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68 Medico-Legal J. 1 (2000)

handle is hein.journals/medlgjr68 and id is 1 raw text is: Medico-Legal Journal (2000) Vol.68 Part 1, 1-2 © Medico-Legal Society 2000 Editorial: Medical Errors - A Costs Burden on Society Diana Brahams Barrister, Gray s Inn, London Most personal injury claims result from accidents at work or on the road. By contrast, I estimate that medical negligence litigation (on behalf of claimants i.e. patients) accounts for over 80% of my practice: as I am instructed by solicitors all round England and Wales, my focus and perspective are different but, I think, complementary to the comments made by Steve Walker (Chief Executive of the National Health Service Litigation Authority), which are published at page 3. We agree there is a need for improved risk management with a view to reducing clinical and administrative errors. The real cash burden of clinical and management errors in the provision of our health services is vast. But much of it is avoidable. It goes far, far beyond the sums paid out in damages and legal fees. There is an old saying, A stitch in time saves nine. The stitch should be in the right place of course. The consequences of delay or incompetent intervention are manifold: patients spend longer in hospital, may require repeated surgery, may not make a full recovery or even die. They may be left seriously mentally or physically disabled for life. Leaving aside the human suffering of the patient and payments that may be made in damages, consider the adverse impact on the provision of medical and legal care that results. Working hours for both staff and patients (and also the patients' family and friends) are lost, relationships may be seriously and irretrievably damaged sometimes to the point where caring relatives and friends too require medical input, financial and other help from the taxpayer. The need for repeat or reparative surgery or extended treatment clogs up operating theatres and ICU beds and then rehabilitation services, causing more strain on the system and other patients. Dependant children and close friends and relatives may suffer mental trauma which impacts on their ability to function and contribute to Society and indeed may result in their becoming patients themselves. Even if an error has caused no serious injury it should be noted as a warning; it is probably indicative of a weakness in the system or individual practice. Sloppy Institutions Sloppy, badly-run institutions let down patients and staff alike, and once word gets round, recruitment will become more difficult, so that the best qualified staff will not apply and standards are likely to fall further along with morale and patient confidence. Staff who feel undervalued or unsupported are more prone to absenteeism causing yet further problems and a greater reliance on expensive agency nurses and locum doctors (whose qualifications and compe- tence will be highly variable). Inadequately super- vised junior and locum doctors (whose qualifications and experience are often not properly checked out) can put patients at risk. Common sense tells us that even the most competent, experienced professionals function less efficiently in an unfamiliar environ- ment, most particularly without adequate support and sound administration that ensures patients' records and test results are available when required. Sensible protocols and guidelines are helpful - but not if they are ignored. There are other hidden costs due to negligent or sloppy practices. These are caused by the avoidable spread of infection to staff and patients, accidents due to poor building or equipment maintenance or management, and manual handling and lifting tech- niques used by porters, nurses and paramedics. Back pain accounts for thousands and thousands of lost working hours. Nurses are particularly vulnerable. Nurses who have enthusiasm and skill and who have been expensively trained are lost year in and year out due to disabling back injuries which were avoidable. The costs to the NHS of staff injuries in lost working time and the need to pay agency staff to take

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