Caution must be used when deeming treatment 'unnecessary'

26th October 2016 Clinical Negligence

As a partner in JMW's medical negligence team I am always slightly concerned when NHS treatments are withdrawn on the basis that they are not beneficial to the majority of patients. Of course NHS managers have to take the cost of treatments into consideration and if this cannot be balanced against the benefits then a business decision will sometimes need to be made.

However if a treatment option is cheap, non-invasive and can avoid significant harm then why discourage NHS staff from using it unless the patient meets a strict set of criteria? This is what I am asking myself following the publication on Monday of a list of treatments medical experts have said have little or no benefits. The list is part of a campaign to reduce the number of unnecessary treatments (BBC).

Some may well be deserving of their place on the list but one stood out to me due to my experience of handling claims arising from mistakes made during labour that have led to brain damage and stillbirths. According to the list electronic monitoring of a baby's heart rate is only needed during labour if the mother has a higher than normal risk of complications.

However the categorisation of women as 'low risk' and 'high risk' is very prescriptive and it would be safer and more beneficial if a plan of care is put in place by doctors and midwives tailored to the individual woman that may involve use of electronic monitoring where the circumstances demand it.

Every woman is different. You can have a low risk woman who develops a complication and therefore becomes high risk at any time. Sweeping edicts like 'you can't use electronic monitoring in a low risk women in labour, they don't make any difference' are not appropriate; the risk changes all of the time during labour and use of electronic monitoring should be based upon clinical and midwifery judgement and the needs of the mother. Any measure which puts pressure on those treating women not to use electronic monitoring has to be a bad idea. A number of cases handled by the team at JMW demonstrate that in a tiny minority of cases, low risk women will require electronic monitoring and it could save their baby's life.

In a current case of mine, a low risk pregnancy / labour included a high risk factor (prolonged rupture of membranes). In that case continuous electronic monitoring would have identified abnormalities which would have prompted earlier delivery and avoided catastrophic brain damage. This would be the case in only a miniscule proportion of births where there had been prolonged rupture of membranes. However electronic monitoring is non-invasive and cheap and if it can reduce such serious avoidable harm then surely it is warranted even though in the vast majority of cases it will not detect any problems? On a statistical basis the use of electronic monitoring in labour in low risk women is likely to show very little abnormality but at JMW we see the tiny percentage of cases where, if used, electronic monitoring could have prevented serious lifelong disability.

In my opinion the risks and downsides of using electronic monitoring are so minor compared to the downsides of failing to detect an abnormality in a baby's heart rate and I hope maternity units use this recommendation with caution.


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Eddie Jones is a Partner and Head of Department located in Manchesterin our Clinical Negligence department

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