£22million paid by mdu to settle medical negligence claims for meningtis diagnostic delays since 1998 - gp's need to review procedures

£22million paid by mdu to settle medical negligence claims for meningtis diagnostic delays since 1998 - gp's need to review procedures

The Medical Defence Union is suggesting GPs review their procedures for managing patients with suspected meningitis as it revealed today it has paid out £22million to settle claims for delay in diagnosing the infection since 1998.

According to a new study of medical negligence claims settled by the Medical Defence Union (MDU) following a failure or delay in diagnosing meningitis or meningococcal septicaemia by GPs, numbers remain small, with 34 cases settled in the last twelve years.1 However, the consequences of missing this difficult to diagnose infection can be very serious for the patients concerned.

While meningitis and meningococcal septicaemia claims account for around two per cent of cases notified by the MDU's GP members overall, they account for 15 per cent of the payments made to settle claims on behalf of its members, including legal costs. This is a reflection of the severe injuries that can result from a delay in diagnosis

Payments range from £7,000 to £6.8 million; the latter amount, which was paid on behalf of a GP member in 2009, is the MDU's highest ever claim to date. Five further claims have been settled in excess of one million pounds since 1998 and a further 20 notified claims are currently valued in excess of one million pounds.

Children are particularly at risk with two thirds of cases (22 claims) involving children under eighteen and over a third of cases (13), patients under five.

Dr Karen Roberts, MDU medico-legal adviser is suggesting members review their arrangements in this area. She said:

"Meningitis causes great concern for the public who read about or experience first hand this devastating illness and for the doctors who diagnose and treat it. It is every GP's worst nightmare that they may miss or delay a diagnosis, not least because they are aware of the potentially serious consequences for the patient.

"Meningitis is a difficult infection to diagnose, particularly in young children, because patients often present with non-specific symptoms in the early stages. Added to this, patients can go downhill quickly so it is important that doctors remain alert to the importance of recognising and treating the illness early on. There is a general perception among the public that any delay in diagnosing meningitis means the GP has been negligent, but that isn't the case. It can be possible to defend doctors whose clinical management is shown to be competent and reasonable.

"But there are steps GPs can take to try to lessen their chances of missing a diagnosis. These include: ensuring they exclude a diagnosis of meningitis, even if they only consider it briefly; conducting and documenting a full clinical, or if appropriate, a telephone assessment of the patient; listening to patients' and parents' concerns; arranging a reassessment if necessary; and ensuring patients and parents know what to do if a patient becomes more unwell in the meantime.

"There are also a number of helpful guidelines such as the recently published NICE guidelines on the management of bacterial meningitis and meningococcal septicaemia in children, which includes a checklist of signs and symptoms of the infection.2"

The MDU has published advice on its website for GP members, including a series of risk management questions which it suggests GPs ask themselves. These include whether GPs have the appropriate, in-date antibiotics to treat a suspected case of meningococcal disease; whether they document negative as well as positive symptoms in the notes, such as absence of neck stiffness or a rash; and whether they tell patients or parents what symptoms or signs to look out for and what to do if they occur.


1 Meningitis and meningococcal disease - a problem diagnosis, by Dr Karen Roberts, is available on the MDU's website for members here.

2 Bacterial meningitis and meningococcal septicaemia, National Institute for Health and Clinical Excellence, June 2010 //guidance.nice.org.uk/CG102

Source: Medical Defence Union

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Section Issues On Medicine: Medical practice