Medical litigation has reached crisis proportions, says doctor

The rate of medical litigation has reached crisis proportions here, according to the Master of the National Maternity Hospital in Holles Street, Dublin . The problem was particularly acute in obstetrics, Dr Declan Keane added.

At a conference on clinical risk management [particularly in obstetrics and midwifery] in Dublin, Dr Keane said a doctor in Ireland was three times more likely to be sued than his or her counterpart in the UK, and obstetricians accounted for more than 50 per cent of the Medical Protection Society's [the main insurer for medical practitioners] costs. Obstetricians make up just 3 per cent of its membership.

"With no legal attempt to control the problem, such as legislative caps on damage awards or pre-trial screening with structured settlements, there is an obvious need for a risk manager within obstetrics and midwifery," said Dr Keane.

Prof John Bonnar, of St James's Hospital, said that, while Ireland had one of the lowest rates of maternal mortality in Europe at 1.83 per 100,000 compared with 9.64 in the Netherlands, 9.34 in France and 7.72 in Britain "the courts remain a place of considerable anxiety and distress for doctors". Furthermore, legal claims in this State were among the highest in the English-speaking world.

Earlier Mr Jerry O'Dwyer, Secretary-General of the Department of Health and Children, said the main reasons people took actions against the obstetric profession were foetal death, birth trauma, surgical swab retention and complications arising from Caesarean sections.

Dr Andrew Symon, of Tayside University in Britain, outlined a number of incidents that happened in maternity wards due to lack of supervision of patients, lack of supervision of less qualified medical staff, lack of communication between staff or between staff and patients.

One involved a midwife admitting "quite freely" she had "spent many hours in watching a foetal heart monitor which she was insufficiently trained to interpret".

Another involved three nursing staff monitoring a baby's heart beat and the monitor showing a flat line [indicating no heartbeat]. An expert's report on the case commented: "The nursing staff faithfully recorded the events but apparently failed to appreciate the significance of the flat trace, and therefore did not report it to the medical staff."

Other problems included junior doctors being allowed to work in the maternity ward without adequate supervision, inadequate chart-keeping, women being left in labour unsupervised, flippant treatment of concerned patients and their families and lack of respect for midwives by doctors. All of these could contribute to unnecessary mistakes and so litigation, Dr Symon said.

Each speaker at the conference stressed that an improvement in the quality of patient care was the main aim of a risk management strategy.

Dr Keane said the risk management committee at Holles Street set up in June last year was still "in its infancy". Senior members of staff remained to be convinced of its value, he said.

Though there had already been a definite improvement, it remained to be seen whether the committee would help to reduce legal claims.