Standard of Care Required of a Trainee in Surgery

A gentleman presented with a lump in the back of his neck just under the skull. This was regarded as a simple lipoma (benign tumour of fat) and the patient was placed on the local anaesthetic operating list to be removed by a surgeon in training.

The lesion was removed through a large transverse incision. There was some bleeding in the area which was successfully controlled with surgical ties and the lesion was completely excised. He was discharged to have the skin clips removed after 10 days at his general practice.

Whilst he was having his clips removed, he remarked that he was having a lot of pain over the top of his head on the right hand side. An examination showed tenderness on the right hand side of the wound and some numbness over the top of the head. After two to three months, when the situation had not resolved, he was referred back to the Surgical Outpatients where he was told that the trainee surgeon was not particularly experienced and had caused some nerve damage which may or may not resolve over a year to 18 months.

The central question relates to the standard of care which a patient has a right to receive, even if they may be aware that the procedure is being carried out by a trainee. The law is clear that there is no such thing as a surgical learning curve. As far as the outcome a patient is entitled to expect, it is a Consultant’s responsibility to ensure, when they entrust a procedure to a trainee, it is carried out with due care and skill. There was a clear breach of duty of care in this instance by both the consultant and the trainee directly leading to the ongoing pain and discomfort which the patient experienced for a considerable time post operatively.

The duty of care is tailored to the actor, not the act which he elects to perform and the law requires the trainee to be judges by the same standards as a more experienced colleague.

MDU figures for 2016 show that less than one in six actions in medical negligence actually succeed with the vast majority failing on the grounds of causation. It must be remembered that subsequence is not the same as consequence.

Initial screening is therefore essential to manage client expectations at an early stage. This avoids unnecessary effort and costs for all concerned. Too many cases are taken to Court with no chance of success. This is stressful for both the client and their legal advisor and indeed for the medical personnel involved.

For fast and effective screening of all potential medical negligence cases contact Peyton Medico Legal Services now on 028 87724177 or email rpeyton@rpeyton.com

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