1. MEDICO – LEGAL CASEBOOK JOHN MEAD NHS LITIGATION AUTHORITY

2. What is NHSLA? -Created in 1995 -Part of the NHS -Not an insurance company -Covers England only

3. -Administers various schemes on behalf of the Secretary of State -Clinical negligence/public liability/employers’ liability/ defamation etc. -Will run Redress

4. -Risk Management initiatives (e.g. CNST Maternity Standards) -Human Rights Act Information Service -Pooling of resources and expertise

5. Percentage of Open Claims by Speciality Obstetrics-23.1% Orthopaedics-12.9% General Surgery- 9.2% Paediatrics- 9.2% Casualty/A&E- 8.5% Gynaecology - 5.0% General Medicine- 4.7% Psychiatry- 2.5% Others-24.9%

6. Value of Open Claims by Speciality Obstetrics-65.4% Paediatrics-10.9% Casualty/A&E- 3.3% Orthopaedic Surgery- 2.8% General Surgery- 2.1% General Medicine- 1.6% Neurology- 1.4% Anaesthesia- 1.0% Gynaecology- 1.0% Others- 11.5%

7. Value of Open Claims by Speciality £m Obstetrics-4,445 Paediatrics- 738 Casualty/A&E- 225 Orthopaedic Surgery- 191 General Surgery- 145 General Medicine- 95 Anaesthesia- 70 Gynaecology- 67

9. Breakdown of Obstetric Claims ( by value)

10. Gynaecology – Most Frequent Causes of Claims Intra-operative problems-27.6% Failure/Delayed diagnosis-16.0% Failure to recognise complication - 8.5% Delayed treatment- 6.0% Lack of consent- 5.7% Failed sterilisation- 5.7% Other causes-30.5%

11. INDIVUDUAL CASES 1)Laboratory Mix-up -Ultrasound: one twin with? Down’s Syndrome -Double amniocentesis -FISH analysis -Selective feticide -Birth of live child with Down’s -Test-tubes had been wrongly labelled

12. 2)Multiple Sites and Poor Layout -On-call registrar at another site -Failure of handover on change of shift at 17.00 -58 minutes from decision to perform C/S to delivery -Theatre on different level to labour ward -Inadequate lifts

13. 3)Uterine Rupture -Term + 13 days -Trial of scar -Excessive use of Syntocinon -Failure to warn -Baby in peritoneal cavity -Quadriplegic cerebral palsy

14. 4)Breakdown of Communication with Ambulance Service -Hospital with two areas to receive emergencies -Mother delivered to A/E, not Maternity Suite -Lack of preparation by obstetric SHO -Delay in delivery of 28 minutes -Birth of child with cerebral palsy

15. 5)Mother Seriously Brain-Damaged -Labour ward locked -Mother suffered seizure -Crash team not informed of change of code -Inexperienced doctor on duty “froze” -Largest claim in NHSLA’s history

16. 6)ERPC Errors -Miscarriage -Doctor inexperienced -Ethical opposition to termination -Failure to review -Failure to check -Mother passed body parts in shower

17. 7)Diathermy Burns -Hysterocopy/sample/cautery -Surgeon stepped on foot pedal -Burns to knee -Alleged remark by SHO

18. 8)McGeehan-v-Stockport Health Authority (High Court, 2004) -Persisting bradycardia -Urgent forceps delivery -V/E at 12.19; scalp electrode -Local anaesthetic -Born at 12.35 – cerebral palsy -Should anaesthetic have been dispensed with, saving ten minutes?