Medical Protection supports a private surgeon when his handover is criticised

Introduction

Mr B, a consultant orthopaedic surgeon, contacted Medical Protection for advice, following a delay in recognising the severity of the condition of a patient.

He had performed a hip replacement on a 73-year-old private patient with multiple co-morbidities, including Type 2 diabetes mellitus, hypertension, recurrent cellulitis, and obesity. The patient developed a wound infection post-operatively and deteriorated over the course of a weekend. She was transferred to an NHS Intensive Care Unit, where she died as a result of multiorgan failure, secondary to sepsis.

Mr B had been informed that the coroner had asked for a statement, and that the private hospital would not be providing him with legal representation for the purposes of the inquest. The patient’s family had also raised a number of concerns, including the fact the patient’s past medical history had not given due consideration in the peri-operative period, and that there was a lack of senior input over the weekend.

Expert opinion

A medicolegal consultant (MLC) reviewed Mr B’s draft statement and advised that Mr B should provide further information regarding the choice of prophylactic antibiotics and the handover given to the weekend team.

She asked Mr B about the usual arrangements for weekend review of patients in the hospital. Mr B explained that he would usually have reviewed this patient himself over the weekend. However, he had become unwell with COVID-19 on the Friday evening, and had therefore asked the ward team to see her and let him know of any concerns. Once he was made aware of the patient’s condition, he contacted senior colleagues who stepped in to assist. However, all this took some time.

Mr B was made an ‘Interested Person’ by the coroner, and the MLC instructed a solicitor to represent him. It was anticipated that there may be some criticism of Mr B due to the lack of formal arrangements for cover, and Mr B was advised to work with the hospital to address this issue ahead of the inquest. He was also advised to reflect on the importance of a comprehensive handover, especially when a new team are to be involved in care.

Outcome

The family was legally represented, so Mr B faced some difficult questions on the day. The coroner ultimately issued a ‘Prevention of Future Deaths’ report, and Mr B was advised to self-refer to the GMC in accordance with paragraph 75 of Good Medical Practice.

His Medical Protection team assisted in drafting the self-referral document, and advised him on seeking out the appropriate CPD and taking time for some reflection. Mr B’s earlier efforts in liaising with the Trust paid off, and the GMC closed the matter without a formal investigation.

Learning points

• Criticism at an inquest can often mean a self-referral to the GMC is required. An employer will not provide assistance to an employee in relation to a GMC self-referral or investigation. Medical Protection, however, will assist, and has significant expertise in the management of such cases.
• Inadequate handovers and staffing issues can compromise patient care, leading to adverse events and an increased risk of claims or complaints, as this case demonstrates. A structured and comprehensive handover is important for patient safety. You may already be familiar with the ISBAR3 model (Identify, Situation, Background, Assessment, Recommendation, Risk, and Read-back), which is widely used in clinical settings. You can read more about this framework here.
• Medical Protection runs virtual workshops on reducing medicolegal risk through clear communication and better management of patient expectations. They are included in membership and can be found here.