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Advice and support for you – all in one place

25 August 2020

The ever-changing nature of modern medical practice means no two days are the same. Unfortunately, this also applies to medicolegal pitfalls and dilemmas, which are unpredictable in nature and can result in anything from a claim or complaint to a regulatory hearing or inquest.

Your membership with Medical Protection means you can call us 24 hours a day, 7 days a week for assistance. Our extensive team of medicolegal consultants – qualified clinicians with legal training – and clinical negligence attorneys 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 provide a complete picture of everything we assist members with. However, the following short case studies are just a small sample from the full range of advice calls and other matters that we have supported members with over the years.

Patient relationships on social media

Dr P was working as a junior doctor in general practice. Three months into her new post, she received a friend request on Facebook from a former patient, Mr T. She had got to know him whilst doing her psychiatry rotation, as he had been an inpatient for a brief period of time.

Mr T told her that he was doing really well and was off all his medication. He had also recently started an arts course at the local college. Dr P accepted his friend request. Initially she enjoyed reading Mr T’s posts, but gradually she noticed his comments were becoming more bizarre, culminating in the statement that he felt he was being followed by the CIA. She recognised this as being a symptom of his mental illness and sent him a personal message urging him to go and see his GP.

Mr T replied stating that he didn’t trust his GP. He asked to meet up with Dr P. She told him that she couldn’t do that and suggested she speak to his GP on his behalf. He became angry and upset. Dr P was concerned about Mr T, so she contacted his consultant psychiatrist who arranged to review him later that week. Mr T ‘de-friended’ Dr P on Facebook a few days later.

A month later Mr T complained to the senior partner at Dr P’s practice. He was unhappy that Dr P had declined to meet him as he had felt that they were friends. He was disappointed that she had contacted his psychiatrist, although he admitted that he was feeling a lot better and back on his medication. Dr P contacted Medical Protection for advice.

We advised that the senior partner and Dr P meet with Mr T to discuss his concerns. Dr P apologised to Mr T and stated that she should never have accepted his friend request. She told him that she had been concerned about him and had felt she had to contact his psychiatrist to try to access help for him.

Mr T accepted Dr P’s apology. He asked her to share the experience, anonymously, with her colleagues, so that they could all learn from this incident.

Providing support at an HPCSA hearing

Dr H visited his local pharmacy with a prescription he had written for himself, for a benzodiazepine – he had a fear of flying and was due to undertake a long-distance flight for a holiday. As this was not the first time that this had happened, the pharmacist was concerned that Dr H might be self-medicating for a more serious psychiatric condition, with potential implications for his ability to practise. Dr H was reported to the HPCSA, whose Health Committee resolved that an informal investigation be conducted into his behaviour to ascertain whether he was impaired. An independently appointed psychiatrist was appointed to assess him and report back to the committee. Dr H was invited to submit a report from his own practitioner as well.

The doctor contacted Medical Protection for assistance. Initially he was angry and embarrassed at this turn of events and felt that he was facing castigation for an innocuous incident. Medical Protection advised him to co-operate fully with the Committee. Dr H was very uncomfortable but was guided by Medical Protection to use the opportunity to show that he was not impaired and was able to continue in practice, while his patients were fully protected by ongoing monitoring through the submission of quarterly reports to the Committee.

While Medical Protection’s medicolegal consultant advised Dr H on the full range of options open to him, he opted for voluntary erasure, which was accepted by the HPCSA. Dr H was close to retirement and explained that he found voluntary erasure more appealing than undergoing what he would feel to be an ordeal .

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 surgery 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 to hand” 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 with claevulanic acid, three times a day.

Unfortunately, the practice 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 practice shortly after Dr S’s telephone call with Mr J.

Later that afternoon, the practice 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. It had prompted an anaphylactic reaction and an ambulance crew were already in attendance. Unfortunately, the resuscitation attempts were unsuccessful, and Mr J passed away.

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

The MLC and the attorney met with Dr S and prepared a statement. At the conclusion of the police investigation, the matter was referred to the National Prosecution Authority but they decided not to pursue criminal charges.

The doctor identified that he had erred in prescribing amoxicillin, but also identified some mitigating factors (including the fact that the practice computer system went down) and made some recommendations to minimise the risk of a similar incident in the future. The MLC directed Dr S to educational resources (including those provided by Medical Protection) to assist with remediation.

The incident was however reported to the HPCSA.

Eighteen months after the incident, Dr S was called to give evidence at the inquest into the death of Mr J. Medical Protection instructed senior Counsel to individually represent Dr S. In order to prepare for the inquest, a conference with the Counsel, the instructing attorney 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.

The inquest magistrate found no act of omission or commission which had led to the death of the deceased. Mr J had died as a consequence of an anaphylactic reaction secondary to the administration of amoxicillin. The magistrate d made no further recommendations to prevent further deaths on the basis of the remedial action taken by both the practice and Dr S.

The family were unhappy and complained to the HPCSA.

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

The HPCSA 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.