Doctors fearing the threat of prosecution are avoiding high-risk procedures and patients who could be denied life-saving treatment as a result, a survey suggests.
The poll, carried out for Doctors and Manslaughter, found 86% of UK physicians who responded said that they had adopted “a more defensive style”.
Defensive medicine is where doctors recommend a test or treatment with the priority being to avoid litigation rather than the patient’s best interests. An example would be declining to carry out a procedure with a relatively low success rate, even if it represents the patient’s only hope of medium to long-term survival.
Almost half of doctors (48%) said the possibility of prosecution meant they were more likely to avoid high-risk patients, while 70% said it would lead to more mistakes being hidden.
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The results have been shared with the Guardian after a case against anaesthetist Eric Cornish, 68, in relation to the 2012 death of Frances Cappuccini collapsed. Cappuccini, 30, never woke up from the anaesthetic following an emergency caesarean section at Tunbridge Wells hospital in Kent, but on Thursday, a judge ruled there was no case to answer.
Doctors and Manslaughter says the case is part of a “trend towards the criminalisation of healthcare”, which has seen nine healthcare professionals charged, prosecuted or convicted for gross medical manslaughter in a year.
Roger Kirby, director of the Prostate Centre in London, said: “Of course it’s a tragedy when somebody dies like this lady in Tunbridge Wells but a manslaughter charge is not the best way to address that. Paranoia spreads very quickly and is not a good way to practise medicine. No-one goes into a hospital intending to harm a patient.”
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He said the implications were particularly likely to be felt in high-risk areas of medicine such as prostate cancer and obstetrics.
Doctors and Manslaughter was formed after David Sellu, a colorectal surgeon, was sentenced to two and a half years in jail for gross negligence manslaughter in November 2013 after the death of James Hughes, 66, who suffered a perforated bowel while undergoing a routine knee replacement operation.
Its survey, which had been completed by 505 people as of Friday, and remains open, includes responses from GPs, general surgeons and specialists.
Nine out of 10 said they believe that the number of criminal charges issued will cause recruitment problems in high-risk specialties. One respondent wrote: “Excellent trainees will simply say ‘why would I take the risk?’ Lots of other jobs pay better and don’t [sic] involve ending up in jail.”
Another said: “Definitely more risk averse now, and I am aware that increases NHS costs, but no-one would support me if I were perceived to have made a wrong call.”
Peter McDonald, a consultant surgeon and senior colorectal consultant at Northwick Park hospital in north London, said: “If the criminal law is going to be used in medicine, you’re not going to to do it [operate] when it comes to high-risk patients who have any risk of dying. They [doctors] will stop operating in cases where there is a high mortality; that’s the real worry about this.
Katherine Murphy, chief executive of the Patients Association, said it was worrying if doctors felt more inclined to practise defensive medicine and/or hide mistakes. “The fear of litigation should not be an issue if they were doing the right thing and providing the best quality of care for patients all the time,” she said. “Though a lot of medical professionals are working under constraints at the moment.”