Obvious mistake, honest apology

BACKGROUND: Mr G is a self-employed builder and attends his local practice for an emergency appointment complaining of a very sore ear. He is seen by the triage nurse who examines the patient and notes a purulent discharge from the ear. She diagnoses otitis media and writes a prescription for amoxicillin.

Next day Mr G’s wife phones the surgery and informs the receptionist that she would like to speak to a doctor in order to make a complaint. The receptionist forwards the call to the practice manager. Mrs G states that her husband had just come home from work early feeling unwell and suffering from an itchy skin rash and swelling. Mrs G checked the label on the tablets her husband had been given from the pharmacy and looked it up on the internet – only then realising that amoxicillin is a "type of penicillin". She says the practice should be aware that her husband is allergic to penicillin. The PM confirms with Mr G that it is okay to discuss the matter with his wife and asks to ring straight back.

She calls up Mr G’s file and confirms there is indeed an alert for penicillin allergy. After speaking to the senior GP partner, she phones Mrs G and advises that her husband should stop taking the amoxicillin. She tells her to pick up some antihistamine tablets for her husband at the pharmacy and advises her to contact the practice or the out-of-hours service if his condition grows any worse. She also apologises for the mistake and offers to send Mrs G a copy of the practice’s complaints procedures.

Three days later Mr G attends the surgery still complaining of allergic symptoms and a painful ear. He is angry because he missed three days of work, and being self-employed this resulted in lost earnings. The senior GP partner sees Mr G and apologises again for the error but the practice later receives a formal letter of complaint from Mr G in which he recounts the consultation for his earache and states that when given the amoxicillin script he had reminded the triage nurse that he was allergic to penicillin. The PM acknowledges the letter and undertakes a formal investigation of the incident.

She speaks (again) to the triage nurse who states that she had consulted the minor illnesses book used regularly by the practice nurses and it stated that many antibiotics were contraindicated in penicillin allergy but for amoxicillin it stated only "avoid using for patients with allergies". The nurse felt it was okay to prescribe the amoxicillin as the word "avoid" did not suggest an explicit instruction not to do so in patients with penicillin allergy. The PM writes a formal reply to the complaint, again apologising for the error and also setting out steps the practice will take to ensure it is not repeated in future.

The next day Mrs G phones the practice to say her husband has received the letter but is surprised there is no offer in respect of his loss of earnings. The PM replies that it is not practice policy to offer compensation in patient complaints. Mrs G then says that she and her husband have taken advice from a solicitor and without such an offer they will be forced to sue. The PM contacts MDDUS who advises the practice to reply in writing restating practice policy on the matter.

Two weeks later a letter arrives from solicitors representing Mr G claiming negligence on the part of the triage nurse for which the practice partners are vicariously liable. The letter states that as a result of Mr G being off work he had lost a contract worth over £3,000 and he is seeking compensation for that amount.

ANALYSIS/OUTCOME: THE PM contacts MDDUS again and forwards all relevant medical records and correspondence. The case is assessed and given the clear breach in duty of care acknowledged by the practice it is decided that the best course is to settle on behalf of the practice, based on an accurate accounting of Mr G’s loss of earnings. The practice later conducts a significant event analysis to ensure that all such contraindications are noted and properly addressed in treatment decisions. Further training is provided for practice nurses involved in prescribing, with particular emphasis on contraindications.

KEY POINTS

• Double-check records and confirm any potential medication allergies.
• Ensure practice staff are fully trained and competent to carry out delegated clinical tasks.
• Consider guidance used to support clinical decisions/prescribing.
• Candour along with a sincere apology can often (though not always) forestall further legal action in patient complaints.