10 • Analysis


MDDUS dental adviser Stephen Henderson highlights for dental teams some key learning points from two recent high-profile cases


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T is unusual for the higher courts to hear claims arising out of professional regulation and clinical negligence, particularly those of relevance to medical or dental practice. There have been two such cases in recent months, one in the Court of Appeal and the other in the Supreme Court. The sad story of Jack Adcock and Dr Hadiza Bawa-Garba has been


widely reported and debated. In summary, a six-year-old boy with a complex medical history was admitted to hospital dehydrated and unresponsive. He died later the same day after a series of errors, some made by individuals and others resulting from the system the staff were working in.


Sadly Jack died. He had been suffering from pneumonia which evolved


into sepsis and this was not identified correctly. Sepsis progresses very quickly in a child. Dr Bawa-Garba and nurse Isabel Amaro were subsequently convicted of manslaughter by gross negligence. Nurse Amaro was erased by the Nursing and Midwifery Council and Dr Bawa-Garba was suspended by the General Medical Council (GMC), a decision that was recently confirmed in the Court of Appeal. What emerged from the Court of Appeal judgment is that the criminal


court and the Professional Conduct Committee are “different bodies with different functions making different decisions at different times”. It does not automatically follow that a serious criminal conviction will result in erasure.


Darnley case The claim of Matthew Mark Junior Darnley made against a hospital Trust arose following an assault in which Mr Darnley sustained a head injury. He was taken to A&E where he told the receptionist that he had sustained a head injury and he felt unwell. It was accepted that Mr Darnley had been told he would have to wait some four or five hours to be seen. Mr Darnley told the receptionist he felt close to collapse but was informed that if he did collapse he would be seen as an emergency. Nineteen minutes after arriving in hospital, Mr Darnley went home without notifying staff. His condition deteriorated and an ambulance was called. During the journey to hospital he collapsed, suffering a large extra-dural haematoma with a midline shift. In spite of surgery Mr Darnley suffered a significant brain injury and has been left seriously disabled.


The claim was made that the non-clinical receptionist breached her


duty of care by giving incorrect information and, but for that breach of duty, Mr Darnley would have had a scan much earlier and the surgery would have been carried out earlier, with a significant chance of success. In overturning the decisions of the lower courts, the Supreme Court found that the Trust had a duty of care to the patient as soon as he was


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booked in, and it did not distinguish between clinical and non-clinical staff. It found that the failure to tell Mr Darnley that he would be seen by a triage nurse within 30 minutes (rather than being told he would have to wait four or five hours to see a doctor) was a breach of the duty of care because the information was incomplete and misleading.


Dental implications So how can these two sad stories be interpreted for dental practices? While the circumstances in dental practice are highly unlikely to mirror the problems faced by Dr Bawa-Garba, nurse Amaro and Jack Adcock, some lessons can be learned. The situation with Mr Darnley is more likely to happen.


Effective systems Dental practice receptionists are often not clinically trained but part of their role is to assess the urgency of a patient’s request for an appointment. We learn from these two cases that it is important that the practice has effective systems in place to properly assess and manage requests for emergency assistance. Patients can present for urgent care with a dental abscess that is


potentially life threatening because the airway is at risk and as a result of the infection the patient may go on to develop sepsis. The whole team needs to be aware of these risks and have a plan for managing the patient, from the first phone call or walk-in. Patients must be given the correct advice, and if the receptionist is in doubt, there must be a system in place that someone with clinical training can speak to the patient and carry out the necessary assessment and triage. This is even more important when the first contact is by telephone.


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