Litigation in gynaecology

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 2 – T E A C H I N G A N D R E S E A R C H

Litigation in Gynaecology Jha S, Rowland S. Litigation in gynaecology. TOG 2014;16:51–57. doi:10.1111/tog.12065

£1.28bn 3 years 70% NHS CLINICAL NEGLIGENCE BILL 2011–12 LIMITATION PERIOD FOR A GYNAECOLOGY CLAIMS SUCCESSFULLY DEFENDED (↑45%) CLAIM

DO N' T-M IS S FA C TS

  1. Limitation: 3 years from injury/date of knowledge; child → from 18th birthday; no limit if lacking capacity; death → 3 years from death

  2. Four elements of negligence: duty → breach → causal link → harm

  3. Only 1–2% of claims reach court; 70% successfully defended; most settled out of court; most cases are multi-track

  4. Sterilisation: conception <12 months = technique failure; >12 months = recanalisation. McFarlane (healthy child = no upkeep costs) vs Parkinson (disabled child = additional costs)

  5. Hysteroscopic perforation: no electrosurgery → observe; electrosurgery used → laparoscopy to exclude bowel injury

  6. Diathermy tip stays hot after power is switched off; rule out bowel injury after primary trocar insertion

  7. Retained foreign body = SUI → inevitably results in payment of a negligence claim

  8. NHS vicarious liability does not cover coronial enquiry or GMC proceedings — keep defence organisation cover

CASE LAW ONE-LINERS

Bolam – responsible body of opinion Bolitho – opinion must be logical Roe – knowledge at time of incident

Ashcroft – burden on claimant, balance of probabilities Hunter v Hanley – departure from routine ≠ negligence

Wilsher – post occupied, “but for” Chester v Afshar – disclose small serious risks

Gillick / Fraser – competence & contraception <16 Janaway – conscientious objection, refer on

AVOIDING LITIGATION

Documentation · communication · accurate representation of experience

Discharge instructions · saying sorry (Duty of Candour, Francis) · integrity

ABBREVIATION KEY

NHSLA — NHS Litigation Authority NICE — National Institute for Health and Care Excellence

MDU — Medical Defence Union IPG — interventional procedure guidance (NICE)

MPS — Medical Protection Society SUI — serious untoward incident

GMC — General Medical Council IUCD — intrauterine contraceptive device

RCOG — Royal College of Obstetricians and Gynaecologists CS — caesarean section

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — Jha S, Rowland S. Litigation in gynaecology. TOG 2014;16:51–57. doi:10.1111/tog.12065

Clinically reviewed by NHS obstetricians and gynaecologists

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