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Medico Legal

Misdiagnosis leads to most medical claims, US study finds

Logo for John Hopkins Medical School for your Expert Witness storyResearchers studying 25 years of medical malpractice claims in the US found that diagnostic errors accounted for the largest number of claims. Diagnostic errors also caused the most severe patient harm and attracted the highest compensation payments –amounted to $38.8bn between 1986 and 2010. The research was carried out by a team from the Johns Hopkins University School of Medicine in Baltimore, Maryland, and was published online by the journal BMJ Quality and Safety.

The leader of the research, Prof David E Newman-Toker MD PhD, said: "This is more evidence that diagnostic errors could easily be the biggest patient safety and medical malpractice problem in the United States. There's a lot more harm associated with diagnostic errors than we imagined."

While the new study looked only at a subset of claims – those that resulted in a compensation payout for malpractice – the researchers estimated the number of patients suffering significant, permanent injury or death as a result of misdiagnosis ranges from 80,000 to 160,000 in the US annually.

Last Updated on Friday, 26 April 2013 14:37

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GPs call for delay of NHS 111 roll-out

GP leaders have urged health minister Earl Howe and NHS Commissioning Board chief executive Sir David Nicholson to delay the launch of NHS 111, according to a report by the British Medical Association.

In a letter sent following reports of problems with the service aired at the March meeting of the BMA GPs Committee, its chair Laurence Buckman wrote: "We have repeatedly asked for the implementation of NHS 111 services not to be rushed and stressed that a smooth transition is essential for patient safety. As yet, many areas seem not to be ready for that transition and, from some of the examples reported, I am worried that patients may be put at risk."

In a statement issued on 28 March, Dr Buckman added: "We cannot sacrifice patient safety in order to meet a political deadline for the launch of a service that doesn't work properly. There have been widespread reports of patients being unable to get through to an operator or waiting hours before getting a call back with the health information they have requested. In some areas, such as Greater Manchester, NHS 111 effectively crashed because it was unable to cope with the number of calls it was receiving."

NHS 111 is the new telephone triage service designed to direct people with urgent but non-life threatening conditions to the right part of the NHS within the appropriate timeframe. It is supposed to replace the former NHS Direct.

John Hughes is honorary secretary of Manchester Local Medical Committee, where a 'soft launch' for NHS 111 had been planned for 21 March. He said signs of trouble emerged when a carer reported that she had been waiting with a 90-year-old woman for 90 minutes for a call back from NHS 111.

"Shortly afterwards, it became apparent that the same thing was happening right across Manchester," Dr Hughes continued. "There were significant delays. People were waiting hours for calls back. There was also information from the North West Ambulance service that they were being completely overwhelmed by 999 calls because people were fed up waiting or couldn't get through."

It later emerged that in parts of inner London NHS 111 was put on hold until at least April 9 after problems emerged in other boroughs.

Dr Stewart Kay represents south-east London region on the GP Committee and worked for the GP OOH (out-of-hours) co-op SelDoc for 12 years.
He said: "We are back to a sort of daft hybrid, where some of the calls are going to NHS Direct and are being forwarded I think via fax to the traditional OOH provider...The majority are going through in the traditional way by GPs putting the co-op telephone number on their answer machines."

In Shropshire, the ShropDoc out-of-hours GP co-op has taken back call handling for four weeks after the Shropshire clinical commissioning group assessed that NHS Direct, which won the bid to run NHS 111 across the wider West Midlands region, was not ready, according to Shropshire Local Medical Committee chair Mary McCarthy.

She said GPs at ShropDoc had to step in and visit patients in their homes after reports of waits of up to 45 minutes for call backs or longer. She said patients have left feedback about their NHS 111 experiences on the ShropDoc website.

Dr Buckman commented: "The chaotic mess now afflicting NHS 111 is not only placing strain on other already overstretched parts of the NHS, such as the ambulance service, but is potentially placing patients at risk. If someone calls NHS 111 they need to be able to get immediate, sound advice and not be faced with any form of delay."

A spokesperson for the NHS Commissioning Board is reported as saying: "NHS England [the board's new name from 1 April] is aware of some difficulties in the introduction of the NHS 111 service in some areas, but we are confident that measures now in place will ensure resolution of these early problems.

"Many sites are already up and running, but in areas where NHS 111 is not yet available we will make a thorough assessment of readiness before new sites are introduced."

Last Updated on Tuesday, 02 April 2013 13:42

BMI criterion for weight-loss surgery ‘too high’, say Swedish researchers

Aerial view of the Sahlgrenska Institute at the University of Gothenburg for Your Expert Witness storyThe criteria for weight-loss surgery need to be changed, according to health experts at the University of Gothenburg in Sweden. In particular, a reduction in the body mass index (BMI) that obese patients must exceed in order to qualify for weight-loss – or bariatric – surgery could result in improvements to the health of many more people, reducing the prevalence of conditions such as type 2 diabetes.

The recommendations are based on the findings of the Swedish Obese Subjects (SOS) study carried out at the university's Sahlgrenska Academy, involving 104 patients who were operated on despite their BMI being 'too low'. As a result, the risk of developing diabetes was reduced by 67%.

Last Updated on Tuesday, 26 February 2013 14:41

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NHS Continuing Healthcare: the deadline approaches

Picture of Norman Lamb for Your Expert Witness storyPeople who believe they should have an assessment of eligibility for NHS Continuing Healthcare funding are being reminded that they should apply soon. The deadline is 31 March. Patients or the relatives of patients who received care that was paid for between 1 April 2011 and 31 March 2012 and were not assessed for NHS Continuing Healthcare but think they should be, have until 31st March to contact their PCT about, a statement from the Department of Health has explained.

Health Minister Norman Lamb (pictured) said: "The deadline to register for an assessment is approaching and we want everyone that should have been entitled to be assessed for a past period of care to be considered as soon as possible.

"In March 2012 we asked the NHS to communicate this deadline as quickly and effectively as possible to local people through whatever means necessary.

Last Updated on Thursday, 31 January 2013 16:43

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Cosmetic surgery responses published

Photo of breast implants for Your Expert Witness story - source US GovernmentThe responses to the call for evidence in the review of cosmetic surgery were published on 31 December. It allowed experts in the cosmetic interventions industry and patient groups to contribute to Sir Bruce Keogh's review of the regulation of cosmetic interventions.

According to a statement from the Department of Health, while there were a wide range of views on the future regulation of cosmetic interventions, some consistent key messages emerged from respondents. Recurrent themes were:

• The current regulatory framework was inconsistent and did not reflect the many changes and innovations in such a fast-growing and dynamic sector
• Training requirements were felt by many to be disproportionately weak compared to the potential risks of a procedure and more specialised training was welcomed
• Dermal fillers and intense pulsed light and laser procedures were highlighted by many as an area where there was insufficient legislation to protect the public

Last Updated on Monday, 07 January 2013 18:18

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