LITIGATION IN GYNAECOLOGY 2012

Litigation Impact of law in O&G far outweighs other medical fields Substantially more interaction with the health care system: Pregnancy Avoidance of pregnancy Childbirth Menopause

NHS: USA: £400m paid out for malpractice 60-70% related to Obstetrics, but only 26% of workload USA: $3,5m

Hippocratic Oath "First, do not harm" BUT Human error is inevitable New treatments and technologies are constantly emerging

GYNAECOLOGY Fit Young patients Previously healthy Elective procedures Subfertility Family planning / abortion Menstrual disorders

REASONS FOR LITIGATION Failure to explain risks and success rates Changing the proposed treatment Complications Delayed / mistaken diagnosis Practicing beyond one’s experience Performing a procedure without indication

Decision to sue Predisposing factors: Precipitating factors: Poor communication Rude Precipitating factors: Complications Failure to provide adequate care

When things go wrong Be open with the patient: Offer support Explain truthfully Do not be evasive Answer all questions Offer support

Reducing numbers of incidents Valid consent Guidelines aren't meant to dictate clinical practice Particular care must be taken with new procedures for which the benefits and risks are uncertain Use of drugs for unlicensed indications

ABORTION Failed termination of pregnancy Ongoing pregnancy Retained products of conception Perforation and trauma to other structures

STERILIZATION Defective consent Failed sterilization SOCIAL OPERATION Pregnant at time of procedure Recanalization of fallopian tubes

OTHER PROCEDURES ECTOPIC PREGNANCY LAPAROSCOPY Delayed or wrong diagnosis LAPAROSCOPY Injury to other organs Laparotomy

OTHER PROCEDURES HYSTERECTOMY No indication Oophorectomy Damage to other structures “The venial sin is injury to the ureter, but the mortal sin is failure of recognition”

OTHER PROCEDURES UROGYNAECOLOGY No perfect operation for incontinence

Informed consent CONCLUSION Be aware of risks, benefits and complications Know the civil and criminal laws relating to Obs and Gynae Informed consent