Medical cockups: more common than officially recognised?

PeakOutput · 18-04-2010 12:14PM

actually i just remember a pretty bad case that was related to my family that actually was negligence

my grandad had dibetes and had bad circulation in his legs, this caused him to effectively have no feeling in his legs

he was in a nun run hospital(this would have been about 15/20 years ago) and they left the radiator right beside(touching) his bed on and the heat came on during the night. as he had no feeling he didnt wake up as it cooked his leg. it resulted in an ulcer that was a problem for the rest of his life(ie it wouldnt heel properly for the next 15 or so years)

he refused to sue the nuns because they were nuns

this is clear negligence

bursting someones ear while looking at it is clear negligence and carelessness there is just no need for it

however you dont just get to come up with every little medical problem you have ever encountered and call it negligence, misdiagnosis for example does not automatically = negligence or carelessness

drkpower · 18-04-2010 12:19PM

opinion guy wrote: »

The third category of bad thing that can happen is the result of a poorly designed system. This would be for example, when the doctor treating you has been forced by his employer to be awake and workign for 2.5days continuously (which happens - no can perform at their peak for that amount of time), or when the wait for a particular test is longer than safety allows. These types of errors are not the fault of the individual Doctor/Nurse, but responsiblity lies higher up with those making managements decisions and defining policy. There currently seems to be little awareness/accountability for this kind of error in Ireland. Sometimes the frontline staff get blamed, since when these kinds of errors occur, the frontline staff are the ones face-to-face with the patient, and the management types who are to blame are never seen by the patient.

A 'systems error' of such gravity is also negligence. But you are right, it is very rarely a major part of any case.

drkpower · 18-04-2010 12:32PM

PeakOutput wrote: »

bursting someones ear while looking at it is clear negligence and carelessness there is just no need for it

however you dont just get to come up with every little medical problem you have ever encountered and call it negligence, misdiagnosis for example does not automatically = negligence or carelessness

On one hand, you rightly warn against labelling every bad outcome as negligence, but then you do exactly that vis-a-vis eardrum perforation.

Perforation of an eardrum during an otoscopic examination is a recognised complication which can and odes occur in the absence of negligence. Some people have narrow and short ear canals, sometimes pus., nfection/abscess can obscure the view to the eardrum, sometimes people move sharply during an examination (usually due to pain). All of the above may be reasons why perforating an eardrum is not negligence.

Now, I will freely admit that the above examples are not that common and I would go so far as to say that most cases of eardrum peforation during otoscopic examination would be as a result of negligence. But the rush to judgment when something bad happens is simply lazy.

PeakOutput · 18-04-2010 12:35PM

drkpower wrote: »

On one hand, you rightly warn against labelling every bad outcome as negligence, but then you do exactly that vis-a-vis eardrum perforation.

Perforation of an eardrum during an otoscopic examination is a recognised complication which can and odes occur in the absence of negligence. Some people have narrow and short ear canals, sometimes pus., nfection/abscess can obscure the view to the eardrum, sometimes people move sharply during an examination (usually due to pain). All of the above may be reasons why perforating an eardrum is not negligence.

Now, I will freely admit that the above examples are not that common and I would go so far as to say that most cases of eardrum peforation during otoscopic examination would be as a result of negligence. But the rush to judgment when something bad happens is simply lazy.

grand i can freely admit it sounds like you know more about it than i do(as a simple patient) but having had water forced into my ear at relatively decent pressure i would imagine it takes quite the sharp application of pressure to burst an ear drum but i dont actually know

drkpower · 18-04-2010 01:02PM

PeakOutput wrote: »

grand i can freely admit it sounds like you know more about it than i do(as a simple patient) but having had water forced into my ear at relatively decent pressure i would imagine it takes quite the sharp application of pressure to burst an ear drum but i dont actually know

Ah, I see. So it wasnt just a regular examination. It was an ear syringing. And that has a higher rate again of causing a perforation. It is avery well recognised complication.

Did it myself once to a patient. Used the same syringing 'machine' a thousand times at the same rate of water ejection. Never burst anyones eardrum. Had a 16 year old kid in; reduced the ejection speed just in case his eardrum was a little less strong. First spurt of water in; blood rushes out; burst eardrum. Nearly shat myself.

So, was I negligent? Should I be sued? Do you see the point; people think that certain procdures are 'so easy' or 'so straightforward' that a bad outcome must be negligence. The reality is often very very different.

That is not to say that medical errors should not be reported and that cases where negligence appears likely should not be investigated thoroughly. That is the only way we will all learn, but to lazily slap the 'negligence' term on a treatment because it has a bad outcome is not on.

opinion guy · 18-04-2010 01:15PM

drkpower wrote: »

A 'systems error' of such gravity is also negligence. But you are right, it is very rarely a major part of any case.

I'm sorry where did I say that ? Please don't put words in my mouth.

drkpower · 18-04-2010 01:23PM

opinion guy wrote: »

I'm sorry where did I say that ? Please don't put words in my mouth.

Which bit? The bit about it being rarely a major part of any case? That should have read:
'A 'systems error' of such gravity is also negligence. But you are right. It is very rarely a major part of any case.'

Many apologies.

Dudess · 18-04-2010 01:31PM

drkpower wrote: »

I dont necessarily doubt your version of events - but the point is that medical procedures have adverse outcomes. Some examinations are not easy because of various anatomical and technical differences. Sometimes eardrums are perforated in the absence of any 'cock-up' merely because of the technical difficulty of the examination.

I disagree - he could have inserted the examining device correctly. You're implying the procedure was followed correctly but the result was just an unfortunate side-effect. He clearly didn't follow the procedure correctly though.

ilovelamp2000 · 18-04-2010 01:33PM

drkpower wrote: »

:rolleyes:;)

What are 'incredibly difficult to nail down'? (very imprecise language from someone who runs a medneg case....:D)

Do you mean it is very difficult to get an expert to say that a case was negligent?

So the conclusion from this is one of two things:
1. There was no negligence;
2. It was obviously negligent but noone will admit it, not even a non-Irish expert who gives expert reports and evidence every day of negligent acts by doctors......:rolleyes:.

You might want to look at what you are doing wrong..?!

It's not difficult to get an independent expert to state there was negligence somewhere when it does exist, it's just that what Joe Public sees as negligence and what the independent expert (and the court) see as negligence vary quite wildly.

It isn't just negligence that needs to be proved though, you've got to prove damage too and show the causal link between the negligence and the damage. In cases where there are multiple pathologies that is not always possible.

drkpower · 18-04-2010 01:36PM

Dudess wrote: »

I disagree - he could have inserted the examining device correctly. You're implying the procedure was followed correctly but the result was just an unfortunate side-effect. He clearly didn't follow the procedure correctly though.

I was talking generally. As I said in the first line of the sentence, 'I dont doubt your version of events'. And of course, it is impossible for me to know what specific technique your doc used.

the more general point I am making is that many people rush to judgemnt when there is a bad outcome, or where something was painful, or felt 'too rough', that the procedure has been carried out negligently. More often that not, that is not the case.

PeakOutput · 18-04-2010 01:41PM

drkpower wrote: »

Ah, I see. So it wasnt just a regular examination. It was an ear syringing. And that has a higher rate again of causing a perforation. It is avery well recognised complication.

Did it myself once to a patient. Used the same syringing 'machine' a thousand times at the same rate of water ejection. Never burst anyones eardrum. Had a 16 year old kid in; reduced the ejection speed just in case his eardrum was a little less strong. First spurt of water in; blood rushes out; burst eardrum. Nearly shat myself.

So, was I negligent? Should I be sued? Do you see the point; people think that certain procdures are 'so easy' or 'so straightforward' that a bad outcome must be negligence. The reality is often very very different.

That is not to say that medical errors should not be reported and that cases where negligence appears likely should not be investigated thoroughly. That is the only way we will all learn, but to lazily slap the 'negligence' term on a treatment because it has a bad outcome is not on.

sorry just to be clear no one has burst my ear drum i was saying that from my experience of having my ears cleaned with a syringe that i would say it is very hard to burst someones ear drum with one of those things you look into someones ear with(which is what dudess said happened her)

every time iv gotten my ears syringed iv been warned that it could cause perforation and if it did i could accept it as having just happened. never have i been warned that the same thing could happen just before the doctor examines my ears with that thing they stick in with the light on it

drkpower · 18-04-2010 01:42PM

Rosco1982 wrote: »

It's not difficult to get an independent expert to state there was negligence somewhere when it does exist, it's just that what Joe Public sees as negligence and what the independent expert (and the court) see as negligence vary quite wildly.

It isn't just negligence that needs to be proved though, you've got to prove damage too and show the causal link between the negligence and the damage. In cases where there are multiple pathologies that is not always possible.

What Joe Public sees as negiligence usually isnt; that is the point; what an independent expert says is the important point.

Of course you need to show that the negligent act caused the damage. That's a given. Imagine the injustices that would arise if someone (doctor or anyone else) was held liable for things they did not cause, just because they did something wrong.....

ilovelamp2000 · 18-04-2010 01:44PM

drkpower wrote: »

What Joe Public sees as negiligence usually isnt; that is the point; what an independent expert says is the important point.

Of course you need to show that the negligent act caused the damage. That's a given. Imagine the injustices that would arise if someone (doctor or anyone else) was held liable for things they did not cause, just because they did something wrong.....

Try explaining that to Joe Public.

drkpower · 18-04-2010 01:48PM

Rosco1982 wrote: »

Try explaining that to Joe Public.

That's exactly what I am trying to do here....;) I have no doubt that it must be difficult.

opinion guy · 18-04-2010 01:48PM

drkpower wrote: »

Which bit? The bit about it being rarely a major part of any case? That should have read:
'A 'systems error' of such gravity is also negligence. But you are right. It is very rarely a major part of any case.'

Many apologies.

The bit about it rarely being a part of any case. I didn't say that.

I'm curious. You say its very rarely a major part of any case. Do you have data to back that up ?

drkpower · 18-04-2010 01:51PM

opinion guy wrote: »

The bit about it rarely being a part of any case. I didn't say that.

No; I did. As I clarified above. It was an issue of a comma instead of a full stop. I have chastised myself repeatedly over it and probably wont be able to sleep tonight because of it. But, on an issue of such fundamental importance, you are right to make the point (twice).:rolleyes:

opinion guy wrote: »

I'm curious. You say its very rarely a major part of any case. Do you have data to back that up ? .

Im not aware of any official stats on whether 'systems issues' are a major factor in medneg proceedings. From my experience, it is very rarely a major factor. Systems issues such as lack of protocols and guidelines are pleaded often but systems issues such as making NCHDs work every hour god sends are very very rarely pleaded (starangely enough).

They are usually not a major factor because it is tough to show that the fact that Dr X was tired actually caused the negligent act. Or even that the lack of a protocol/guideline caused the negligent act.

doubleglaze · 18-04-2010 02:10PM

Yes, and I/they chose to report it

I suffered a huge medical cock up. The doctor in question never apologized or made amends.

Eventually, I decided not to pursue the matter legally because I couldn't afford to fight the legal case. I'm not entitled to free legal aid and I wasn't prepared to lose my house just to administer justice to a rogue doctor. I was also told by an attorney who works in the area of medical malpractice that the relevant Medical Board (not the Irish one - a foreign one) was ineffective, so I felt that bringing the matter any further would be a complete waste of my energies.

I hope he gets his justice in the hereafter!

opinion guy · 18-04-2010 03:07PM

drkpower wrote: »

No; I did. As I clarified above. It was an issue of a comma instead of a full stop. I have chastised myself repeatedly over it and probably wont be able to sleep tonight because of it. But, on an issue of such fundamental importance, you are right to make the point (twice).:rolleyes:

Fair enough.

Im not aware of any official stats on whether 'systems issues' are a major factor in medneg proceedings.

Indeed. Problem number 1 - that data isn't even collected. The best way to avoid awkward answers is not to ask the question in the first place.

From my experience, it is very rarely a major factor.

That's some nice anecdotal evidence there. Do you base your treatment decisions on anecdotal evidence, or do you look for scientifically rigourous data ?

Systems issues such as lack of protocols and guidelines are pleaded often but systems issues such as making NCHDs work every hour god sends are very very rarely pleaded (starangely enough).

They are usually not a major factor because it is tough to show that the fact that Dr X was tired actually caused the negligent act. Or even that the lack of a protocol/guideline caused the negligent act.

But again. If you don't ask the quesitons and gather the data, its pretty much all just speculation isn't it ?

drkpower · 18-04-2010 03:32PM

opinion guy wrote: »

Indeed. Problem number 1 - that data isn't even collected. The best way to avoid awkward answers is not to ask the question in the first place.
But again. If you don't ask the quesitons and gather the data, its pretty much all just speculation isn't it ?

In order to 'collect' that data, you would need to assess all medneg cases that have been taken in Ireland form X to Y. You would then need to determine what is a 'major factor' in the case? How would you do that?

In decided cases, that would be pretty easy, as you could see from the judgment what the judge considered to be the major factor. But the vast vast majority of cases are settled without admission of negligence and the determination of what is the 'major factor' in that case is a matter of subjective judgment rather than objective scientific data. So even if you could collect this data (which would be next to impossible), whose judgment as to the 'major factor' would you consider correct? The Plaintiff's legal team? The Defendant's? The Plaintiff's? The Defendant doctor?

It seems a very common tactic on these Boards to call for scientific data for every single claim asserted, and in the absence of same, to declare that a claim is worthless. It is a childish approach that simply betrays an ignorance of how the world actually works. To label the exercise of judgemnt and experience in the interpretation of anectdotal evidence as 'just speculation' is utter nonsense. Certain fields and problems are amenable to an evidence-based approach based on studies performed using objective data. Others are not; law is a good example of a middle ground. Sometomes there is solid peer-reviewed evidence for a path you choose to take; at least as often, you have to take an approach based on your experience and your judgment. There is a reason people with experience and sound judgment are sought after and well rewarded. If you could simply always pick the right option by looking at objective studies, a computer could practice medicine, law or any other discipline which requires an exercise of judgment based on experience and objective facts.

Muckie · 18-04-2010 03:54PM

Going from personal experience, "Doctors differ and patients die."
If you ever have a loved one go into hospital, don't for a minute
believe the experts know exactly what their doing.

Basically a family member went into hospital died after spending
two weeks being injected, scanned and being almost convinced the
problem was in her mind, on the last procedure they did,
they tore the inside of her stomach, led to blood posioning
and she died, in another hospital

Doctors that caused it never once talked to us, even said sorry.
Come collect her stuff its in a bag.

opinion guy · 18-04-2010 04:59PM

drkpower wrote: »

In order to 'collect' that data, you would need to assess all medneg cases that have been taken in Ireland form X to Y. You would then need to determine what is a 'major factor' in the case? How would you do that?

In decided cases, that would be pretty easy, as you could see from the judgment what the judge considered to be the major factor. But the vast vast majority of cases are settled without admission of negligence and the determination of what is the 'major factor' in that case is a matter of subjective judgment rather than objective scientific data. So even if you could collect this data (which would be next to impossible), whose judgment as to the 'major factor' would you consider correct? The Plaintiff's legal team? The Defendant's? The Plaintiff's? The Defendant doctor?

So basically what you're saying is 'it's hard to quantify so don't try' ?

Why assume you would have to measure this by analysing legal cases ? It would sem to me an easier and more accurate way to do it would be to encourage front-line staff to report incidents and 'near misses' and for them to be analysed en mass. It would quickly become obvious what factors are important. Of course this would require a change in culture amongst medical staff - but thats looonnnnggggg overdue in any case.

It seems a very common tactic on these Boards to call for scientific data for every single claim asserted, and in the absence of same, to declare that a claim is worthless. It is a childish approach that simply betrays an ignorance of how the world actually works. To label the exercise of judgemnt and experience in the interpretation of anectdotal evidence as 'just speculation' is utter nonsense. Certain fields and problems are amenable to an evidence-based approach based on studies performed using objective data. Others are not; law is a good example of a middle ground. Sometomes there is solid peer-reviewed evidence for a path you choose to take; at least as often, you have to take an approach based on your experience and your judgment. There is a reason people with experience and sound judgment are sought after and well rewarded. If you could simply always pick the right option by looking at objective studies, a computer could practice medicine, law or any other discipline which requires an exercise of judgment based on experience and objective facts.

An equally common tactic is the "appeal to authority".
http://en.wikipedia.org/wiki/Argument_from_authority
An evidence base trumps an appeal to authority.

Your comparison of the current discussion to the practice of law or medicine is not valid. We are not discussing here, whether treatment X or y is better in such and such a circumstances, we are talking about properties of a logicstical system. The things we are talkign about in this thread are easily quantifiable if someone bothers to go quantify them (by someone I'm not meaning you by the way - I mean well....someone). it simply logistics. The aviation industry has been doing this kind of thing for years quite successfully, which is why a pilot (or truck driver for that matter) is not allowed to work beyond a certain limit. Why all incidents and nearmisses are investigated and the system modified if needs be? And why checks and double checks are built into the routine of the system. The difference being a tired pilot can kill lots of people at once, a tired doctor likely only endangers one at a time.

The argument 'its too hard' just doesn't cut it.

drkpower · 18-04-2010 05:30PM

opinion guy wrote: »

So basically what you're saying is 'it's hard to quantify so don't try' ?

Why assume you would have to measure this by analysing legal cases ?.

Because my initial assertion was that 'systems issues' were not a 'major factor', in my experience, in medical negligence cases....!!! That was what we were talking about!:rolleyes:

And when did I say it was 'too hard, so dont try'.....:rolleyes: FFS, I specifically explained why these statistics would not be very valuable (as they would be judgment-based anyway).

Now, you have gone off on a tangent on compiling statistics on all medical incidents. Which, of course, we can; and I agree with much of what you say.

But that is a slightly different issue to determining what the 'major factor' is in medical negligence cases, which require specific proofs in each specific case. So, as an example, compiling statistics on tired doctors will show that errors, in general, increase as tiredness increase; and then policies can be made on that basis. But in a medico-legal case, you need to show that a specific error occurred specifically because a specific doctor was tired. That is a very different animal and it is a very difficult to prove; and that is why it is not a 'major factor' in medico-legal cases. Which is where we started and what you initially took issue with.

So your post above is full of good ideas with which I agree, but it is mainl irrelevent to the specific issue we were discussing.

we'llallhavetea_old · 18-04-2010 05:31PM

i'm afraid i didn't read all of the thread yet.

i think that people should start reporting these "cock-ups".

if the same doctors/nurses are constantly making mistakes surely they are incompetent at their jobs.

biggins list has scared the life out of me. this is one man, with way too many bad experiences.

opinion guy · 18-04-2010 06:13PM

drkpower wrote: »

But in a medico-legal case, you need to show that a specific error occurred specifically because a specific doctor was tired. That is a very different animal and it is a very difficult to prove; and that is why it is not a 'major factor' in medico-legal cases. Which is where we started and what you initially took issue with.

Ah yes I take your point. But really I'm not interested in proving beyond doubt what happened in a specific case. I'm much more interested in cutting down the total number of cases and you can do do that without getting into blame apportioning in every case. Woudln't you say ?

And actually to be uber-pedantic with you -we are not talking about medical negligence cases. We are talking about when things went wrong. Most of the time that doesn't lead to a case. In which case blame never gets apportioned. Simply put - the data isn't recorded. You can cut down these indicences of negligence that doesn't make it to the courts without the level of rigor you are describing. without even intending it, it will have a knock on effect on the cases that do make it court.

drkpower · 18-04-2010 06:51PM

opinion guy wrote: »

Ah yes I take your point. But really I'm not interested in proving beyond doubt what happened in a specific case. I'm much more interested in cutting down the total number of cases and you can do do that without getting into blame apportioning in every case. Woudln't you say ?

And actually to be uber-pedantic with you -we are not talking about medical negligence cases. We are talking about when things went wrong. Most of the time that doesn't lead to a case. In which case blame never gets apportioned. Simply put - the data isn't recorded. You can cut down these indicences of negligence that doesn't make it to the courts without the level of rigor you are describing. without even intending it, it will have a knock on effect on the cases that do make it court.

I agree with all of the above. Except to be uber-uber-pedantic with you (;)), this entire mini-debate commenced when you asked me if I had any evidence data to back up my specific assertion that 'systems issues' were not a 'major factor' in medical negligence cases....!

opinion guy · 18-04-2010 07:17PM

drkpower wrote: »

I agree with all of the above. Except to be uber-uber-pedantic with you (;)), this entire mini-debate commenced when you asked me if I had any evidence data to back up my specific assertion that 'systems issues' were not a 'major factor' in medical negligence cases....!

Ah see now clearly I meant that within the context of the thread we are speking thou, which is specifically about those which don't get to trial no ?

drkpower · 18-04-2010 07:34PM

opinion guy wrote: »

Ah see now clearly I meant that within the context of the thread we are speking thou, which is specifically about those which don't get to trial no ?

Sure.

Dionysus · 09-01-2011 04:42PM

Yes, and I/they chose to report it

Tucked away in yesterday's Irish Times is this astonishing statistic: €900 million was paid out by the Irish state for medical negligence claims in 2010.

'€1BN PAYOUT CLAIMS AGAINST STATE

The State Claims Agency paid out €93.2 million in personal injury, property damage and clinical negligence claims in 2010, up 46 per cent on the previous year. The National Treasury Management Agency, which oversees the claims agency, attributed the rise to higher clinical negligence claims.

During 2010, the agency received 1,623 new claims against the State authorities covered by the agency, resolving 1,690 existing claims. By the end of the year, it had 4,114 claims under management.

The total estimated liability against all active claims was about €1 billion, €900 million of which relates to clinical claims. The agency said the portfolio of clinical claims was maturing. The remaining €100 million relates to employer liability, public liability and property damage claims.

The upward trend in civil actions against hospitals and medical practitioners was flagged by Minister for Health Mary Harney in September, when she said failure to protect patient safety in hospitals was having economic as well as human consequences.

The State Claims Agency is awaiting a new delegation order that will see it act as the fund covering bullying and harassment claims against State authorities.

In 2010, it took on the management of the Health Service Executive’s employer and public liability and third-party property damage claims for the first time.'

Story here.

Chuchoter · 09-01-2011 05:28PM

Yes, and I/they chose to report it

When I was 12 I was given pills for tiredness/nausea. I kept fainting. We went to A&E and the doctor there said that you're never supposed to give them to children :S :S

Naikon · 09-01-2011 05:53PM

Yes, and I/they chose to report it

Biggins wrote: »

Father - left implements inside him after an operation. After effects: lung problems, constant infections, blood in the urine all the time, and loads more over 6 to 18 months of pure hell.
Daughter: Mis-diagnosed one complaint and failed to completely see another.
Brother: Starved of oxygen because the trainee nurse managed to wrap a cord around his head at birth. Effect: permanent brain damage and permanent epilepsy fits (grand-mal type. The worst kind.)
Wife: Early birth, went to hospital - nurses wanted to send her back home, said it was nothing. While waiting for lift - she lost the baby in a room. (thats the short clean version)
Myself: Missed numerous infections, though it was just me wanting off school at the time!
Effect: Infection nearly killed me in 6 hours. Got to my heart and lungs. Parts were so badly damaged, it took years to recover.
(A junior doctor and his senior doctor father BOTH covered up for each other)

And thats only the start...

Some were reported, some were not by my parents who thought at the time "it was not the done thing!"

**** me. That is some serious, serious stuff, Biggans. Hope your family(including yourself) is coping somewhat and more critical of doctors as a result. I could never properly forgive myself in those cases, even if it was not intentional.
For the record, yes, there has been medical cockups I have been involved in. Nothing like the above.

Medical cockups: more common than officially recognised?

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