 The cost of spinal claims is largely a reflection of the severe damage that can occur on the rare occasions when things go seriously wrong when surgeons are operating close to the spinal cord |
| Dr Karen Roberts | The Medical Defence Union, the UK’s biggest provider of medical indemnity and insurance to doctors, paid out nearly £9million in damages and legal costs to compensate patients harmed as a result of spinal surgery in the independent sector over a recent ten year period.
The MDU’s analysis of 255 claims from orthopaedic surgeons’ independent practice, published in the latest Independent Practitioner* magazine, revealed that spinal surgery was the most expensive category of settled orthopaedic claims and the most common, comprising nearly a quarter of the total (22 per cent). The 56 spinal procedure claims arose following procedures such as reducing pressure on the spine (decompression), excision of part or whole of an intervertebral disc (discectomy) and fusing two or more spinal vertebrae (spinal fusion). Claims from knee surgery such as joint replacements and arthroscopies (to inspect problems inside a joint) were almost as common with 55 cases, while hip procedures - mainly replacements - accounted for 49 cases.
| The number of settled claims remains small compared to the thousands of procedures carried out in the UK each year but the MDU believes it is important to look at the reasons why things can go wrong so that we can alert members to the possible pitfalls of orthopaedic procedures |
| Dr Karen Roberts | Dr Karen Roberts, author of the study, said:
“The cost of spinal claims is largely a reflection of the severe damage that can occur on the rare occasions when things go seriously wrong when surgeons are operating close to the spinal cord. In the UK, compensation is calculated according to what it costs to restore the patient to the position they would have been in had the negligence not occurred rather than the gravity of any alleged negligence, and these patients may need medical care for the rest of their lives, which has to be provided privately.
“The number of settled claims remains small compared to the thousands of procedures carried out in the UK each year but the MDU believes it is important to look at the reasons why things can go wrong so that we can alert members to the possible pitfalls of orthopaedic procedures. We also advise doctors on ways to reduce the possibility of an error occurring in the first place. For example, the importance of performing simple manual identification checks and ensuring the operation site is properly marked to help ensure procedures are carried out on the correct side, site or level as wrong site incidents were found to be a particular problem in spinal and knee surgery.
The size of settlements across the orthopaedic specialty ranged from £800 for a retained swab to just over £1million which was awarded to a patient who suffered partial paralysis following shoulder surgery. Overall, the most common reasons for claims were an unsatisfactory outcome (49 cases), missed or incorrect diagnosis (33 cases), nerve damage (32 cases) and surgery being carried out on the wrong site or the wrong procedure being carried out (26 cases).
The MDU published risk management advice to its orthopaedic surgeon members, based on the findings of the study, including:
- Communication - advise patients of the risks and benefits of undergoing surgery, the complication rates and any other treatments available, including the option of no treatment.
- Diagnosis - take a thorough clinical history and examine all areas that could have been injured, ensuring appropriate investigations are carried out and results reviewed. Make a note of the initial diagnosis and management plan in the record. Be prepared to reassess the diagnosis if symptoms fail to improve.
- Post-operative complications - ensure patients are carefully monitored post-operatively and that patients themselves are aware of the signs of complications and what steps to take in problems arise after their discharge from hospital.
- Retained items - ensure that swab, instrument and needle-counting policies are strictly adhered to and disposable items checked before use.
The following are examples of the types of orthopaedic cases settled by the MDU. The composite case histories are based on real files drawn from the MDU's analysis but the details have been changed to protect the confidentiality of patients and the anonymity of members.
- An elderly patient underwent a hip replacement but suffered recurrent dislocations following the operation and then had to undergo two further procedures. The claim was settled for £60,000 plus legal costs.
- A middle-aged patient suffered nerve damage during a discectomy which resulted in bowel and urinary problems. The claim was settled for £180,000 plus legal costs.
- A 25-year-old man underwent a knee arthroscopy after a football injury. Following the operation, he contracted an infection at the operation site but this was not diagnosed for several days and he then had to have a skin graft. He received £9,000 compensation.
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