Clinical negligence claims notified by MDU radiology members are examined here by Dr Shabbir Choudhury, who advises on how to manage risk.
Consultants working privately as radiologists who have been notified of a clinical negligence claim against them are often assisted by the MDU.
While claims are less frequently made against radiologists than consultants working in some surgical specialties, such as orthopaedics or cosmetic surgery, they remain relatively common and compensation can sometimes exceed a million pounds.
So managing known risks linked to clinical negligence claims is important both to protect patients and to avoid claims being brought.
The analysis below is based on 200 recent claims brought against consultant radiologists working in the independent sector who were MDU members.
Nearly three-quarters of claims were successfully defended with compensation paid in only around a quarter of cases.
Of the cases that settled, the majority were well in excess of £50,000.
However, this does not reflect the seriousness of the allegation but rather the cost of restoring the claimant to the position they would have been in had the negligence not occurred. But this figure does demonstrate the importance of having appropriate indemnity arrangements in place, as even lower-value claims can settle for costs that are beyond the means of most radiologists to pay.
Reasons for claims
1 Delayed or incorrect diagnosis
Eighty per cent of radiology clinical negligence claims related to a delayed diagnosis. A quarter of these cases involved a delayed diagnosis of cancer.
Other conditions commonly resulting in a claim being made were fractures and cauda equina syndrome.
Allegations usually centre on an abnormality not being detected, but in some cases it was alleged that an abnormality was picked up but misinterpreted, leading to unnecessary or incorrect treatment.
2 Interventional radiology
Some claims involved a substantial interventional radiology element. Although interventional radiology is perceived to carry more risks, it is still far less commonly carried out than general radiology. It may also be that MDU members are more aware of the risk of interventional radiology and are justifiably cautious when undertaking complex procedures.
3 Medication issues
In a small number of cases, the main allegation was about a medication issue such as allergic reactions or providing the wrong medication.
One claim involving the use of contrast in a child was settled for well over £100,000 with substantial claimant’s legal costs.
4 Communication skills
A number of cases focused on the communication skills of the doctor, often when getting appropriate consent for a radiological procedure.
There are a number of actions radiologists can take, which, if managed appropriately, can help to reduce risks. These include:
Ensure robust procedures are in place for communicating results to relevant parties to ensure appropriate and prompt follow-up and treatment.
Consent should be obtained by an appropriate member of the team and, ideally, by the radiologist undertaking the procedure.
Be aware of the GMC’s guidance on consent and other relevant guidelines such as those from NICE.
Ensure the patient is aware of the risks, benefits and complications of the proposed procedure as well other therapeutic options. These should be carefully documented.
Provide further information such as patient leaflets and information sheets which can help patient understanding. Remember that the use of these should be documented in the records.
Consider the patient’s past medical history, medication history and allergies before administering pre-procedural medication and contrast media.
Ensure appropriate hand-over to recovery staff for interventional procedures or those under sedation.
Offer a chaperone to patients undergoing any intimate examinations – for example, pelvic ultrasound.
Consider contacting the referring doctor if you find something unexpected or that needs urgent investigation.
Have a system in place to verify the right site and patient undergoing treatment and to cross-check information provided against the referral.
Ensure interruptions in the reporting room are kept to a minimum.
If things go wrong, be open and honest with the patient by providing an explanation of what has happened and the likely short- and long-term effects of this. Say sorry and get advice from the MDU if you believe the incident triggers the organisation’s duty of candour requirements.
Our expert claims handlers and medico-legal advisers will defend claims whenever possible. They involve members in the conduct of their cases and will always seek your consent before settling a case.
While claims numbers have remained steady in recent years, the cost of claims has spiralled. This is not due to clinical standards but to a deteriorating legal environment which the MDU is campaigning to reform. You can see more at www.themdu.com/faircomp.
Dr Shabbir Choudhury (right) is medico-legal adviser and former senior medical claims handler at the Medical Defence Union