By Helle Sorensen, Membership Services Officer
Findings from the ICM Trainee Day. On 16 March 2016, the ICS hosted a dedicated trainee day. The topic was ethical and legal aspects of intensive care, and 7 speakers were invited to present interesting cases – and what we can learn from them.
The ethical and legal aspects of the practice are becoming increasingly more important the further you climb the career ladder. Cases are common and important, but lack attention in day-to-day practice.
Fiona Wallace, Member of the Trainee Committee and organiser of the day, on the choice of topic
Dr Maryam Crews gave a talk on deprivation of liberty. In 2009, as a result of the Bournewood case, the government introduced Deprivation of Liberty Safeguards. These provide extra protection for human rights of people who lack capacity and find themselves deprived of their liberty. If a patient is a) subject to continuous supervision and control and b) not free to leave their placement (the ‘acid’ test) then they are likely to have been deprived of their liberty.
The Bournewood case. HL, a 45 year old autistic man with severe behavioral issues, ws adopted by a family after spending 32 years in an institution. Together, they manage to deal with his condition and give HL a decent life. HL made weekly visits to a day care centre using hospital transport. On one occasion, when his usual driver was absent, he became agitated due to a variation in routine. He was detained in Bournewood under the mental health act. His carers were not permitted to visit in case he wanted to leave with them. A case for unlawful detention was taken to the High Court, which ruled against HL. The Appeal Court overturned the decision in 1997. In 1998, the House of Lords overturned the ruling that HL’s detention had been illegal. The case was then taken to the European Court of Human Rights, which in 2004 ruled in HL’s favor.
Dr Sally Old presented on obligations – for trusts and trainees. Contrary to common thought, she said, a Trust is obliged to follow up on Serious Untoward Incidents, and a lot of Trusts are being checked by the CQCs to see if they are following the rules. It is also widely, but wrongly, thought that organizations urge professionals to not get involved. Dr Old’s advice is to be open and transparent when things go wrong.
“Apologise openly and in a letter, and try to do things right. After all, if we were patients, we would expect that to happen, wouldn’t we?”
Dr Sally Old
Dr David Bogod gave the coroner’s perspective. Doctors can make mistakes that can kill patients – from the coroner’s perspective, we need to identify when a mistake has been made.
The Essex case. In 2001, 9 year old Tony Clowes fell off his bike and lacerated his thumb and required surgery. He was anaesthetisted but the circuit was blocked with the cap from end of a intravenous giving set. This resulted in severe hypoxia and the boy died. The NHS Trust was fined for neglect.
The Cardiff case. In 2009 a newly qualified nurse miscalculated the dose of insulin for an 85 year old diabetic woman. As a result the lady died and the coroner returned a verdict of unlawful killing.
PS. If you are interested in the Trainee Committee’s work or have ideas for an event, contact Chair Nish Arulkumaran at email@example.com.