Multiple Jeopardy requires multi-response

State-indemnified doctors still face stresses and challenges when mistakes happen, writes Dr Michael Devlin – and a professional response is needed when doctors face inquiries by coroners, employers or the Medical Council

When someone suffers harm because something has gone wrong during their care, there is invariably a great deal of soul-searching. While the patient is rightly the focus of everyone’s concern, it’s common for the doctors involved to be left shaken, distressed, and in need of support.

In the aftermath of an adverse incident, it’s important to look into the causes, so that families understand what happened to their loved one, and lessons are learned. However, it may surprise you to know many investigations can be launched in the wake of a single clinical incident, a phenomenon known as multiple jeopardy.

As the following fictionalised scenario reveals, these investigations can be distressing and stressful for the doctor under scrutiny.

The incident
A 66-year-old man was admitted for dynamic, contrast-enhanced imaging of his prostate. He was seen by the clinical staff who explained the process and the risks, including allergic reaction to the gadolinium-based contrast agent.

A few minutes into the procedure, the patient felt unwell and pressed the alarm button. A radiologist attended within minutes to find the patient in respiratory arrest, and assessed that anaphylaxis was the likely cause.

Unfortunately, the doctor was unable to find any adrenaline on the emergency trolley, and the crash team were delayed by almost ten minutes because of a major incident in the emergency department. By the time they arrived it was too late to save the patient, who was found to have suffered severe anoxic brain damage, and later died.

This incident triggered inquiries by a range of different organisations:
The hospital – The doctor’s employer launched an immediate internal review and asked the doctor to provide a full report of what happened. With help from his medical defence organisation (MDO), he produced a factual statement based on his clinical notes and memory of events, but avoiding speculation about the missing adrenaline.

The review concluded that there had been multiple systems failures, and a failure by the radiologist to have personally reviewed the emergency trolley at the beginning of the procedure.

The hospital advised the doctor that there would also be an inquest to determine the circumstances, and the patient’s family had already been strongly critical of him.

The coroner – A few weeks later, the doctor was notified that he would need to provide a statement to the coroner. The hospital’s legal services manager, who was liaising with the coroner, recommended the doctor obtained separate legal representation, because the family had instructed a solicitor and there was a possibility of a conflict of interest.

While the purpose of an Inquest was not to apportion blame or to consider questions of civil or criminal liability, the doctor was still nervous about hostile questioning from the family’s lawyer and that he might be criticised.

At the inquest, the doctor followed the advice of his MDO: he gave factual responses on areas that were within his expertise and avoided giving opinions. After two days, the coroner recorded a verdict of medical misadventure, and recommended that the hospital address its procedures on emergency medication.

The Medical Council – While the coroner’s investigation was taking place, the doctor received notification from the Medical Council that it had received a complaint from the patient’s family about his involvement in the patient’s death.

It then contacted him after the case had been considered by its Preliminary Proceedings Committee, inviting him to comment on the allegations and providing additional documents. With assistance from his MDO, the doctor prepared a response for the PPC which also sought an expert opinion, and reviewed the clinical records. After six months, it eventually decided to take no further action.

What happened next
While three investigations ultimately concluded that the doctor was not personally responsible for the patient’s death, he was shaken by the experience, but acutely aware that it could have been much worse.

He knew of colleagues who had been questioned by the Gardaí, while others had seen their reputations ruined by adverse press coverage. It was also possible that he would be asked to give evidence in the event of a clinical negligence claim against the hospital in the future.

Mind the gap
While the doctor could rely on State indemnity in the event of a clinical negligence claim, this doesn’t extend to complaints, Medical Council proceedings, coroner’s inquiries where a conflict of interest exists, and police investigations.

No doctor should have to experience the ordeal of multiple jeopardy without expert legal representation, advice and support. Ultimately, this is why it is so important to have an MDO in your corner.

MDU Advice

  • The earlier you involve your defence organisation the better.
  • Speak to your defence organisation before you respond to a complaint or adverse incident, but write a statement to share with them while it’s fresh in your mind.
  • Multiple investigations are stressful. Get support from colleagues, your occupational health department, or your GP.
  • When the dust settles, take time to reflect on what you have learned and what you would do differently. This helps demonstrate insight and professionalism.

Information
When you need support the MDU is by your side. Our membership is specially designed for State-indemnified doctors and gives you the expert guidance you need, such as support with patient complaints, Medical Council referrals, inquests and criminal investigations.

To find out if you can save on your indemnity costs visit themdu.com/ireland.

This is an advertorial feature on behalf of MDU.

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