A patient's unexpected death can be devastating both for the relatives and the treating doctors.

Sadly, the doctor's conduct is often scrutinised in these circumstances, and in a small number of cases doctors can face police investigations into allegations of gross negligence manslaughter following such incidents in England, Wales and Northern Ireland.

It's worth noting that while there's no offence of gross negligence manslaughter in Scotland, if a doctor were to be prosecuted in a 'medical manslaughter' case in Scotland, the offence might be charged as culpable homicide.

Fortunately in our experience only 10% of investigations or fewer result in a criminal prosecution, and only about 25% of prosecuted cases we've been involved in have resulted in conviction.

However, the investigation can be lengthy and takes a considerable toll on the doctor involved, both emotionally and professionally.

Police investigations rarely take less than six months and can take several years. During that time, the GMC may impose restrictions on your practice due to the seriousness of the allegations.

Responding when something goes wrong

Understanding how to respond when the worst happens can help reduce the risk of facing a criminal investigation. Consider the following steps.

Work within your capabilities. If you're not sure about something, seek advice and/or supervision.
Understand and follow any local procedures that are part of the clinical governance framework where you work. Be prepared to justify any deviation from relevant local and national guidelines.
Conduct and document a full and complete clinical assessment of patients, including important negatives as well as positive symptoms and signs. It's easy to miss something when time is limited.
Be flexible in your thought processes. When treating a patient, be ready to stand back and consider all available information. If something doesn't seem quite right, it probably isn't, and you may need to consider a wider differential diagnosis, or a referral.
Flag up systems or practices you believe are unsafe and address them if you can. For example, if there aren't enough resources or poor system design means you can't provide a safe and effective service to patients, raise this formally and take a personal interest to make sure there is progress.
If you have management responsibilities, make sure serious incident investigations are properly conducted, with accurate minutes that deal with the relevant issues. Identify the problem and solution, rather than the blame. This will help the whole team learn lessons from serious incidents in the interest of patient safety. It could also prevent mistakes recurring that could lead to a manslaughter investigation.
Think about patient safety in your CPD planning. Some of the mistakes that lead to prosecutions have happened before and raising your awareness of them will have obvious benefits. Seek out relevant patient safety courses, conferences and initiatives.

After something goes wrong

Here's what to do if something does go wrong and a patient dies or is seriously injured, and there are concerns about your involvement with the patient's care.

Get advice from your medical defence organisation at the earliest opportunity.
Don't try to produce a statement/information for any investigation without access to the clinical records and advice from your medical defence organisation or a solicitor instructed by them.
Never make the mistake of thinking that the police won't know the subject matter - any interviews are likely to be conducted by skilled officers.
For the best reasons, you're unlikely to have experience of a police interview. Contact your defence organisation for help and assistance, including specialist representation. Be ready to ask for and follow your solicitor's advice. It's your right to consult your solicitor and it doesn't make you look guilty if you do.

Avoiding a medical manslaughter investigation

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