1. LITIGATION IN GYNAECOLOGY 2012

2. 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

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

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

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

6. 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

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

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

9. 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

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

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

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

13. 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”

14. OTHER PROCEDURES
UROGYNAECOLOGY
No perfect operation for incontinence

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