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CASE FILES COMPLAINT HOCKEY TWIST


BACKGROUND A 15-year-old girl – Liz – twists her knee playing field hockey at school. Her mother – Mrs K – is called and brings Liz to the local A&E. Here she is seen by a specialist registrar Dr J. The doctor examines Liz and notes pain and mild swelling. Liz displays a good range of movement and there is no obvious deformity or neurologic symptoms. Dr J sends Liz for an X-ray which reveals no


evidence of bony injury. She advises Liz and Mrs K that it is likely “just a sprain”. She provides Liz with a Tubigrip and advises rest and over-the-counter analgesia. Should there be no improvement in the next few days she advises that Liz attend her own GP for further investigation. Later that night the pain grows worse and


the next morning Liz cannot walk unaided. Mrs K makes an emergency appointment with her GP – Dr L. He examines Liz and diagnoses a probable torn meniscus and refers her to a private orthopaedic surgeon. An appointment is arranged for the


following day. The surgeon examines the knee and an MRI is arranged which confirms a medial meniscal tear. Liz is placed on crutches and prescribed physiotherapy in advance of ACL (anterior cruciate ligament) reconstruction and meniscus repair in three to four weeks when the swelling is reduced.


16 / MDDUS INSIGHT / Q3 2018 The surgeon expresses “surprise” that the


diagnosis was missed in A&E and that there was no onward referral to an on-call orthopaedic specialist. A week later the hospital receives a letter


of complaint from Mrs K in regard to her daughter’s treatment in A&E. She is critical of the decision to send Liz home without a referral considering it might have further damaged her knee.


ANALYSIS/OUTCOME Dr J is required by the hospital to make a statement in regard to her care of the patient and contacts an MDDUS adviser for guidance on the wording. The adviser first reminds Dr J that when


responding to a complaint made by a third party it is essential to obtain the subject patient’s consent prior to doing so. Liz at age 15 would be considered competent to provide such consent and Dr J is encouraged to confirm with the hospital complaints officer that this has been secured. She is advised to open her statement with


an acknowledgement of the family’s dissatisfaction and regret for the pain and inconvenience suffered. In setting out her recollection of the patient examination Dr J is reminded to highlight the source of any significant comments made, for example


from review of the contemporaneous medical records, recollections of events, discussions with colleagues and usual practice. It is also helpful to include both the positive and negative findings that led to the clinical diagnosis and management. In particular the statement should include


the justification behind Dr J’s conclusions from the examination and that a “wait-and- see” approach was appropriate. The records state that the patient managed to walk into A&E and a little more detail on this point could be helpful. The MDDUS adviser then reviews the


statement before it is returned to the complaints officer. Nothing more is heard from the complainants and the case is closed.


KEY POINTS ●A considered response with an expression of regret can often prevent a complaint escalating into a negligence claim. ●Patient notes should include clear justification behind clinical decisions. ●Ensure that appropriate “safety netting” is recorded in the notes.


These case summaries are based on MDDUS files and are published here to highlight common pitfalls and encourage proactive risk management and best practice. Details have been changed to maintain confidentiality.


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