Case Study  1

Orthopaedic surgeon in a shoplot practice performs an “Anterior transposition of the ulnar nerve” on a 58-year old female with Hypertension, under field block with ½ % marcain-adrenaline.  Good anaesthesia to the field of surgery was obtained but the patient arrested while operation was in progress.  Patient  was intubated and resuscitated.  There was no in-house anaesthetist.  “Locum” anaesthetist called in. Resuscitation was unsuccessful. Results of post-mortem autopsy:  ischaemic heart disease. 

The Orthopaedic surgeon concerned was practising with no medical indemnity!  Orthopaedic surgeon contacted MDM.  He was advised to settle out of court after the bereavement period.   Family of patient settled for (?) RM15,000.00 with  no admission of liability.

Comments

(i)                Failure to ‘buy’ medical indemnity.

(ii)             Shoplot practice inadequately equipped to provide the required care for such surgery.

(iii)           Amount of marcain-adrenaline used could have been excessive.

(iv)           Such major surgery should be done in a hospital setting for back-up, bearing in mind the risk factors;  patient should have been assessed by a physician because of her age and hypertension. (After the incident the surgeon signed up with MDM!)

(v)              Surgeon had contacted lawyer earlier and was told not to settle.

(vi)           58-year old – no award for loss of income, if the case had been pursued in Court.

Case Study  2

Obstetrician, non-MDM member, called for advice.  Six years ago whilst working in a medical centre, he delivered a full term normal baby. The baby was never seen again since that discharge.  Six years later, he received a medical negligence claim from the solicitors for allegation of brain damage (cerebral palsy).  The obstetrician has left the medical centre to set up his own medical practice.  

MDM advised obstetrician to return to the medical centre to retrieve the medical records, make photocopies for himself and advise the medical centre to keep that file under lock and key.  He was advised to contact his foreign-based MDO immediately.

Comments

When leaving a centre to set up your own practice, it is advisable to have a copy of records of patients you have treated, especially in obstetrics and paediatrics.  The ‘tail’ here could be as long as 24  years.

[ Note: the time scale of the Australian case of Diamond v Simpson where the highest award ever in a medical negligence (or personal injury) claim was made – Aust $ 14.2 million in 2001 ] [1]

Case Study  3

A physician, non-MDM  member, called for advice. 

He had treated a patient for chest pain.  The patient was evaluated and investigated (including ECG).  He was diagnosed to have pulmonary oedema and treated accordingly.

Six months later, the patient wrote to the CEO of the hospital alleging that the physician had misdiagnosed him.   He had a CABG done after the first physician treated him.  The CEO wrote to the physician for an explanation.  The physician then wrote to his foreign-based MDO’s solicitors for advice and how to reply to the CEO’s letter.

The solicitors were slow in responding and the CEO assumed that the physician was “hiding” something.

MDM advised him to reply to the CEO immediately, explaining the chain of events, giving the facts of the case, but no opinion. 

Comments

(i)                Immediate response from MDM to a non-member.

(ii)             Imperative that doctors reply as quickly as possible to any allegation – MDM can do this :  “HERE WHEN YOU NEED US”.

Case Study  4

The CEO of a hospital wrote to an MDM member, alleging that a patient had written a complaint against him.

CEO’s Allegation 1.   “…that you were rude and arrogant”,  and

CEO’s Allegation 2.  “…that you advised the patient to buy medication

 from  your private clinic.”

Member was advised by MDM to reply to the CEO asking for a copy of the patient’s letter. 

The CEO declined to give a copy.

Comments

  (i)   It is vital that a copy of the patient's letter be obtained

         to enable the doctor to "answer the charges".

 (ii)  CEO was being unfair.  The allegations may be his/her

         interpretation of the patient's letter.

(iii)  It is important to reply to the CEO to state that the

         allegations should be regarded as abstract since the

         patient's letter was not made available for inspection,

         and the context of the complaint was not made clear.

Case Study  5

A 59-year old female with thalassaemia was assisted by two aides to come down from the X-Ray table, when her left knee buckled and she fell. This occurred  in a shophouse-located private Radiology Centre. The patient sustained a supracondylar fracture of the left femur.

The Radiologist, an MDM member, arranged for the patient to be admitted to a private hospital to have the fracture surgically treated.  The Radiologist paid all the expenses.

Comments

  (i)  No medical negligence was involved. 

 (ii)  Patient could have claimed for accident liability insurance

         from the X-Ray unit.               

(iii)  Radiologist was commended by MDM for his quick action

         and good patient care        .

(iv)   All clinics are advised to buy public liability insurance.

Case Study 6

Non-MDM member treated a patient with laceration on the flexor surface of the left index finger.  There was no tendon injury or neurovascular damage.  Laceration cleaned, debrided and sutured.  Patient did not keep follow up.

Six months later patient confronted doctor that he now needs further surgery to release the fixed flexion contractures of the index finger.  Patient implied that the doctor was at fault and that the doctor should bear the expenses.

Comments

 (i)     All patients must be followed up with after a surgical

          procedure has been done.

 (ii)   If patient fails to keep appointments, patient must be

          contacted and informed to return;  and all these must

          be recorded.

(iii)   Scarring of wounds on the flexor surface of fingers is

          known to occur unless early mobilisation is instituted; 

          hence follow-ups are important for assessment.