In his recently published report Lord Justice Jackson (LJJ) has recommended substantial reform to the current system of clinical negligence litigation funding to remedy the inadequate control of public expenditure in the pursuit of these claims.

Tom Armstrong explores the impact the recently published LJJ report on costs may have on clinical negligence claims. Read more.

Claimant alleged negligence in delaying treatment which allowed the line to migrate causing a need for extensive surgery and prolonged hospital stay during which he developed clostridium difficile. Liability disputed; Defendant submitted the delay had occurred due to other patients requiring more urgent treatment. The Claimant was more susceptible to clostridium difficile as he had been taking oral antibiotics prior to admission.

Out of court settlement: £4,000 (estimated General Damages £3,600).

Out of court settlement: £20,000 (estimated General Damages £18,000).

Out of court settlement: £35,000 (estimated General Damages £13,000).

Breach of duty and psychiatric injury were both disputed and claim was resolved in an out of court settlement for £20,000 (with General Damages estimated at £7,000).

Ten months later she again consulted her GP when it was recorded that there was a three and a half inch mass in the area previously examined. She was again referred to the breast clinic but mammogram did not reveal any significant change. An ultrasound did not reveal any mass type or focal type lesion however, upon recommendation from the treating doctor an ultrasound guided needle core biopsy was carried out. The biopsy revealed that she had an invasive moderately differentiated carcinoma measuring 120mm and five out of thirteen lymph nodes were found to be infiltrated by metastatic disease.

Five weeks later the Claimant underwent right mastectomy and axillary node clearance. She subsequently had adjuvant treatment consisting of chemotherapy and radiotherapy to the chest wall and supraclavicular fossa, as well as adjuvant hormonal treatment.

The Claimant brought an action against the Defendant alleging negligence in failing to carry out needle biopsy as part of a full triple assessment when she was initially referred. Had the cancer been identified at that stage she submitted she would have received a lumpectomy and avoided mastectomy with associated physical and psychological problems. Further, the ten month delay was likely to have an adverse effect on survival. Liability admitted in part.

Out of court settlement: £80,000 (General damages).

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Strengthening national commissioning: consultation

The consultation document seeks views on proposals to:

1. improve the process by which funding decisions are made for specialised new technologies which are candidates for national specialised commissioning
2. amend the scope of the system to allow consideration of technologies not appropriate for NICE.

The consultation process closes on 19 February.

Department of Health 14 December 2009

New professional guidelines from Law Society and BMA to help doctors and lawyers assess capacity

The Law Society published guidelines on 14 December 2009 to assist professionals in the assessment of mental capacity. The guidelines set out best practice for doctors and lawyers. They also aim to provide practitioners with a deeper understanding of all issues surrounding assessment of mental capacity.
View the guidelines.

Law Society 15 December 2009

Generic medicines: Consultation paper recommending new powers for pharmacies to replace branded drugs

The Department of Health proposes introducing generic substitution in primary care. This will enable pharmacists and other dispensers to fulfil a prescription for a branded medicine by dispensing an equivalent generic medicine. Provision will be made to allow opting out of substitution where, in the prescriber’s clinical judgment, it is appropriate for the patient to receive specific branded medicine. The consultation process closes on 30 March 2010.

View the full document.

Department of Health 5 January 2010

Changes to medicines legislation to enable mixing prior to administration in clinical practice

The Medicines and Healthcare products Regulatory Agency (MHRA) has put in place changes, effective from 21 December 2009, to medicines regulations to enable mixing of medicines prior to administration in clinical practice:

• Doctors/dentists who can already mix medicines, can direct others to mix
• Nurse and Pharmacist Independent Prescribers to mix themselves and direct others to do so
• Supplementary Prescribers to mix themselves and direct others to do so, but only where that preparation forms part of Clinical Management Plan for an individual patient
• Nurse and Pharmacist Independent Prescribers to prescribe unlicensed medicines for their patients, on same basis as doctors and dentists (and Supplementary Prescribers if part of Clinical Management Plan)

The changes define mixing as “the combination of two or more medicinal products together for the purposes of administering them to meet needs of a particular patient”.

Department of Health 7 January 2010

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Thalidomide victims to receive £20 million

The Department of Health will pay a grant of £20 million over three years to the Thalidomide Trust, which helps young people disabled by the drug. The funding will be distributed among survivors to help meet health needs and minimise further deterioration of their condition. The Department of Health will also look at how this approach of working through an expert national body may be applied to other small groups of patients with specialised needs who are geographically dispersed.

Times 21 December 2009

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