Minutes of the West of Scotland Obstetric Anaesthetists and Glasgow Obstetric and Gynaecological

Minutes of the west of Scotland Obstetric Anaesthetists and Glasgow Obstetric and Gynaecological Society.

Held on the 27th November 2013-12-09 At The Royal College of Physicians of Glasgow.

Dr Willie Frame, retired Consultant Anaesthetist (Princess Royal Maternity Hospital) presented in his usual humorous style his lecture: Anaesthetists, ‘Obstetricians and the Law’

He outlined that negligence is in the eyes of the law a breach of duty of care, in addition to evidence of harm or detriment arising due to that breach (causation). In Scotland ‘Hunter v Hanley’ (1955) has set the legal bar with regards to breach of duty. A doctor of ordinary skill acting in ordinary care is the standard for duty of care. If a breech occurs however causation is difficult to prove. Approximately only 1% of claims are therefore pursued through court.

He discussed that the law’s view of appropriate patient’s consent for any intervention is a concerning area where the goal posts are moving. The case ‘Rogers v Whitaker’ (1992) established the concept of ‘material risk’, a risk that a ‘reasonable patient’ would attach significance to no matter how rare the risk. This is a concerning development especially in obstetrics and anaesthetics where risk of loss of life is always a ‘material’ risk. Information booklets are useful in the eyes of the law. Dr Hanretty, president of GOGS wondered how long (in pages!) we should design obstetric information booklets.

From this point onwards in his presentation the mood lightened for the obstetric population as he presented case histories of anaesthetic claims. We also gained much information single nerve damage and on the risks of the ’incorrect’ lithotomy position in the aetiology of a vast array of post partum neuropathies.

Dr Frame summed up his comprehensive presentation with top tips ‘to help avoid being sued’. Obviously do your best for your patients but ensure effective communication, keep comprehensive (but not unusually detailed) notes, keep up to date in developments in practice, deal effectively with complaints, ensure appropriate supervision of junior colleagues and always call for help if required.

The future of the current claims system is uncertain. Lord Gill’s review on Civil Justice may result in a no fault compensation system. Dr Frame, reflecting on his experience, points out that such a system will only work fairly if patients are realistic about what they claim for. An increase percentage of claims settled will reduce the value of awards, which is likely to be detrimental to those patients truly in need.

Dr Frame received great applause from a full lecture theatre and happily outlined his plans for a well deserved retirement.