Criminalisation of unintentional error in healthcare in the UK: a perspective from New Zealand

Ameratunga, Rohan; Klonin, Hilary; Vaughan, Jenny; Merry, Alan; Cusack, Jonathan

doi:10.1136/bmj.l706

Cited by 12 publications

(8 citation statements)

References 14 publications

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“…The interviews explored factors which participants felt reduced risk and the key themes related to this were that staff were acutely aware of the risks and the potential personal and legal repercussions of a pursuit that ends in injury which made them risk averse. This kind of criminalisation of unintentional error has been described in health care when errors by medical staff cause unintentional a harm to patients (Ameratunga, et al, 2019). The literature on this suggests that recording and understanding the circumstances of when things go wrong provides an opportunity to learn for practitioners to be reflective and avoid similar circumstances in the future.…”

Section: Figure 1 Thematic Map Of Factors That Participants Perceived Influenced the Risks Of Pursuitsmentioning

confidence: 99%

Managing the safety of police pursuits: A mixed method case study of the Metropolitan Police Service, London

Christie¹

2020

Safety Science

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Section: Figure 1 Thematic Map Of Factors That Participants Perceived Influenced the Risks Of Pursuitsmentioning

confidence: 99%

Managing the safety of police pursuits: A mixed method case study of the Metropolitan Police Service, London

Christie¹

2020

Safety Science

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“…The needs of consumers who have experienced harm are acknowledged and we also acknowledge that other than in extremely rare instances, health practitioners intend the very best care for their patients. 36 When things go wrong, they too suffer. Health practitioners' needs are the focus of this research.…”

Section: What Gap This Fillsmentioning

confidence: 99%

Health practitioner experience of Health and Disability Commissioner investigations

Wilkinson

Marshall

2021

J. Prim. Health Care

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INTRODUCTIONThe New Zealand Health and Disability Commissioner (HDC) Act 1994 was designed to protect the rights of consumers and provide a fair, simple, speedy, and efficient resolution to complaints. No recent studies have been published about the health practitioner experience of HDC investigations following a patient complaint, and none that include nurses and midwives. AIMTo use a restorative inquiry framework to understand the impacts and needs of health practitioners arising from an event that led to an investigation by the HDC during the last 10 years. METHODSA descriptive qualitative approach was used with data collected using semi-structured interviews with doctors, nurses, and midwives (n = 13). The data were analysed using thematic analysis. RESULTSParticipants worked in primary care, aged care, and services provided by public hospitals. The emotional impacts arising from the event and investigation were profound, with long-lasting effects on participants’ sense of self, reputation, and how, or if, they continued to practice. Participants indicated a need for support from colleagues and employers, a fair and relational investigation process, and a meaningful way of connecting to put things right. DISCUSSIONA shift to a restorative approach whereby people involved in a complaint come together to speak truthfully about what happened and its impact on their lives, offers hope for a process that repairs relationships and improves health services. Restorative approaches clarify accountabilities and could lead to more satisfactory outcomes for all parties. This study contributes to emerging thinking about the use of restorative approaches in health-care contexts.

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“…27 Others challenged the GMC’s punitive stance adopted towards Dr Bawa-Garba, 28 the criminalisation of medical errors and the impact of adopting this position on the culture of openness and learning from mistakes in the interests of patient safety. 29 Moreover, while it was recognised that accountability for one’s actions is vital, many doctors felt that a distinction should be drawn between unintentional error and egregious violations, with an onus on systems as opposed to individuals, 29 and that moral intention, as opposed to clinical outcome, should influence decisions on doctors’ culpability in cases of harm to patients. Overall, it has been argued that the GMC’s approach to the Dr Bawa-Garba case has highlighted the existence of a ‘blame culture’ and contributed to defensive medical practice.…”

Section: Introductionmentioning

confidence: 99%

Cross-sectional exploration of the impact of the Dr Bawa-Garba case on doctors’ professional behaviours and attitudes towards the regulator

et al. 2021

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ObjectiveThis paper examines the impact on doctors’ attitudes towards the General Medical Council (GMC) and on professional behaviours (reflective practice and raising concerns) following the Dr Bawa-Garba case.DesignA cross-sectional survey designed using the theoretical lens of the theory of planned behaviour (TPB) was administered from September 2017 to February 2019. By chance, this coincided with critical events in the Dr Bawa-Garba case.SettingPrimary and secondary care settings across a broad geographical spread in England.Participants474 doctors.Outcome measuresAttitudes towards the GMC and two professional behaviours in TPB dimensions.ResultsAttitudes towards the GMC became more negative during the period that the Medical Practitioners Tribunal Service and GMC suspended and subsequently erased Dr Bawa-Garba from the medical register. Specifically, confidence that doctors are well regulated by the GMC and that the GMC’s disciplinary procedures produce fair outcomes was rated more negatively. After this period, overall attitudes start to recover and soon returned close to baseline; however, confidence in how the GMC regulates doctors and their disciplinary procedures improved but still remained below baseline. There was no change in doctors’ attitudes or intention to reflect or raise concerns.ConclusionsThe lack of change in doctors’ attitudes towards the GMC’s guidance, the approachability of the regulator, defensive practice and professional behaviours as a response to the Dr Bawa-Garba case demonstrates the resilient and indelible nature of medical professionalism. At the time, professional bodies reported that repairing doctors’ trust and confidence would take time and a significant effort to restore. However, this study suggests that attitudes are more fluid. Despite the high-profile nature of this case and concerns articulated by medical bodies regarding its impact on trust, the actual decline in doctors’ overall attitudes towards the GMC was relatively short lived and had no measurable impact on professionalism.

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Criminalisation of unintentional error in healthcare in the UK: a perspective from New Zealand

Abstract: Legal reform in New Zealand that saw changes to the prosecution of health professionals for gross negligence manslaughter may have important lessons for the UK in light of the recent case of Hadiza Bawa-Garba, say Rohan Ameratunga and colleagues

Cited by 12 publications

References 14 publications

Managing the safety of police pursuits: A mixed method case study of the Metropolitan Police Service, London

Managing the safety of police pursuits: A mixed method case study of the Metropolitan Police Service, London

Health practitioner experience of Health and Disability Commissioner investigations

Cross-sectional exploration of the impact of the Dr Bawa-Garba case on doctors’ professional behaviours and attitudes towards the regulator

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