The Standard of Care

A doctor is not guilty of negligence if he acts in accordance with what a responsible body of clinicians endorse as proper practice provided there is a logical basis for that view.

This means that if there exists a responsible group of doctor's who would support your doctors decision even if they are a minority, you will not succeed with a claim unless their view is illogical. A medical school of thought would be illogical if there were no adequate scientific basis for it.

In practice, whether or not a school of thought is logical is rarely in issue. What is usually in issue is whether or not a particular doctor acted in accordance with what a responsible group of his or her peers would endorse.

Medical knowledge is developing all the time so acceptable standards change. A doctor's conduct is judged by reference to the standards that applied at the time care was provided.

Judging what is acceptable is not determined by considering what most doctors would have done. A minority view may amount to a responsible body of opinion.

Did the error cause an injury?

To succeed with a clinical negligence claim it is not enough to prove that an error occurred and that care fell below an acceptable standard. To succeed with a claim it is necessary to prove that the error caused an injury. Not all errors result in injury and not all injuries result from error. The question that arises in all cases is therefore, did the error cause an injury?

The answer to this question is not always as easy as it may sound. The victim of a car accident will have no doubt how and when injury occurred. The victim of a medical error is in a different position. The injury may be masked by the underlying condition for which treatment was required in the first place or confused with it. The error is not necessarily something that can be apprehended or appreciated like the moment of a collision.

For these reasons an independent medical expert will in most cases be required to express an opinion on the injury and its cause.

To succeed with a clinical negligence claim it is necessary to prove that the error caused or materially contributed to the injury. This means the error need not be the only factor, it is enough if it made a material or important contribution.

Events that may suggest error

Accident and Emergency Department

• Patients reattending after being discharged
• Missed fractures
• Injuries to patients within the department
• Deaths within the department
• Cardiac/respiratory arrest on or subsequent to attendance

Anaesthetics

• Permanent neurological damage
• Kidney or liver failure
• Accidental damage to teeth, lips, gums
• Loss of memory
• A degree of paralysis
• Myocardial infarction
• Laryngeal damage
• Fitting
• Burns

Intensive Care

• Endotracheal tube complications
• Arterial/central line complications
• Drug errors, especially infusions
• Hospital acquired infections

Clinical Oncology

• Deaths from cancers which are usually successfully treated
• Major complications
• Deaths within a short time after treatment

Laboratory Medicine

• False negative cytology/histology

Obstetrics

• Apgar score 3 or less at five minutes
• Maternal complication after normal delivery
• Maternal readmission within 14 days of delivery
• Third-degree laceration
• Haemorrhage requiring transfusion
• Newborn injury
• Neonatal convulsion within 48 hours
• Stillbirth or death

Gynaecology

• Return to theatre within 24 hours
• Urinary tract injury
• Bowel injury
• Perforated uterus at suction termination
• Post-operative deep-vein thrombosis
• Wound breakdown

Radiology

• Mis-reporting of films X-ray , CT, MRI and ultrasound imaging
• Missed fractures
• Complications of invasive procedures
• Reactions to contrast media

Surgery and Related Specialists

• Deaths during or shortly after surgery
• Subsequent admissions to intensive care
• Unplanned second operations
• Unplanned readmissions

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