Statistics show that prosecutions against doctors for gross negligence manslaughter are increasing and the latest data published by the Department of Health (DoH) on medical “never events” suggest that gross medical negligence may also be on the increase.
According to government guidelines a “never event” occurs when an avoidable medical error results in a patient’s permanent injury or death. The current list of never events is reproduced at the end of this article. A medical error that could have been avoided is never acceptable but one that falls into the category of never events can have devastating consequences for a patient and his or her family.
Whilst there is never any justification for medical negligence, treatment that is grossly negligent is at the worst end of the spectrum. It is treatment so bad that it warrants criminal prosecution. The occurrence of a medical error that should never occur therefore can be regarded as gross negligence.
The DoH never events data shows an increase in the number of never events reported to SHAs (strategic health authorities) from 166 in 2010/11 to 326 in 2011/12. Separate figures for events reported to the NRLS (National Reporting and Learning Service) show an increase from 56 in 2010/11 to 163 in 2011/12. Do these figures mean that gross medical negligence is on the increase? The answer is we don’t know and that is because the data collection is flawed.
The DoH are quick to defend the apparent increase by stating that the list of never events has been increased from 8 to 25 in 2011 and that may be skewing the figures.
They also say that there may be duplication between the SHAs and NRLS’ figures as some events may have been reported to both. Neither of these points is much of a defence to the apparent increase and it is worrying that a true picture cannot be gained from the data.
The figures may actually be higher than they appear because it is recognised that a number of never events go unreported, sometimes only coming to light through a patient’s complaint about their treatment.
Is gross medical negligence increasing? The answer is we don’t know but the occurrence of even one never event is not acceptable. There is ample evidence from the statistics that the current system of preventing such events is not working and the reasons for this need to be analysed without delay in order to protect patients.
9th November 2012
List of Never Events
1. Wrong site surgery
2. Wrong implant/prosthesis
3. Retained foreign object post-operation
4. Wrongly prepared high-risk injectable medication
5. Maladministration of a potassium-containing solution
6. Wrong route administration of chemotherapy
7. Wrong route administration of oral/enteral treatment
8. Intravenous administration of epidural medication
9. Maladministration of insulin
10. Overdose of midazolam during conscious sedation
11. Opioid overdose of an opioid-naïve patient
12. Inappropriate administration of daily oral methotrexate
13. Suicide using non collapsible rails
14. Escape of a transferred prisoner
15. Falls from unrestricted windows
16. Entrapment in bedrails
17. Transfusion of ABO-incompatible blood components
18. Transplantation of ABO incompatible organs as a result of error
19. Misplaced naso- or oro-gastric tubes
20. Wrong gas administered
21. Failure to monitor and respond to oxygen saturation
22. Air embolism
23. Misidentification of patients
24. Severe scalding of patients
25. Maternal death due to post partum haemorrhage after elective caesarean section