By Lisa Cheyne, Medico-Legal Manager, SpecialistInfo
Image © Tero Vesalainen
By Lisa Cheyne, Medico-Legal Manager, SpecialistInfo
Hernia mesh complications
After a BBC investigation, the scale of patients living with hernia mesh complications has been revealed as shockingly high.
One in 10 people will develop a hernia and the most common treatment involves surgical mesh.
There have been between 90,000 and 100,000 hernia mesh operations in England each year since 2011-12, so if the complication rate is estimated to be 12-30%, up to 170,000 patients could have been adversely affected in the past six years.
Mesh has been increasingly used for hernia repairs since the 1990s, rather than traditional suture techniques, so the total number who have experienced complications since its introduction is thought to be much higher.
With the cost of treating those experiencing serious hernia mesh complications estimated to be upwards of £25,000 per patient, the cost to the NHS could be high.
Labour MP Owen Smith, who chairs the All Party Parliamentary Group on Surgical Mesh Implants, said he feared the UK could "potentially have another scandal on our hands".
"It reflects the flawed system we have in place," he said. "Neither the MHRA or the manufacturers have to follow up on problems”.
A spokesperson for the Royal College of Surgeons said “A recent 2018 study found that both mesh and non- mesh hernia repairs were effective for patients and are not associated with different rates of chronic pain. A minority of hernia mesh operations are associated with complications. However, it is also important to stress that such complications range dramatically from minor and correctable irritations to more serious complications.”
NHS trusts in England still have no consistent policy for guidelines on treatment or follow-up with patients.
Read More: https://www.bbc.co.uk/news/health-45604199
The Medico-Legal Conference – 16th May 2019, at the Queen Elizabeth Hall, South Bank, London
Tickets are now selling fast for SpecialistInfo’s ML Conference in London on 16th May 2019. Please visit the website for details of the programme and to book:
http://www.medicolegalconference.com/programme.html
Please contact nicola@specialistinfo.com for further information if you are interested in presenting or sponsorship.
Following his appointment as Chair of the Infected Blood Inquiry earlier this year, Sir Brian Langstaff and the Inquiry Team conducted a consultation on the Inquiry’s Terms of Reference and will investigate as follows:
What happened and why?
Impact on those infected and their families.
The response of Government and others.
Consent - whether and to what extent people were treated or tested, and their infection
status was recorded without knowledge or consent.
To examine the circumstances in which patients treated by the NHS were given infected blood and infected blood products, since 1970, and to what extent people given infected blood or infected blood products were warned beforehand of the risk that they might thereby be exposed to infection, and if so whether such warnings as were given were sufficient and appropriate.
The Inquiry will be holding meetings for people affected throughout the UK in the first months of 2019, ahead of the public hearings starting at the end of April.
Liz Carroll, chief executive of The Haemophilia Society, called on the inquiry to work diligently to "uncover the truth, bring justice and ultimately closure for victims and their families".
If the new inquiry finds culpability, it opens the door to victims seeking large compensation pay-outs through the courts.
Read more: https://www.infectedbloodinquiry.org.uk/
The Supreme Court unanimously allowed the above appeal alleging a breach of duty by the reception staff on the basis that the duty of care is owed by the respondent and it is not appropriate to distinguish, in this regard, between medical and non-medical staff
BACKGROUND TO THE APPEAL
The appellant, Michael Mark Junior Darnley, was struck on the head on 17 May 2010. A friend drove him to the A&E Department at Mayday Hospital, Croydon which was managed by the respondent, NHS Trust.
The trial judge found that at the A&E reception, the appellant informed the receptionist that he thought he had a head injury and that he was feeling very unwell. The receptionist told him that he would have to wait up to four to five hours before he could be seen by a clinician and that if he did collapse then it would be treated as an emergency. The A&E receptionists’ usual practice when a person with a head injury asked about waiting timeswould be to say that they could expect to be seen by a triage nurse within 30 minutes of arrival.
The appellant left after 19 minutes because he felt too unwell to remain and went to his mother’s home. He later became distressed and an ambulance was called. He was taken back to Mayday Hospital and a CT scan identified a large extradural haematoma. He was transferred to St George’s Hospital and underwent surgery the same night. Unfortunately, he suffered permanent brain damage in the form of a severe and very disabling left hemiplegia.
The appellant brought proceedings against the respondent alleging a breach of duty by the reception staff concerning the information he was given about the time he would have to wait and the failure to assess him for priority triage. The High Court dismissed the claim. The appellant appealed to the Court of Appeal. The appeal was dismissed by a majority on the grounds that neither the receptionist nor the health trust acting by the receptionist owed any duty to advise about waiting times, the damage was outside the scope of any duty owed, and there was no causal link between any breach of duty and the injury. The appellant appealed to the Supreme Court.
JUDGMENT
The Supreme Court unanimously allows the appeal and remits the case to the Queen’s Bench Division for assessment of damages. Lord Lloyd-Jones gives the sole judgment with which the other Justices agree.
CAUSATION
The appellant’s decision to leave was reasonably foreseeable and was made, at least in part, on the basis of the misleading information from reception staff. The trial judge made further findings of fact that, (1) had the appellant been told he would be seen within 30 minutes he would have waited, been seen by a doctor and admitted, and (2) had the appellant suffered the collapse at 21:30 whilst at the Mayday Hospital, he would have undergone surgery earlier and he would have made a nearly full recovery. Thus, the appellant’s departure did not break the chain of causation.
Read more: https://www.supremecourt.uk/cases/uksc-2017-0070.html
Following a successful mediation pilot scheme to resolve clinical claims, NHS Resolution’s new claims mediation service has been designed to support patients, families and NHS staff in working together towards the resolution of incidents, complaints, legal claims and costs disputes – avoiding the unnecessary expense, time, stress and potential emotional distress of going to court. The service will provide access to an independent and accredited mediator, selected from a panel drawn from a wide range of backgrounds.
Partners for its mediation service are:
The Centre for Effective Dispute Resolution (CEDR) and Trust Mediation Limited, appointed to mediate disputes arising from personal injury and clinical negligence incidents and claims.
Costs Alternative Dispute Resolution (CADR), appointed to mediate disputes arising from the recoverability of legal costs.
Read more at: https://resolution.nhs.uk/
Research commissioned by the General Medical Council (GMC) for its 2018 The state of medical education and practice in the UK report, published on 5 December 2018, reveals continued pressure on health services.
"Doctors are telling us clearly that the strain that the system is under is having a direct effect on them, and on their plans to continue working in that system." Professor Sir Terence Stephenson, Chair of the GMC
Dr Kailash Chand OBE, Honorary Vice president of the BMA, also claimed recently that the NHS in England has dangerously low staffing levels and is currently estimated to have a shortfall of 100,000 employees out of its approximately 1.8 million staff.
The NHS is the world’s fifth largest employer, but the chronic staff shortage is predicted to worsen over the next 5-10 years as the average age of GPs,nurses and midwives is high and many will retire, combined with the recent reduction in recruitment from EU countries.
Reasons given by staff who leave the NHS include: rising workloads, worsening moral, NHS pay cap combined with austerity, and the insecurity around Brexit.
Read more: http://flickread.com/edition/html/index.php?pdf=5b86bd48a793b#38
In November, The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), The British Association of Aesthetic Plastic Surgeons (BAAPS) and The Association of Breast Surgery (ABS) welcomed the news that England’s Breast and Cosmetic Implant Registry (BCIR) has published its first report, detailing over 20,000 breast implant operations across England.
The BCIR was launched in October 2016 in response to safety concerns following the high rupture rate of Poly Implant Prosthese (PIP) and the inability to trace women who might be affected.
BAAPS, ABS and BAPRAS have long-championed the need for a registry and are pleased to sit on the steering committee responsible for the development and running of the BCIR alongside NHS Digital.
With over 20,000 women receiving breast implants for reconstructive or cosmetic reasons in the last year, the registry is a vital patient safety initiative which enables the collection of long-term safety data and ensures the patient recipients of specific makes of implants can be traced, if needed.
Due to the recently identified link between breast implants and a rare form of cancer called Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) the importance of accurately recording this data is crucial.
Currently, submission to the registry is not mandatory, but BAAPS, ABS and BAPRAS encourage all women receiving implants to consent to the submission of data. The associations look forward to this invaluable patient safety asset becoming available across all devolved nations.
BAAPS is also supporting calls for a register of aesthetic medical providers using dermal fillers, and for these treatments to only be performed by doctors, nurses and dentists.
Dr Marc Pacifico, a consultant plastic surgeon from the British Association of Aesthetic Plastic Surgeons (BAAPS), said dermal fillers are a "complete wild west in the UK".
"We are one of the few western countries who regard [fillers] as a device not a medicine," he said. "There have even been cases of blindness.
"It was really about time stronger regulation was brought in."
Read more: https://digital.nhs.uk/data-and-information/clinical-audits-and-registries/breast-and-cosmetic-implant-registry
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