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The Doctors’ Bill

Irish society is, to an extent, like a disorderly bus queue.* As little analysis as possible is done and even less is published, on social problems.

Metaphorically speaking, the bus service pretends the queue is not its concern and defines success by reference to the bus schedule, not the requirements of the public.

The extent of injury inflicted on hospital patients by clinical negligence is a case in point. We do not know what it is. When it happens the consequences are real. Somebody somewhere pays for the injury. Clearly, the victim suffers the injury and pays in that fashion. The family of the victim may pay in care deployed or care costs paid. Or, if the family consists of children of the victim, the children may suffer diminished life opportunities by being deprived of care they would have got from the victim.

Possibly it is a misnomer to label clinical negligence as a social problem; arguably, if it is not, public maladministration is a social problem.

In any event we must look elsewhere for estimates of the frequency and cost of such events.

In 1990 the Harvard Medical Practice Study estimated the incidence and causes of medical mishaps in New York hospitals.

Errors in management were found to be involved in the majority of mishaps. Drug complications were involved in 19%; wound infections in 14%; technical complications in 13%; surgery in 48% (of which only 17% were actual surgical errors); faulty diagnosis was involved in 75%; “errors of omission” were involved in 77%; events in the emergency room were involved in 70%.

The study covered a sample of 30,195 randomly selected hospital records. 1,133 patients (3.7 percent) were found to have suffered disabling injury caused by medical treatment.

In the UK, the NHS has produced a study entitled Handling Medical Negligence Claims in England.

While its approach is an administrative instrumental approach (a function frequently, inappropriately, assumed in Ireland by judges), it nevertheless makes a fair stab at measuring the problem.

One of the most interesting “macro” issues in the field is the issue of determining the true cost of the injury. In the case of catastrophic injuries (cerebral palsy and brain damage generally) the largest proportion of compensation is determined by the “special damage” – the cost of care.

There are serious and unresolved disputes on the calculation of these costs. Currently, only the legal profession is addressing that problem.

*(a disorderly queue is not a queue?)