Medicine has an almost unique place in the professions because of the risk a patient might die from either lack of the right treatment, or receiving the wrong treatment.
The unexpected death of a patient is a devastating experience both for the deceased's relatives and the treating doctors. Usually these tragic events follow a combination of errors, coupled with system failures. Sadly, however, it is often the conduct of an individual doctor that is scrutinised and more and more doctors are facing police investigation for gross negligence manslaughter following such incidents.
The number of manslaughter investigations is increasing, but fortunately in the MDU's experience only 10% or fewer result in a criminal prosecution, and only about 25% of our prosecuted cases result in conviction.
However, the investigation alone can be lengthy and invariably takes a considerable toll on the doctor involved, both emotionally and professionally.
Police investigations rarely take less than six months and can take a number of years. During that time, because of the seriousness of the allegations, doctors can usually expect to have restrictions on their practice imposed by the GMC.
The following steps can help doctors to reduce the risk of facing a criminal investigation or to know how to respond if the worst happens.
- Work within your capabilities. If you're not sure about something, seek advice or supervision.
- Understand and follow any local procedures that are part of the clinical governance framework. Be prepared to justify any deviation from national guidelines.
- Conduct and document a full and complete clinical assessment of patients which will include negative as well as positive symptoms and signs. It's easy to miss something when your time is under pressure.
- 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. 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.
- 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 interests of patient safety. It could also help prevent a recurrence of mistakes 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 personal awareness of them will have obvious benefits; so seek out courses, conferences and initiatives relevant to general practice.
If something does go wrong and a patient dies or is seriously injured:
- Get advice from your medical defence organisation at the earliest opportunity.
- Don't try to produce a statement/information for any investigation without the notes or 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 of reasons you are very unlikely to have experience of a police interview. Contact your defence organisation to secure assistance, including specialist representation. Be ready to ask for and follow your solicitor's advice. It is your right to consult your solicitor and it does not make you look guilty if you do.
This guidance was correct at publication 03/05/2019. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.