ADVICE DISCLOSURE DEMANDED


BACKGROUND A medical practice has received a letter from solicitors acting on behalf of the Nursing and Midwifery Council (NMC). It is in regard to an NMC investigation into allegations of ill-treatment of a patient registered with the practice while in a local nursing home. The letter is requesting disclosure of confidential patient information and cites a statutory requirement. The practice contacts MDDUS for advice on its duty to disclose this information.


ANALYSIS/OUTCOME A medical adviser offers assistance to the practice manager both by phone and in a follow-up letter. He first draws attention to GMC guidance on Confidentiality which states: “Various bodies regulating healthcare providers and professionals have legal powers to require information to be disclosed, including personal information about patients.”


The statute referred to in the solicitor’s


letter is the Nursing & Midwifery Order 2001; Section 25.1 which empowers an NMC Practice Committee to “require any person (other than the person concerned) who in his opinion is able to supply information or produce any document which appears relevant to the discharge of any such function, to supply such information or produce such a document.” MDDUS advises the practice that


although this may seem unambiguous it does not necessarily mandate disclosure of confidential medical records. It is essential to take account of GMC guidance to ensure that disclosure is necessary for the purpose. The practice manager is advised to


respond to the solicitor acknowledging their letter and asking whether they have sought the patient’s consent to the disclosure and, if not, to provide an explanation of why it would be unnecessary or inappropriate to obtain patient consent in this instance. The


NMC would also be at liberty to seek a court order to compel disclosure of the medical records and it would be appropriate to comply with any such order if received. In the end the regulator provides


evidence regarding the relevance of the requested information and it is disclosed with the patient’s consent.


KEY POINTS ● Disclosure of confidential data should normally be with the patient’s consent. ● Disclosure without consent may be appropriate if the patient lacks capacity and it is in their best interests, or if specifically required by law. ● Disclosure may also be justified in the public interest.


CLAIM MOLE TO MELANOMA


BACKGROUND A 42 year-old-patient – Mrs B – attends her GP surgery in regard to apparent conjunctivitis. In addition the patient mentions that she is worried about a mole just under her right breast. She reports that it has been there for a number of years but is worried about its appearance. Dr J examines the lesion and notes in the records benign mole, smooth edge/no itch or bleeding. He reassures the patient that the mole is “nothing to worry about” and referral is not necessary. A year later Mrs B is back in the surgery


for a stubborn chest infection. She again mentions the mole and expresses her concern that it might be skin cancer. She does not think the mole has changed since the last attendance, but is keen to have it removed. Dr J again records in the notes benign mole and reassures the patient that there is nothing to be concerned about but to return if she notices any change in size or appearance. Around 18 months later Mrs B sees


another GP in the practice – Dr L. The patient expresses concern that the mole


has recently increased in size and changed colour. The GP records: Pigmented lesion under right breast – longstanding; recent increase in size. Variable pigment 0.6 cm. A two-week referral is made to a plastic


surgeon with a suspected diagnosis of melanoma. The mole is excised and biopsy confirms melanoma. Mrs B undergoes a wider excision and further investigation shows no metastatic spread. A claim of negligence is later brought


against Dr J by solicitors representing the patient. It is alleged that at the first consultation no follow-up was arranged to monitor the mole after Mrs B had reported a change in appearance. It is also alleged that given the change in appearance the GP should have referred Mrs B for further investigation.


ANALYSIS/OUTCOME MDDUS instructs a primary care expert to assess the case. He is critical of Dr J in respect of his note keeping. The appearance of the lesion at the first consultation should have been documented in more detail, including the size, shape and


colour. This would have provided more evidence to support his conclusion that the mole appeared benign. Similarly the records in relation to the second consultation were very brief and lacked a sufficiently detailed description of the mole for comparison with the earlier consultation. It is difficult, however, to comment on the


point where the mole may have begun to show changes suggesting melanoma. A letter of response is drafted denying


liability and causation on the basis of Dr J’s views that at both consultations the mole appeared benign with no change. The case is subsequently discontinued.


KEY POINTS ●Good notes support a sound legal defence. ● Follow latest clinical guidelines in regard to suspect skin lesions. ●Proof of negligence requires evidence of both breach of duty and causation.


MDDUS INSIGHT / 17


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24