Real life examples of medico-legal issues for locum doctors

This article has been written in collaboration with MDDUS, one of the leading medical defence organisations. They have offered a £50 discount to locum doctors who join them using a voucher code from Messly, which you can read more about here.

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Following on from our article which breaks down the kinds of legal issues which can arise for locum doctors, we have asked Dr Richard Brittain, medical and underwriting adviser at MDDUS, to share some of his personal experiences of cases that he was directly involved with while working in locum roles.

Example 1: Sued by a barrister

After my F2 year I worked in an emergency department and reviewed a patient with arm swelling. I under took various investigations, including Dopplers and CT scanning but there was no obvious cause found. After discussion with the consultant, the patient was discharged with worsening advice. He was later found to have a DVT and sued the hospital in a clinical negligence case, suing for damages for significant loss of earnings, arising from his apparent inability to continue working as a barrister. Many months later, I was asked to provide a statement for the hospital’s legal team.

This was the first occasion I had been asked to write a formal statement for an adverse incident and I found real benefit in discussing the case and my statement with my medical defence organisation.

They reassured me that I wasn’t being sued personally and that the steps I had taken meant that my involvement in the case would be very limited. The crux of the matter came down to the discussions I had with the consultant and the subsequent decisions made, and the case was settled out of court. My MDO advised correctly that my only involvement in proceedings was writing this initial statement, since it contained all of the required information.

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Example 2: Cauda equina syndrome

The first complaint case I was involved with also arose from locum work in the emergency department.

A patient presented with leg swelling and I undertook a history and examination. Nothing was particularly concerning and the patient was discharged. A few weeks later I received a call from the ED consultant. I was very upset to learn that the patient had gone on to develop cauda equina syndrome (CES) and was questioning why this was not diagnosed earlier. The patient’s recollection was that he could not walk when he presented to the ED.

I was very much aware of the classic presentation of CES and confused by the disparity between my recall of the case and the patient’s account. After I provided my statement, which included reference to the normal neurological examination I had documented, the hospital’s complaint investigation concluded that the patient had been experiencing early symptoms of CES, in the form of a heaviness sensation in his legs. This was not evident through neurological examination.

More significant symptoms had developed after discharge and on further presentation to out-of-hours GP services. My management of the case was judged to have been appropriate, based on my documentation and a comprehensive statement produced with the support and guidance of my MDO. On this occasion I felt supported by the hospital but having that additional layer of support and detailed guidance was a real benefit in seeing me through the process.

Example 3: Stroke in a young person

This case involved an internal significant incident investigation, undertaken when concerns had been raised about the management of a patient found to have minor stroke arising from carotid artery dissection.

A medical consultant had raised concerns when the patient was found not to have been transferred to the hyper acute stroke unit. This was the first time that concerns had been raised directly by a senior member of staff in regard to my management, and the independent support of my MDO was invaluable.

I was able to write a report which clarified the numerous conversations I had regarding this patient. These included taking advice from the hyper acute stroke unit. It was this advice that meant that the patient was not immediately transferred. In retrospect, this was the wrong decision but I was able to evidence how this had come to pass and the incident was closed.

Thankfully I have never personally been involved in cases that required individual representation for myself, such as can arise in inquests (if there is conflict between a doctor and the employer), GMC referrals, disciplinary cases and criminal investigations.

However, having now worked for two MDOs over the past decade, I have seen many such cases arise and know that the support MDDUS and other MDOs are able to provide is of vital importance to both junior and senior doctors.