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Medical Indemnity Insurance

Medical Professional Indemnity - How To Comply With Duty of Candour

Working as a RHCP ( Remote Healthcare Practitioner ™), IRHC advises that you have a responsibility to be honest with patients, or any person acting on their behalf — particularly when something unexpected or potentially harmful happens during their care or treatment.

A breach in your duty of care or other acquisition of negligence may lead to a claim under your Medical Professional Indemnity Insurance (malpractice), with associated costs such as policy excess and / or reputational damage. As such, it is vital that you understand current regulation and adhere to best practice.

This obligation, or responsibility of care is known as the duty of candour and as an example in the United Kingdom the Care Quality Commission (CQC) has developed a detailed guidance to help you fulfil that commitment. However other countries have similar guidelines

What Is The Duty of Candour Overview and Requirements

The duty of candour affects any UK organisation that is regulated by the CQC, and applies to all registered persons working with patients such as:

· Domiciliary Care Providers

· Nurse & Nurse Practitioners

· Health Care Volunteer

· General Practitioners

· Surgeons

However the IRHC advises that even if you work outside the jurisdiction of the United Kingdom the IRHC recognises “the duty of candour” for the purpose of IRHC membership standards of ethics which is part of the eligibility for IRHC membership.

What Is a “Notifiable Incident”?

As a medical professional, if a ‘notifiable incident’ occurs during a patient’s care or treatment, you are obligated to comply with the regulations outlined by the duty of candour.

A notifiable incident is any unexpected incident that causes unintended physical or mental harm to patients while they are receiving care or treatment. The CQC has described the four following unintended consequences of care as notifiable incidents:

1. Death: Immediate or resulting from the incident

2. Severe harm: A permanent lessening of bodily, sensory, motor, physiologic or intellectual functions—including removal of the wrong limb or organ as well as brain damage

3. Moderate harm: Significant but not permanent harm that requires a moderate increase in treatment, such as an unplanned return to surgery

4. Prolonged psychological harm: Psychological harm that was experienced, or is likely to be experienced, for a continuous period of at least 28 days

What Should I Do If an Incident Occurs?

If a patient in your care suffered any of the four types of notifiable incidents, you would be obligated to take the follow action:

1. Tell the patient, or the person acting lawfully on his or her behalf, as soon as reasonably possible, that an incident has occurred. This should involve providing a detailed account of how the incident occurred.

2. You may apologise to the patient that the incident has occurred. However whilst it is natural to express sorrow or regret, you should also take care not admit nor imply fault or liability for the error.

3. Offer a proposed solution or appropriate support or remedy — be it surgery, therapy or other action within your remit —in order to correct the incident.

4. Explain carefully to the patient, or the person acting lawfully on his or her behalf, both the short- and long-term effects of what has happened and likely impact.

In addition to being forward and honest with patients, you must provide a written account of both the incident and your notification for your organisation’s records.

Yet, the CQC is unable to monitor every organisation full time in order to detect a breach of duty. It is therefore important that you understand your responsibility to be forward and honest with your patients, colleagues and relevant organisations in the event of a notifiable incident.

Implementation & Guidance for the IRHC Duty of Candour

Developing an honest and open and culture between health care providers and patients is critical in terms of providing an adequate quality of care. To help to develop the right cultural environment within your health care practice, consider adopting these four key procedures:

1. Provide regular training for all health care staff and volunteers on what constitutes a notifiable incident and what steps should be taken to address the issue.

2. Offer health care staff training on how to properly apologise without implying or admitting liability.

3. Draft a notification letter template to streamline the record-keeping process.

4. Develop procedural documents which outline the organisation’s commitment to exemplifying the characteristics of candour.

Medical General Practice Examples

To clearly and effectively illustrate the kind of scenarios in which the duty of candour would be relevant, consider the following examples, both of which could highlight a breach and a potential Medical Malpractice Insurance claim:

Example #1

While treating a patient for pneumonia, the physician identified a ‘suspicious lung lesion’ on an X-ray which would require a follow-up. Upon discharging the patient, the physician carried out the appropriate investigations of the lesion — the results of which were normal. However, the medical primary healthcare practice centre failed to follow normal processes for relaying the results to the patient and he was not informed for more than one month. Consequently, the patient spent several weeks in a state of anxiety and extreme distress, concerned about the possibility of cancer, and he developed enhanced symptoms of depression and anxiety which lasted more than 28 days.

This example illustrates a notifiable incident resulting from prolonged psychological harm, as the practice failed to communicate the results of the test on the lesion in a timely manner.

Example #2

A patient has been prescribed to take 10 milligrams of morphine sulphate twice a day for chronic back pain. However, the prescription is incorrectly written down as 100 milligrams. The patient’s wife, unaware of the error, gives her husband the incorrect prescribed dosage. The next day, the patient is unresponsive and is rushed to the hospital where he goes into cardiac arrest and dies.

This example illustrates a notifiable incident resulting from death, as the prescription was incorrectly written down.

Both examples are likely to result in significant Medical Professional Indemnity claims, not to mention reputation damage and could easily have been avoided with adequate care and planning.

It’s YOUR Professional Duty & Reputation

Honesty is always the best policy, especially if an error was made which could be potentially harmful, and it is paramount when communicating with patients or the people acting lawfully on their behalf.

Neglecting that duty of care not only reflects poorly upon you, as a health care professional, but also on your health care practice. Get A Malpractice Quote

FREE Indemnity Insurance Review

IRHC in partnership with Insync who specialise in cover for the medical profession, from individual Medical Professional Indemnity Insurance, to Medical Service providers are offerring a Free Indemnity Insurance Review. Applicants need to be either existing IRHC “Associate” members or IRHC Corporate Members to qualify for a quotation. Cover can be tailored to specific requirements and insync insurance pride themselves on being able to obtain cover for even the most complex risks.

Insync insurance offer IRHC members a minimum of 10% discount on any standard quote

Request a quotation online, alternatively, why not book a free review with one of our expert advisors at a time that suits your diary. Click here to request a quote or find out more about Insync. 

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