NHS Litigation Authority Database Research Articles

Analysis of 11 years of clinical negligence claims in esophagogastric cancer in England

In the National Health Service (NHS), clinical negligence claims and associated compensations are constantly rising. The aim of this study is to identify the size, trends, and causes of litigations claims in relation to esophagogastric (EG) cancer in the NHS. Data requests were submitted to the NHS Litigation Authority (NHSLA) for the period of January 2003 to December 2013. Data were reviewed, categorized clinically, and analyzed in terms of causes and costs behind claims. In this time period, there were 163 claims identified from the NHSLA database. Ninety-five (58.3%) claims were successful with a pay out of £6.25 million. An increasing overall claim frequency and success rate were found over the last few years. Majority of the claims were from gastric cancer 84 (88.4%). The commonest cause of complaint in successful claims was delay or failure in diagnosis (21.1%) and treatment (17.9%). There were only 10.5% successful intraoperative claims, of which 50% were due to unnecessary or additional procedures. The frequency and success rates of malpractice claims in EG cancer are rising. The failure or delay in diagnosing and treatment in EG malignancy are the common cause for successful litigation claims. The findings further reinforce the need to improve early diagnosis.

The cost of adverse events from knee surgery in the United Kingdom: An in-depth review of the National Health Service Litigation Authority database

BackgroundThere has been a significant rise in the number and value of claims against the National Health Service (NHS), with limited studies on litigation in orthopaedic surgery and none in knee surgery alone. We aimed to examine claims against the NHS involving all aspects of knee surgery with respect to costs and trends. Clinical relevanceTo raise awareness of the reasons for litigation in knee surgery, thus potentially improve patient care and reduce future claims. MethodsWe analysed the NHS litigation authority (NHSLA) database for all orthopaedic surgery claims reported to the NHSLA between 2005 and 2010, with calculation of litigation success rates and odds ratios for those relating to knee surgery. ResultsThere were 515 cases identified from the 4609 orthopaedic cases in the NHSLA database (11.2%): 298 (58%) involving total knee replacements (TKRs), 11 (2%) involving unicondylar knee replacements, and 90 cases (30%) remaining open. The total pay out for closed cases was £10.45 million and amputation following TKR resulted in the highest single pay out. Litigation success rates for claimants were highest for retained drains (100%), incorrect prosthesis/prosthesis size (78%), renal failure (75%), poor outcome requiring further surgery (74%) and malalignment (71%). There were also 60 cases of delayed diagnosis which resulted in pay outs totalling £2.90 million. Based on these data, projected future pay out costs for the open TKR cases were estimated to be £2.71 million. ConclusionLitigation success rates for TKR were highest following technical errors such as malalignment compared to events less under the surgeon's control, such as infection. The number of claims involving incorrect prosthesis/size continues to be of concern. Despite the increased availability of imaging modalities, missed diagnosis also resulted in substantial pay outs.

A NATIONWIDE ANALYSIS OF LITIGATION IN NEUROLOGICAL PRACTICE

ObjectivesWe set out to study the nature of successful litigation claims in order to inform neurologists and neurosurgeons about hazardous areas within their specialties and potentially alter clinical practice.DesignNationwide retrospective...

A nationwide analysis of successful litigation claims in neurological practice.

ObjectivesNeurological practice has previously been highlighted as a high-risk speciality with regard to malpractice claims. We set out to study the nature of these claims in order to inform physicians about hazardous areas within their speciality and potentially alter clinical practice.DesignNationwide retrospective analysis of successful neurology and neurosurgery claims over a 17-year period.SettingWe studied all successful claims occurring between 1995 and 2012 using the NHS Litigation Authority database, which collects data on claims made against clinicians practising in England and Wales.ParticipantsFour hundred and twenty-three successful claims were identified during the study period.Main outcome measuresThe errors involved, the patient groups affected, the resulting mortality and the litigation payments.Results63.1% of claims were due to negligence in neurosurgical care, whilst 36.9% were due to negligence in neurological care. Litigation payments were significantly higher in neurosurgery compared to neurology cases. Diagnostic error was the most common cause of litigation. The disease categories with the highest numbers of successful litigation claims were spinal pathology, cerebrovascular disease including subarachnoid haemorrhage, intracranial tumours, hydrocephalus and neuropathy/neuromuscular disease.ConclusionsThis is the first study of successful litigation claims against the NHS for negligent neurological or neurosurgical care and provides data to help reduce risk and improve patient safety.

Medical malpractice claims in relation to colorectal malignancy in the National Health Service

Under the current increased financial constraints affecting the National Health Service (NHS), clinical negligence claims and associated compensations are constantly rising. Our aim was to identify the magnitude, trends and causes of malpractice claims in relation to a common pathology such as colorectal malignancy in the NHS. Data requests were submitted to the NHS Litigation Authority (NHSLA) and to the Medical Defence Union (MDU) and Medical Protection Society (MPS). Data were reviewed, categorized clinically and analysed in terms of causes and costs behind claims. Data from the MPS and MDU were unavailable. In all, 169 claims were identified from the NHSLA database between 2003 and 2012; 123 (73%) cases had been closed, 80 (65%) of which were successful. An increasing overall claim frequency and success rate were found over the last few years. Total litigation expenses were £8.6 million, with 39% paid out as legal expenses. The commonest cause of complaint in successful claims was in relation to diagnostic delays or failures (58%, £5.1 million), with a delay or failure by the clinician to take action in response to an abnormal investigation result being a major factor. The occurrence of peri-operative complications (20%, £1.6 million) was the second commonest cause. Average frequency and success rates of malpractice claims in secondary care in the NHS are rising, leading to significant overall payouts. The failure or delay in diagnosing colorectal malignancy or its postoperative complications is a common cause behind malpractice claims. Improvement in these areas could enhance patient care and reduce future claims.

A Three-Step Technique to Correctly Identify the Trapezium without the Need for Fluoroscopic Imaging

Thumb pain secondary to degenerative arthritis of the carpometacarpal joint of the thumb is a common disabling condition. The key principles of successful basal joint arthroplasty involve trapezial excision, which is required for pain relief, with or without some form of ligament reconstruction. The majority of basal joint reconstructive procedures include partial or complete trapeziectomy, with and without some types of tendon transfer and ligament reconstruction and with or without tendon interposition and/or temporary wire stabilisation. When performing a trapeziectomy, it is important to identify the trapezium correctly before excising it. Excision of the incorrect bone during trapeziectomy for basal joint arthritis of the thumb has been reported within the NHS Litigation Authority database. We describe the senior author's routinely used three-step technique to confirm the identity of the trapezium before excision. This technique has been reliably used in over 300 cases with successful excision of the trapezium without intraoperative fluoroscopy.

Can we use medicolegal experience to improve management of patients with subarachnoid haemorrhage?

Subarachnoid haemorrhage (SAH) causes high mortality and morbidity. Learning lessons from litigation are a standard aspect of risk management in many industries. This study, therefore, examined data from the NHS Litigation Authority (NHSLA) on SAH to determine its usefulness in informing clinical risk management. Under the Freedom of Information Act, the NHSLA database was interrogated for cases of SAH. Data were retrieved from 1995 to 2008. Over this period, 126 cases relating to SAH were reported, 102 of which were closed. Damages were awarded in 64 cases, totalling £13.5 million. Seven claimants, associated with a high cost of continuing care, were awarded more than £0.5 million. Mean damages awarded were circa £211k. The majority of successful claims related to failure/delay to diagnose or treat. On average, 10 cases of SAH were reported annually to the NHSLA. The rate of successful litigation was circa 1:769 presenting cases of SAH. Using lessons learned from litigation to manage risk requires good quality-supporting data. Information in the NHSLA database is limited and precludes detailed root-cause analysis. The initial concept of the NHSLA database as a claims management tool perhaps represents a lost opportunity.

Toward safer practice in otology: A report on 15 years of clinical negligence claims

To determine the characteristics of medical negligence claims arising from otological practice. Retrospective analysis of medical negligence claims contained in the National Health Service Litigation Authority (NHSLA) database. Claims relating to otology and neurotology between 1995 and 2010 were obtained from the NHSLA database and analyzed for cause of injury, type of injury, outcome of claim and costs. Over 15 years there were 137 claims in otology, representing 26% of all the claims in otolaryngology. Of these, 116 have been closed, and 84% of closed claims resulted in payment. Of the 97 successful claims, 63 were related to operative complications. This included six cases of wrong side/site surgery, and 15 cases of inadequate informed consent. The most common injuries claimed were hearing loss, facial paralysis, and additional/unnecessary surgery. Middle ear ventilation and mastoid surgery were the procedures most commonly associated with a successful claim. There were 15 successful claims of misdiagnosis/delayed diagnosis, with chronic suppurative otitis media the condition most frequently missed. There were nine successful claims related to outpatient procedures, of which seven were for aural toilet and six claims of medical mismanagement, including three cases of ototoxicity from topical medications. There were also four successful claims for morbidity due to delayed surgery. This is the first study to report outcomes of negligence claims in otology. Claims in otology are associated with a high success rate. A significant proportion of claims are not related to surgery and represent areas where safety should also be addressed.

POS06 Subarachnoid haemorrhage: 13 years of litigation in the NHS

IntroductionSubarachnoid haemorrhage (SAH) causes high mortality and morbidity. Learning lessons from litigation is a standard aspect of risk management in many industries. This study, therefore, examined data from the NHS...

PTU-020 Endoscopy-related litigation in UK: causes, costs and outcome

<h3>Introduction</h3> When endoscopy-related complications occur, patients may seek legal redress. Although the majority of complaints in the UK are resolved locally by NHS Trusts, since its inception in 1995 approx 4% of cases referred to the NHS litigation authority (NHSLA) required settlement in the court. <h3>Aims</h3> To investigate the annual frequency of endoscopy-related claims, the endoscopic procedures and complications that result, and the outcome of claims handled by NHSLA. To assess how these claims may inform risk management strategies. <h3>Methods</h3> A search of the computerised NHSLA database was undertaken to extract the endoscopy related claims handled between 1995 and 2008. Search keywords used were “endoscopy”, “ERCP”, “colonoscopy”, “gastroscopy” and “PEG”. Details available included year of incident and claim, incident summary, clinical outcome, success/failure of claim, and financial settlement. <h3>Results</h3> 418 endoscopy-related negligence claims submitted to NHSLA during this period, which comprised 17% of total NHSLA claims requiring settlement in court. Of 353 claims that have been settled to date, 175 (49.6%) were successful, resulting in total costs of £6 773 686 and 178 (51.4%) were unsuccessful but still incurred legal costs of £258 656. Claims reached a peak in 2002–2003. Upper GI endoscopy and colonoscopy were associated with 65% of settled claims, but ERCP was the procedure most frequently linked to the 74/353 (21%) of claims related to a fatal outcome. Factors underlying claims following fatal complications included: inappropriate endoscopic treatment/direct complication (51%); delay in recognising complication±its management (39%); consent issues (6%); and medication issues (4%), including incorrect management of anticoagulation. <h3>Conclusion</h3> As &gt;500 000 endoscopies/year are performed in UK, the proportion of endoscopies that result in court proceedings through the NHSLA is tiny but the relative human and financial cost is high. Although the data suggest that claims are falling this may be misrepresentative, as claims can be made several years after the incident and the NHSLA has recently revised policies. Although successful claims resulted from direct endoscopic complications (eg, perforation, haemorrhage), many related to delays in the diagnosis and appropriate management of endoscopic complications, with adverse, and sometimes fatal, consequences. The findings may further inform the need for robust systems within endoscopy units to identify early and in particular late endoscopic complications.

Litigation related to drug errors in anaesthesia: an analysis of claims against the NHS in England 1995–2007

Ninety-three claims (total cost 4,915,450 pounds) filed under 'anaesthesia' in the NHS Litigation Authority database between 1995 and 2007, alleging patient harm directly by drug administration error or by an allergic reaction, were analysed. Alleged errors were categorised using systems employed by the National Coordinating Council for Medication Error Reporting and Prevention, the American Society of Anesthesiologists Closed Claims Project and the UK Health and Safety Executive. The severity of outcome in each claim was categorised using adapted National Patient Safety Agency definitions. Sixty-two claims involved alleged drug administration errors (total cost 4,283,677 pounds) and 15 resulted in severe harm or death. Half alleged the administration of the wrong drug, in most (16) a neuromuscular blocker. Of the claims alleging the wrong dose had been given (25), nine alleged opioid overdose including by neuraxial routes. The most frequently recorded adverse outcomes were awake paralysis (19 claims; total cost 182,347 pounds) and respiratory depression requiring intensive care treatment (13 claims; total cost 2,752,853 pounds). Thirty-one claims involved allergic reactions (total cost 631,773 pounds). In 20 claims, the patient allegedly received a drug to which they were known to be allergic (total cost 130,794 pounds). All claims in which it was possible to categorise the nature of the error involved human error. Fewer than half the claims appeared likely to have been preventable by an 'ideal double checking process'.

Do falls and falls-injuries in hospital indicate negligent care—and how big is the risk? A retrospective analysis of the NHS Litigation Authority Database of clinical negligence claims, resulting from falls in hospitals in England 1995 to 2006

Background:Accidental falls are very common in older hospital patients—accounting for 32% of reported adult patient safety incidents in UK National Health Service (NHS) hospitals and occurring with similar frequency in...

A decade of clinical negligence in ophthalmology

BackgroundTo present an overview of the clinical negligence claims for ophthalmology in the National Health Service (NHS) in England from 1995 to 2006. To compare ophthalmic subspecialties with respect to claim numbers and payments.MethodsAll the claims on the NHS Litigation Authority database for ophthalmology for the period 1995 to 2006 were analysed. Claims were categorised by ophthalmic subspecialty, and subspecialties were ranked according to numbers of claims, total damages paid, average level of damages and paid:closed ratio (a measure of the likelihood of a claim resulting in payment of damages).ResultsThere were 848 claims, 651 of which were closed. 46% of closed claims resulted in payment of damages. The total cost of damages over the period was £11 million. The mean level of damages was £37,100. Cataract made up the largest share of claims (31%), paediatric ophthalmology had the highest mean damages (£170,000), and claims related to glaucoma were most likely to result in payment of damages (64%).ConclusionClinical negligence claims in ophthalmology in England are infrequent, but most ophthalmologists will face at least one in their career. Ophthalmic subspecialties show marked differences with regard to their litigation profiles. From a medical protection perspective, these results suggest that indemnity premiums should be tailored according to the subspecialty areas an ophthalmologist is involved in.