One in 18 Avant anaesthetist members had a claim for compensation, complaint to a regulator or another matter raised about the provision of their care in FY2017-18.
In half of these cases, experts and/or regulators concluded that the anaesthetist met the standard expected. Claims took up to three and a half years to close and disciplinary complaints up to two years and nine months.
Our medico-legal data
Members asked us for more information about medico-legal matters, such as claims for compensation and complaints to regulators that come to our attention. In response, the following is a retrospective review of routinely collected data. This is based on approximately 300 matters involving Avant anaesthetist members from across Australia, finalised over the five-year period from July 2013 to June 2018.
We anticipate that these insights will help members better understand and manage their medico-legal risks, and help them to optimise the quality and safety of their care.
Types of matters
Types of anaesthesia associated with medico-legal matters
Common claims and complaints
61% of medico-legal matters were claims for compensation and regulatory complaints. Of these, 55% related to procedural matters, 17% related to practitioner behaviours, 6% related to consent and 22% to other issues.
The stage of treatment during which matters arose:
Pre-operative issues included: inadequate consideration of co-morbidities and other patient risk factors.
Intra-operative issues included:
- allegations about anaesthetic administration, skill or performance (42%) e.g. damage or injury from anaesthetic administration or inadequate pain relief
- dental damage (36%)
- claims of awareness or sensation during surgery (8%).
Post-operative issues included: allegations arising after anaesthesia, such as during follow-up and after discharge.
Issues relating to practitioner behaviours contributed to 17% of claims and complaints, and included impaired physicians, communication and attitude issues.
Consent issues are of increasing concern and contributed to 6% of claims and complaints. These related primarily to the provision of information about the procedure and non-disclosure of fees.
Types of physical injuries associated with claims and complaints
In 81% of claims and complaints, the patient experienced minor physical injury (e.g. dental damage) or no physical injury. In 19% of claims and complaints the patient died or experienced major or catastrophic physical injury and these were related primarily to pre-operative issues, intra-operative issues and medication-related issues.
Key insights and implications for practice
Our data highlights that claims and complaints against anaesthetists are fairly infrequent. It is not surprising the majority of matters that arose related to procedural issues, occurring during the intra-operative stage of treatment.
Whether or not an anaesthetist’s care is considered to be appropriate, medico-legal matters can take time to resolve. Having good clinical and technical skills is fundamental, but avoiding and defending claims takes more than that.
Taking steps to reduce the risk of a claim or complaint occurring in the first place is a good investment.
Opportunities to avoid claims and complaints:
The importance of pre-operative consultations, consent and managing adverse events
Our data shows that many allegations arise from a failure to adequately consider co-morbidities and other patient risk factors pre-operatively. Challenges exist, especially in urgent cases, or if the patient is unexpectedly frail or ill. A thorough pre-operative consultation that explores and documents co-morbidities and other risks factors can reduce the risk of a claim or complaint, as well as improve patient care.
Allegations about inadequate consent processes also contribute to claims and complaints. When a patient has the opportunity to ask questions and have their concerns discussed, they are less likely to make a claim or complaint following an adverse outcome, particularly when they were aware of the risks.
The patient should have a sound understanding of the risks of the particular type of anaesthesia including, for example, the risk of dental damage or unexpected awareness. You are responsible for discussing anaesthetic risks with the patient – relying on the consent discussion that the surgeon may have had can be difficult to defend.
We know that adverse events do occur unexpectedly. Claims or complaints can arise when the process is not handled by experienced practitioners with firsthand knowledge of the incident, is handled insensitively, or there is poor communication or delay after the incident.
Open, honest and timely communication is essential even when a clinical event occurs that results in harm to a patient. This includes informing a patient about what has gone wrong, ameliorating any harm to the patient and learning from the experience.
Avant supports open disclosure by our members in line with the Australian Open Disclosure Framework. We encourage you to contact us early in this process so we can provide advice, information and support, in what can be a stressful and difficult time.
Successfully defending claims and complaints:
The importance of good medical records
Good records are not only essential for optimising patient care, they are also vitally important in the defence of any claim or complaint.
For anaesthetic practice, each of your pre-operative discussions should be tailored to the particular concerns and risk factors of each patient, and your discussion should be well documented.
Before the procedure, document risks that you have identified for the patient and your discussion with the patient about these risks. This is the documentation of your consent process.
Document any strategies you take during the procedure to mitigate specific risks – dental and others – in the anaesthetic or medical record.
If you receive a claim or complaint, contact our Medico-legal Advisory Service on 1800 128 268 for expert advice on how to respond, available 24/7 in emergencies.
Read our articles, factsheets, case studies and other resources on a range of topics such as consent, open disclosure and dental damage, available in the Avant Learning Centre.
- Claims refers to claims for money, compensation and civil claims.
- Complaints relates to formal complaints to regulators.
- Coronial matters are investigations or inquests into the death of a patient by the coroner or police.
- Employment disputes are matters where Avant defends members against complaints or supports members to resolve employment issues.
For any queries please contact us at firstname.lastname@example.org
IMPORTANT: Avant routinely codes information collected in the course of assisting member doctors in medico-legal matters into a standardised, deidentified dataset. This retrospective analysis was conducted using this dataset. The findings represent the experience of these doctors in the period of time specified, which may not reflect the experience of all doctors in Australia. This publication is not comprehensive and does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practice proper clinical decision making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgment or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss suffered in connection with the use of this information. Information is only current at the date initially published.