to be unlikely however as this individual certainly doesn't seem to have been too adversely impacted.
As you say though, it's one case. Trawling through Google and news stories throws up others.
I know of one by personal experience (Think I've mentioned it to you previously) whereby a GP prescribed medication to my step father for a new condition that when combined with his existing medication for high blood pressure can result in uncontrolled internal bleeding. Thankfully it was spotted by the pharmacist. Said GP was, in the words of the practice manager, subject to a stern word.

I was previously an engineer designing subsea electro-hydraulic systems. Basically oil wellheads and such. I'm now the principal engineer of a large marine engineering, supply and fabrication site.

 

[Dis86]

Was it an inexperienced junior doctor, being based at the oxford teaching hospital, who was unaware of the correct procedure and consequences of an incident of this type?


Didn't you know Dis was an actor? He plays that dwarf fella on GoT

Ah, ole tripod himself?

 

[Dis86]

It is clear to me in the above case that if the Clinician is still employed it was a mistake that they didn't think would be harmful and during an investigation all came clear.
I'll also say that it takes a lot to get somebody struck off and I've only known 3 in 10 years but because they have ended up with a God complex.

That seems a bit contradictory there!

It's worth noting that even the NHS accepts estimates up to 8% of deaths in their care are a result of negligence (may be as low as about 2.5% though).

https://www.nhs.uk/news/medical-practice/one-in-20-hospital-deaths-preventable/

So seems to me you should be seeing a lot more people struck off than you clearly are based on these numbers. That is unless there's a significant level of leniency.

Also they speak out? How's Gosport these days?

 

[NVP]

Ah, ole tripod himself?

Oh him? I thought you played Frances

 

[Dis86]

Oh him? I thought you played Frances

Wrong dwarf.

 

[SexyGreyFox]

That seems a bit contradictory there!

It's worth noting that even the NHS accepts estimates up to 8% of deaths in their care are a result of negligence (may be as low as about 2.5% though).

https://www.nhs.uk/news/medical-practice/one-in-20-hospital-deaths-preventable/

So seems to me you should be seeing a lot more people struck off than you clearly are based on these numbers. That is unless there's a significant level of leniency.

I would have thought it was more then 8% but hey ho.
Just remember that no Clinician is harming a patient on purpose so you could say there is a lot of leniency and after Inquests, Complaints, Negligence etc they will be spoken to and in a lot of cases new protocols will be passed on to other clinicians if it's their discipline.
I don't know of one case where negligence has been proven/admitted on an individual case in a death and a Clinician has been sacked, it does take multiple errors.

I've had my own 'negligent' experience this last two weeks.
My 84 year old Mum was rushed in on Nov 30th with respiratory & heart failure + pneumonia and I thought she would be dead within a couple of days
She has a prescription of 3 litres of oxygen 24/7 but we noticed she was on 1 litre in the hospital. We asked the questions but told it was normal to wean them off but was concerned that she may be OK on 1 litre when lying down but if she goes to the toilet she may need 3 litres but I was told it doesn't work like that.
She became very ill and started hallucinating then on Friday (nearly two weeks later) the Clinicians apologised and said she should never have been taken of 3 litres so basically admitting that they had made her worse. What I did find strange is that it is a respiratory ward so they should know about a patients prescriptions for oxygen!!!

 

[Dis86]

I would have thought it was more then 8% but hey ho.
Just remember that no Clinician is harming a patient on purpose so you could say there is a lot of leniency and after Inquests, Complaints, Negligence etc they will be spoken to and in a lot of cases new protocols will be passed on to other clinicians if it's their discipline.
I don't know of one case where negligence has been proven/admitted on an individual case in a death and a Clinician has been sacked, it does take multiple errors.

I've had my own 'negligent' experience this last two weeks.
My 84 year old Mum was rushed in on Nov 30th with respiratory & heart failure + pneumonia and I thought she would be dead within a couple of days
She has a prescription of 3 litres of oxygen 24/7 but we noticed she was on 1 litre in the hospital. We asked the questions but told it was normal to wean them off but was concerned that she may be OK on 1 litre when lying down but if she goes to the toilet she may need 3 litres but I was told it doesn't work like that.
She became very ill and started hallucinating then on Friday (nearly two weeks later) the Clinicians apologised and said she should never have been taken of 3 litres so basically admitting that they had made her worse. What I did find strange is that it is a respiratory ward so they should know about a patients prescriptions for oxygen!!!

Yeah you would think they'd have a bit of a clue! Especially given her age and the fact that she's evidently unwell that could have been so much worse. What you're saying is supporting my point however. What other career could you have where you take someone's life, whether through negligence or otherwise, and not end up facing prosecution and certainly the sack?
Like I've said I certainly would. I know individuals who have for inadvertent health and safety breaches.

 

[SexyGreyFox]

Yeah you would think they'd have a bit of a clue! Especially given her age and the fact that she's evidently unwell that could have been so much worse. What you're saying is supporting my point however. What other career could you have where you take someone's life, whether through negligence or otherwise, and not end up facing prosecution and certainly the sack?
Like I've said I certainly would. I know individuals who have for inadvertent health and safety breaches.

You are correct, it takes a lot to sack a Clinician but you have to take intent into it and there is never any intent, only mistakes that the Coroner will have a lot to say about.
Of course if the Coroner says that we made mistakes the family makes the choice to visit a Solicitor which means I move it from the Inquest folder into my CN folder.
Most families just want answers.

The only other profession I know where somebody can be completely crap at their job and then walk into another job are Football Managers.

 

[Dis86]

You are correct, it takes a lot to sack a Clinician but you have to take intent into it and there is never any intent, only mistakes that the Coroner will have a lot to say about.
Of course if the Coroner says that we made mistakes the family makes the choice to visit a Solicitor which means I move it from the Inquest folder into my CN folder.
Most families just want answers.

The only other profession I know where somebody can be completely crap at their job and then walk into another job are Football Managers.

Shouldn't laugh but it's true. I think it's fundamentally wrong. Without accountability there can be no improvement. It's also morally wrong.

 

[Minstadave]

Shouldn't laugh but it's true. I think it's fundamentally wrong. Without accountability there can be no improvement. It's also morally wrong.

If you think there's no accountability in medicine you're very wide of the mark. The NHS barely functions due to the vast amount of time spent on adverse event reporting, root cause analysis, action plans, duty of candour, supervision, reflection etc.

What we are trying to achieve is an awareness that rarely an individual fails in isolation, there is no point in pinning every mistake on an individual, we all function of part of a system.

 

[Dis86]

If you think there's no accountability in medicine you're very wide of the mark. The NHS barely functions due to the vast amount of time spent on adverse event reporting, root cause analysis, action plans, duty of candour, supervision, reflection etc.

What we are trying to achieve is an awareness that rarely an individual fails in isolation, there is no point in pinning every mistake on an individual, we all function of part of a system.

See I disagree with that. Individuals fail. If you remove that as a fact you remove individual accountability. That means people will get lazy or take unnecessary risks. The case we've discussed would seem to demonstrate that.

 

[SexyGreyFox]

Shouldn't laugh but it's true. I think it's fundamentally wrong. Without accountability there can be no improvement. It's also morally wrong.

If every Clinician got sacked or suspended for making one-off negligent mistakes we would be in a right mess.
I've just done a quick add up and at our Trust we could have 35 Clinicians sacked a year if made 'accountable' but you've got to also take into account the amount of lives they save and there wasn't intent to kill or maim.
Honestly, there have been cases where they have saved lives but the patient has put a claim in because they gave them a 1" scar or similar.

and what Minstadave says in post #51, our system is called DATIX and all the stuff he mentions has to be done.

See I disagree with that. Individuals fail. If you remove that as a fact you remove individual accountability. That means people will get lazy or take unnecessary risks. The case we've discussed would seem to demonstrate that.

Individuals fail but would you want to sack a Clinician who has saved 100s, maybe 1000s of lives?

 

[Dis86]

If every Clinician got sacked or suspended for making one-off negligent mistakes we would be in a right mess.
I've just done a quick add up and at our Trust we could have 35 Clinicians sacked a year if made 'accountable' but you've got to also take into account the amount of lives they save and there wasn't intent to kill or maim.
Honestly, there have been cases where they have saved lives but the patient has put a claim in because they gave them a 1" scar or similar.

and what Minstadave says in post #51, our system is called DATIX and all the stuff he mentions has to be done.

How many lives do police officers and fire fighters save? Should we spare them prosecution if through negligence or incompetence they kill people? Just recently we've seen officers prosecuted because a man died during restraint. We've got a situation where medical professionals are not treat the same as the rest of society. All should be equal.

 

[Minusorange]

but I'm a doctor and I wouldn't know a small knick to the stomach would compromise the other organs.

I guess this is why medical threads are forbidden

 

[NVP]

@Dis86

You already understand that most professionals who provide services for the public are subject to controls and processes with which order and safety are attempted.

Police have strict guidelines, just as medical professionals do, however the volume of procedures and tasks multiplied by the amount of differing job roles which cross multiple departments and systems within our NHS means much more work is required to implement, maintain and most importantly improve.

The Police inquests are notoriously one sided and it takes a hell of a lot for an officer to be struck off - they pretty much have to be a criminal.

The NHS is still learning and implementing controls, but when incidents happen they are analysed and more controls added to prevent them in the future. It takes something akin to the criminal behaviour mentioned above for severe punishment.



First hand experience was the issues we had when my first was born 3 months early and spent 2 months in NICU:
In NICU the nurses & care workers were very hit and miss. One almost killed my son by force (syringe) feeding him 50+ml when he was on less than 10ml, luckily my wife was there to tell the idiot to stop when she went for the next syringe load. Another really old one who should have retired 20 years ago forgot to feed my son twice on the same day, saying she already did when we had been by his side all day (we had to make her get the food each time, even though she contested that she had already). I saw the life drain from my son's eyes when he had his first cannula removed with it being too much for his ~2lb little body and the doctor didn't hit the crash alarm (as is procedure) and resuscitated him himself, saved his life but didn't follow procedure and didn't tell a soul [that moment is forever burned into my brain]. Many more things happened like finding mittens celotaped to his hands, nurses joking in front of parents about how "this one dies on me all the time", head being banged on the incubator by a nurse, and a few other things.

My wife lodged formal complaints and we were contacted and informed of all new procedures put into place and of the actions taken against those accused. I felt this was all investigated correctly and the controls implemented made sense, responsibilities were taken from care workers... but the old forgetful bint who didn't feed my son (so god knows who ever else wasnt fed, as we were the only parents constantly by our babys side) kept her job, although was now supervised.


NHS knows it's got problems and is still learning to fix them, getting rid of people isn't really the answer unless they have repeatedly proven incompetence and inability to improve, or they have been criminally negligent or simply criminal.

 

[Minstadave]

I guess this is why medical threads are forbidden

To pretend to know everything is very dangerous.

This case isn't run of the mill. Gastric candida isn't common at all and a small knick to the stomach or even the bowel is normally sorted with a washout and a few sutures or a patch.

Organs will be prepared to reduce the risk of infection but again candida is an uncommon and hard to treat infection that may not be covered as part of that process.

 

[SexyGreyFox]

The Police inquests are notoriously one sided and it takes a hell of a lot for an officer to be struck off - they pretty much have to be a criminal

Also the same for Medical Professionals, I've only known 3 in 10 years and they fit the criteria with multiple cases and all appeared on the National News.
Also importantly none of these caused deaths.

 

[alx]

Shouldn't laugh but it's true. I think it's fundamentally wrong. Without accountability there can be no improvement. It's also morally wrong.

You should read Black Box Thinking by Matthew Syed, has interesting comparisons between how the airline industry and medical professions learm from their mistakes. Good read.

 

[Orionaut]

How many lives do police officers and fire fighters save? Should we spare them prosecution if through negligence or incompetence they kill people? Just recently we've seen officers prosecuted because a man died during restraint. We've got a situation where medical professionals are not treat the same as the rest of society. All should be equal.

Be careful what you wish for.

Make the terms of service too onerous and people will stop wanting to do the job altogether (Or will be only willing to do it for considerably greater wages)

The reason why US health care costs several times as much as the UK's isn't because US medicine is technically superior. It is because wages are a lot higher across the board and part of the reasons for that are because they have to cover the costs of medical negligence insurance.

For example, See https://fitsmallbusiness.com/medical-malpractice-insurance/ (Not a particularly definitive link, just one that popped up with a quick google) In particular scroll down and check out the annual premium range for OB-GYN and General Surgery in New York!

Pretty sure I recall reading somewhere a couple of years ago about a growing problem in some parts where some Hospitals will simply refuse to deal with OB-GYN at all!