A&E blunders responsible for one in seven medical claims
Monday November 23 2009
MISTAKES made mostly by junior doctors in hospital A&E departments now account for one in seven cases of medical negligence brought by patients.
Of those cases which were settled in recent years -- without a full court hearing -- 94pc were due to the failure of the doctor to make a correct diagnosis, new figures reveal.
The figures from the State Claims Agency, obtained by the Irish Independent, come in the wake of the tragic case of Adam O'Connor, the baby from Mallow, Co Cork, whose leukaemia was dismissed as colic and constipation by junior doctors at Cork University Hospital (CUH).
An internal review is now under way at the hospital into how little Adam, who died in February, was misdiagnosed.
His parents had repeatedly taken him to see GPs and out-of-hours doctors, rang nurse helplines and twice brought him to CUH's accident and emergency unit.
However, an analysis of cases brought against some of the country's 35 hospital emergency departments in recent years by the State Claims Agency, shows that emergency medicine is responsible for 15pc of all medical negligence claims.
Of the 203 cases examined, 25pc were settled out of court and in the vast majority of these cases, the blunder was a failure to diagnose.
Three-quarters of these misdiagnosis mistakes related to broken bones or other musculo -skeletal conditions.
A senior house officer -- a grade of junior doctor -- was most likely to be involved (74pc) as against 14pc for registrars and 8pc for consultants.
The agency pointed out that it is the senior house officer grade of junior doctor that most often evaluates and treats the majority of patients in emergency departments.
In more than one in two of the errors made by these junior doctors it was found the root cause related to skill, knowledge and competence.
Independent experts who examined X-rays -- which the doctor had misread -- found the fracture was visible but missed by the medic, making the claim indefensible and leading to an out of court settlement.
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The agency pointed out that around 3,300 patients attend hospital A&Es daily in 35 of the country's 51 acute hospitals.
Given that the majority of these are seen by junior doctors, it is important to have adequate training and supervision when it comes to interpreting X-rays.
Follow up with more senior colleagues needs to be encouraged and there should be an ongoing emphasis on education and feedback.
A portfolio of X-rays which have been at the centre of different interpretations should be compiled for staff review.
Monthly meetings should also be held to review errors in diagnosis, with all members of the team.
The report also stressed that "communication with the patient with regard to the difficulties interpreting the radiograph are also important as it was found they were less likely to be upset in the event they were called back if they received adequate information during their first presentation".
- Eilish O'Regan Health Correspondent
Irish Independent
