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Advice and support for you – all in one place

17 August 2020

The ever-changing nature of modern medical practice means no two days are the same.

Unfortunately, this also applies to medicolegal issues, which are unpredictable in nature and can result in anything from a claim or complaint to a Medical Council hearing or inquest.

Your membership with Medical Protection means you can call us 24 hours a day, 7 days a week for assistance. Our team of medicolegal consultants – qualified clinicians with legal training – and clinical negligence solicitors are on hand to support you through a wide range of scenarios. Our press office is also available to handle any media intrusion on your behalf.

What types of issues will Medical Protection assist with?

It is almost impossible to list everything we assist members with. However, the following short case studies are just a sample from the full range of advice calls and other matters that we have supported members with over the years.

Incorrect information on social media

Dr P was working as a GP in a new clinic. As part of the clinic’s advertising, the owner of the clinic set up a Facebook page which listed all of the doctors at the clinic and their specialties. The administrator at the clinic was in charge of keeping these details up to date. Dr P was not involved in this setting up of the Facebook page or indeed what details were listed on the page.

Three months into her new job, she was told by a colleague that her details were listed on the clinic’s Facebook page as being a ‘Specialist in Dermatology and Venereology’ and that she had experience in using various skin products on patients. This was inaccurate as Dr P was not qualified in dermatology, she only had experience in her previous clinic of various dermatological procedures, and she was concerned that the experience listed could be seen as promotional by the Medical Council.

Dr P therefore contacted Medical Protection for advice and was advised by one of the case managers, in conjunction with our lawyers, on the necessary steps she could take to ask for it to be removed. Dr P was also advised that the statement that she was experienced in using skin products could also be seen as promotional contrary to the Medical Council of Hong Kong Code of Professional Conduct, so advised that this should also be removed.

Dr P therefore contacted the owner of the clinic to ask for her title to be amended to ‘General Practitioner’ and that the statement on her experience be removed. The owner of the clinic complied with this request and asked that the administrator make the necessary amendments. The owner of the clinic was then more aware of the need to seek consent on the details listed on the Facebook page from the doctors involved.

Providing support during a regulatory investigation

Dr H was working as a GP in a clinic when he saw a patient who had suffered a fall and had hurt her knee. Dr H examined her knee, which he noted to be swollen, and ordered an x-ray to rule out dislocation or a fracture. When the x-ray came back as normal, Dr H prescribed the patient with various analgesics for the pain and arranged a follow-up for one week’s time.

The patient then stated that she required sick leave as she was meant to be working for the next few days. As Dr H agreed she would have difficulty in walking, Dr H issued a certificate for two days of sick leave. The patient then paid and left.

Unfortunately, after the patient had her two days’ sick leave, she then returned to her job as a waitress and suffered another fall as her knee was still painful. She had to undergo further treatment at a hospital for this problem.

The patient then complained to the Medical Council, alleging that Dr H should have provided her with more sick leave as she was on her feet all day as a waitress. She also alleged that she had to undergo extensive physiotherapy because of this incident, which would not have happened if  Dr H had initially given the appropriate length of sick leave.

Dr H then contacted Medical Protection after receiving a Preliminary Investigation Committee (PIC) Notice from the Medical Council and the case manager, alongside the instructed lawyer, assisted him in providing a detailed explanation of  the events that took place. After taking into account the submissions made, the Medical Council decided to dismiss the complaint at the first stage and issued Dr H with a letter of advice that he should take into consideration a patient’s occupation before deciding on the length of sick leave to prescribe. Dr H was very pleased with this and implemented changes to his practice to ensure all the correct steps were taken before issuing sick leave again.

Advice for a surgeon on a tricky mental capacity issue

Mrs G, an elderly patient with type 2 diabetes, respiratory disease and uncertain mental capacity, fell during the night in the care home where she lived. Her care home called an ambulance immediately as Mrs G was in a lot of pain and was distressed by the fall.

When Mrs G arrived at the hospital, she was assessed by the staff in the Emergency Unit and an X-ray revealed a fractured neck of femur. Dr L, an orthopaedic surgeon, examined her, and was of the opinion that Mrs G needed surgery.

Mrs G was distressed and confused, and Dr L believed that she possibly lacked capacity to consent to surgery. He attempted to contact her next of kin, but he was unable to do so as they were in Greece.

Dr L was not sure how to proceed, so he called Medical Protection.

The extent of Dr L’s enquiries depended on the urgency of the treatment. If the proposed treatment was non-urgent, Dr L should continue to attempt to contact Mrs G’s family and gather information from other sources (such as staff at the care home and the GP).

Dr L was reminded that it should not be assumed that the patient lacks capacity simply because she has a presumptive diagnosis of early dementia.

He was reminded that the doctor who ultimately delivers the treatment is the decision maker, and assessments of capacity and best interests had to be carefully documented in Mrs G’s records.

He therefore referred the case for a psychiatric assessment whereupon a Psychiatric registrar performed the 100 point Addenbrooke’s Cognitive Examination (ACE) Mini Mental assessment as well as a MoCA 30 point assessment which suggested that she was able to make an informed decision provided that she understood the ramifications of the procedure and rehabilitation.

Dr L then proceeded to take an fully informed consent from the patient including:

  • explaining the diagnosis and prognosis
  • addressing any uncertainties about the diagnosis or prognosis, including options for further investigations
  • discussing options for treating or managing the condition, including the option not to treat
  • pointing out the desired treatment and what it will involve
  • the potential benefits, risks and burdens, and the likelihood of success, for each option, including information, about whether the benefits or risks are affected by which organisation or doctor is chosen to provide care
  • clarifying who will be mainly responsible for and involved in their care, what their roles are her right to seek a second opinion
  • any bills they will have to pay.

Mrs G made an uncomplicated recovery and her mild confusion abated as her pain subsided. She was mobilised , discharged and went on to full rehabilitation.

Supporting a GP through a police investigation, complaint and inquest

Dr S, a GP, was asked to review a positive sputum culture result that seemed to indicate treatment with antibiotics was required.

The patient was Mr J, a 48-year-old non-smoker who rarely attended the clinic, but had been seen by a GP colleague (who was on leave when the sputum culture result was received) the previous week with a productive cough.

Dr S reviewed the records, which stated “defer antibiotic therapy until sputum culture results are available”, and decided to contact Mr J by telephone.

Mr J explained that whilst there had been some improvement in his symptoms, he continued to have a cough productive of green sputum. Dr S explained that the results of the sputum culture suggested that antibiotic treatment may help, and prescribed amoxicillin 500 mg, three times a day.

Unfortunately, the clinic computer system was unexpectedly down. Dr S wrote a handwritten prescription and made himself a note to record this (together with a note of his telephone conversation) on Mr J’s records when the system was back online.

Mr J’s wife collected the prescription from the clinic shortly after Dr S’s telephone call with Mr J.

Later that afternoon, the clinic computer system came back online, and Dr S realised that Mr J was allergic to penicillin. Dr S immediately called Mr J to prevent him from starting the antibiotics, but was informed by Mrs J that Mr J had taken his first dose of amoxicillin. It had prompted an anaphylactic reaction and an ambulance crew were in attendance.

Unfortunately, the resuscitation attempts were unsuccessful, and Mr J passed away.

Dr S was invited to a police interview under caution to investigate a potential criminal charge of medical manslaughter. Dr S immediately called Medical Protection and spoke to a medicolegal consultant (MLC).

A lawyer, experienced in the field and familiar with the vulnerabilities that doctors face, was instructed by Medical Protection to represent Dr S at the police interview. Dr S was naturally distressed at this development and was provided with details of the Medical Protection counselling service at the outset.

In advance of the police interview, the MLC and the lawyer had a conference with Dr S and prepared an anticipatory statement. At the conclusion of the police investigation, the matter was referred to the Department of Justice, but they decided not to pursue criminal charges.

The clinic undertook a Root Cause Analysis (RCA) and the MLC, together with the lawyer, assisted Dr S in providing a statement. The RCA did identify that Dr S erred in prescribing amoxicillin, but also identified some mitigating factors (including the fact that the clinic computer system went down), and made some recommendations to minimise the risk of a similar incident in the future.

The MLC advised Dr S to reflect on the incident and directed Dr S to educational resources (including those provided by Medical Protection) to assist with remediation.

The family then made a complaint to the clinic and the MLC assisted Dr S with the provision of the response.

Eighteen months after the incident, Dr S was called to give evidence at an inquest into the death of Mr J and Medical Protection instructed a barrister to individually represent Dr S. In order to prepare for the inquest, a conference with the barrister, the instructed lawyer and the MLC was arranged. In addition, the MLC involved the Medical Protection  press office to assist with any potential media attention – an anticipatory press statement was prepared in advance of the inquest.

Dr S came across well at the inquest and the coroner returned a narrative verdict referencing the fact that Mr J had died as a consequence of an anaphylactic reaction secondary to the administration of amoxicillin. The coroner indicated that whilst he had considered making recommendations to prevent further deaths, he had not chosen to do so on the basis of the remedial action taken by both the clinic and Dr S. The family were unhappy and asked the coroner to refer Dr S to the Medical Council – the coroner declined to do so, so the family referred Dr S themselves.

A few months later, the Medical Council opened an investigation into Dr S. Medical Protection, alongside the instructed lawyers, helped Dr S to prepare a letter, which included reference to Dr S’s insight and the steps that he had taken to remediate.

The Medical Council subsequently closed their investigation with no action (other than some advice relating to prescribing guidance), on the basis that this was an isolated incident for which Dr S had demonstrated insight and had taken appropriate steps to remediate at an early stage.

Support for your mental health and wellbeing

In addition to our expert medicolegal advice and support, Medical Protection provides access to a counselling service, which is provided at no extra charge as part of your membership. The service means we can support you with work-related stress, or stress that you feel could impact your practice.

The service is entirely independent and confidential. We’re here to support you beyond cases and claims, by not only protecting your career and reputation, but your wellbeing too.