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AN IMPORTANT JUDGMENT
" / would have everie man write zohat he knowes and no more.'''—MONTAIGNE
BRITISH JOURNAL
OF
VOL. XXVIII, No. 3
ANAESTHESIA MARCH 1956
AN IMPORTANT
fully injected Ferrivenin into a vein of the anticubital fossa of the right arm. On the fourth occasion a small quantity of the substance entered the tissues surrounding the vein, causing an abscess to develop which subsequently required the patient's readmission to hospital for treatment. In her evidence, the plaintiff said that at the beginning of the injection she had felt a terrible pain in her arm and that Dr. I. P. C. had persisted in the injection despite her continued complaints of pain. Crossexamined by Miss Rose Heilbron, Q.C, instructed by Messrs Hempsons, solicitors acting for the Medical Defence Union, the plaintiff said that she had not watched the injection nor had she seen what the doctor was doing. She based her allegation on the fact that when she complained of pain Dr. I. P. C. had said " I'll have to let the whole lot go now." Dr. I. P. C. gave evidence describing the technique he had employed and said that on this occasion the patient complained of pain after he had injected about 1 ml. He had realized that the point of the needle had come out of the vein and at once withdrew the needle and ordered poultices to be applied to the arm. An expert witness for the plaintiff said that he had given over 120,000 intravenous injections but had never had a case where an adverse reaction had occurred. He agreed that extravenous injection could occur even if good care was taken. Expert evidence was given by the defence that it was not always easy to ensure that the point of the needle remained in the vein and that the escape of the irritant solution into the surrounding tissues had happened on a number of occasions to practically everyone of experience.
" PHYSICIANS of all men are most happy; whatever good success they have the world proclaimeth, and what faults they commit the earth covereth." So wrote Francis Quarles in the " Hieroglyphickes of the Life of Man " in 1638. However true this might have been in the seventeenth century, it is certainly less than the truth in the second half of the twentieth. " What faults they commit", are in these days all too likely to be displayed naked and ashamed in a court of law. A year or so ago legal proceedings between patients and doctors or patients and hospital boards were assuming an importance sufficient to provoke more than one responsible and authoritative warning that the correct treatment of the patient was being endangered by fear of litigation. One suspects that recently there is some easement of the situation, because the general public has been made aware that " accidental " is not always synonymous with " negligent". The case, tried at the Liverpool Court of Passage on December 19 last, should help many physicians, especially anaesthetists, to control the intention tremor which may have developed during recent months, when making intravenous injections. The aetiology of this tremor has been apprehension, conscious or subconscious, regarding possible consequences of this everyday and routine procedure. In this action Mrs. C. P. alleged that Dr. I. P. C , a House Physician, had been negligent in the performance of an injection of Ferrivenin in June 1952 and claimed damages from the doctor and from the Hospital Management Committee. The plaintiff, a married woman aged 53, was being treated as an inpatient for anaemia and on three previous occasions Dr. I. P. C. had successA
JUDGMENT
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Downloaded from http://bja.oxfordjournals.org/ at University of Iowa Libraries/Serials Acquisitions on June 8, 2015
EDITORIAL
BRITISH JOURNAL
OF
VOL. XXVIII, No. 3
ANAESTHESIA MARCH 1956
AN IMPORTANT
fully injected Ferrivenin into a vein of the anticubital fossa of the right arm. On the fourth occasion a small quantity of the substance entered the tissues surrounding the vein, causing an abscess to develop which subsequently required the patient's readmission to hospital for treatment. In her evidence, the plaintiff said that at the beginning of the injection she had felt a terrible pain in her arm and that Dr. I. P. C. had persisted in the injection despite her continued complaints of pain. Crossexamined by Miss Rose Heilbron, Q.C, instructed by Messrs Hempsons, solicitors acting for the Medical Defence Union, the plaintiff said that she had not watched the injection nor had she seen what the doctor was doing. She based her allegation on the fact that when she complained of pain Dr. I. P. C. had said " I'll have to let the whole lot go now." Dr. I. P. C. gave evidence describing the technique he had employed and said that on this occasion the patient complained of pain after he had injected about 1 ml. He had realized that the point of the needle had come out of the vein and at once withdrew the needle and ordered poultices to be applied to the arm. An expert witness for the plaintiff said that he had given over 120,000 intravenous injections but had never had a case where an adverse reaction had occurred. He agreed that extravenous injection could occur even if good care was taken. Expert evidence was given by the defence that it was not always easy to ensure that the point of the needle remained in the vein and that the escape of the irritant solution into the surrounding tissues had happened on a number of occasions to practically everyone of experience.
" PHYSICIANS of all men are most happy; whatever good success they have the world proclaimeth, and what faults they commit the earth covereth." So wrote Francis Quarles in the " Hieroglyphickes of the Life of Man " in 1638. However true this might have been in the seventeenth century, it is certainly less than the truth in the second half of the twentieth. " What faults they commit", are in these days all too likely to be displayed naked and ashamed in a court of law. A year or so ago legal proceedings between patients and doctors or patients and hospital boards were assuming an importance sufficient to provoke more than one responsible and authoritative warning that the correct treatment of the patient was being endangered by fear of litigation. One suspects that recently there is some easement of the situation, because the general public has been made aware that " accidental " is not always synonymous with " negligent". The case, tried at the Liverpool Court of Passage on December 19 last, should help many physicians, especially anaesthetists, to control the intention tremor which may have developed during recent months, when making intravenous injections. The aetiology of this tremor has been apprehension, conscious or subconscious, regarding possible consequences of this everyday and routine procedure. In this action Mrs. C. P. alleged that Dr. I. P. C , a House Physician, had been negligent in the performance of an injection of Ferrivenin in June 1952 and claimed damages from the doctor and from the Hospital Management Committee. The plaintiff, a married woman aged 53, was being treated as an inpatient for anaemia and on three previous occasions Dr. I. P. C. had successA
JUDGMENT
97
I Continued
on
pane
112
Downloaded from http://bja.oxfordjournals.org/ at University of Iowa Libraries/Serials Acquisitions on June 8, 2015
EDITORIAL