Rising cost of health legal claims 'unsustainable'

A group of Cork-based medics has called for practical reforms in health services which could help to reduce the risk of medical error.

The rising cost of legal claims in the health system is “unsustainable” and will impact care if reforms are not urgently made, a group of Irish doctors and academics has warned.

Conditions leading to medical errors should be fixed and the claims system reformed for patients and staff, urges a call to action published in medical journal BMJ Open Quality.

The medics, which include Cork University Hospital (CUH)-Mercy, South Infirmary Victoria oncologist Seamus O’ Reilly and Cork University Maternity Hospital obstetrician Keelin O’Donoghue warned the “financial burden” is a serious risk for a system already facing “unprecedented pressures” with money spent on managing claims instead of improving healthcare.

“If current trends continue, the opportunity costs of the current medicolegal landscape will impact the future provision of healthcare,” the analysis states.

The State Claims Agency, which acts for the HSE, is estimated to need €3.85bn to manage and settle clinical claims, they said.

“This figure represents a 65.2% increase over 5 years since 2018 and a 270.2% increase over 10 years since 2013," the group found. The medics warned that “the trajectory of liability is unsustainable and its opportunity cost is significant”.

Practical reforms are needed to reduce the risk of medical error happening as currently “significant financial resources will be spent on managing and resolving clinical claims rather than managing and improving clinic services”. 

The analysis said medical staff also experience an impact from errors, leading to “profound numbness, guilt and isolation”. 

'Litigation-heavy'

An obstetrician in training was quoted saying that “the current litigation-heavy, fear-inducing, undermining system makes me reconsider my life choice almost every day”.

'Current Irish medicolegal landscape: an unsustainable trajectory' was written by Prof O’Reilly, Prof O’Donoghue, CUH oncologist Dearbhaile Collins, and Clara Forrest of University College Cork.

They called for practical reforms in health services which could help to reduce the risk of medical error occurring at source.

They pointed to a “stalled” plan for electronic health records even though these would reduce the risk of errors, staff shortages which “compound patient safety concerns”, and the slow pace of implementing the open disclosure policy.

At a time of many shortages in medical staffing worldwide, they highlighted a survey of surgical practice which found over one-third of doctors surveyed were considering early retirement as a result of the current medicolegal climate.

This survey also found that doctors reported practising at least one defensive medicine behaviour occasionally. This can include avoiding patients with complex conditions or avoiding giving complicated treatments.