Quarrel the Big Bureaucracies!

Tracking twitter (yes I like many am struggling to figure out what all the hype is about and why we won't be able to live/work without it!), I came across a site 'helping' people to how to find the best med neg lawyer.

My guess, english isn't the first or second language of the author.
On the other hand, you've got to love someone who's prepared to "quarrel the big bureaucracies with tenacity" so you get "the probity you have been acid for." Can't ask for more than that!

Why Early Settlement Still Remains a Good Idea (only)

Musing on a claim that I settled a week or so ago. The matter was settled within 45 minutes, via pre-trial settlement discussions at Court supervised mediation.  The claim concerned complications following a hysterectomy.

The allegations of negligence related to the gynaecologist's failure to discuss alternatives to hysterectomy for control of our client's pre-menopausal heavy periods.  

In the last couple of years, this has been our most common type of claim - hysterectomy remains a medical procedure with a relatively high frequency of serious complication.  These days there are a whole range of conservative alternatives to seek to treat heavy bleeding type symptoms for women. 

The settlement was a good result for the client in what was an indefensible case.
 
I was reflecting however on how we had written to the relevant medical insurer 12 months ago, before any court proceedings were commenced, suggesting early settlement discussion, because of the claim's relatively modest size (<$50,000 - thankfully our client made a good recovery after a fairly torrid initial post-surgery period) and the strength of the negligence allegations.
 
I can say with certainty that if such approach had been pursued by the insurer, the claim could have been resolved on precisely the terms negotiated this week, at that time.
 
The benefits of this are clear. A saving of legal costs for both sides (ultimately largely borne by the insurer), saving of Court resources on the dispute and the therapeutic advantages for my client of any earlier resolution, without the fight.
 

This is clearly a problem being grappled with internationally.

 

Failure to Warn - another Warning (about how difficult these cases are)

Reading the recent West Australian Court of Appeal decision in Gingin -v- Coomb [2009] WASCA 92, handed down last month.  This was a case concerning a catastrophically injured young man who suffered injury when he lost control of his trail-bike when riding it in a designated off-road recreational area, near Lancelin, a beach side town an hour or so North of Perth.

Unfortunately for Mr Coomb, the Court of Appeal (2:1) reversed the trial judge's finding that the Shire were in breach of the duty they owed him, in failing to more adequately warn him of the potential for such injury when riding in the dune area.

I have to say I am very surprised at the evidence at trial (which it does not seem was contradicted) that because the dunes in the designated area were "ever changing, depending on wind strength and direction" (Martin CJ @ R26), it was not feasible for the Shire to inspect the area and cordon off obviously dangerous areas, despite it being found the Shire encouraged use of such area (R20) and that a designated area was set aside for this activity (and was very popular).

It surprises me that it seems the dune face Mr Coombs fell down, which was 10 - 15m high at an angle of 80 degrees, with a hard rock bottom, would not have been an obvious hazard, had it been inspected even a month or 2 before the accident.  In fact very shortly prior to Mr Coombs' accident (on the same day) another rider was fatally injured at the precise same location. This suggests the area was commonly crossed and again, in my view, indicates that inspection/identification of the particular and unusual hazard of the particular location ought to have been possible. The danger (or near inevitability of injuries) for someone riding at anything other than very low speed, over such a dune, and confronting such a face, seems absolutely clear as a matter of common sense.

The case is another example of the difficulty of demonstrating claims, based on an alleged failure to warn. See the contrasting factual conclusions by Martin CJ (in the majority) -v- McLure JA on this.

Once again, the case faced a fundamental evidentiary gap, because Mr Coombs was not asked (as he should have been) and so did not say, how a better sign warning of the particular risk of this sort of dune, would have changed the way he approached the relevant dune on his trail bike (appreciating the difficulty of this, because he had no recollection of the accident).

Although this is not a medical negligence case, it is relevant, given a 'failure to warn' is a very common type of medical negligence or malpractice case investigated.  The key question of whether the person making claim can show that if warned, they would have acted differently (in a medical context, would not have had the surgery etc), remains the most substantial hurdle for claims.

image: GrahamKing 

IPL - the Dangers

 We have for some time been investigating a potential claim for a young women in her 20s with a fair complexion who underwent IPL for freckles on her face, including eyelids. Our client suffered quite severe iris damage as a consequence of the treatment.  It seems the IPL damaged the pigment in her iris, leading to an asymmetrical appearance.

We have now received our expert's report. This has confirmed the inappropriateness of such treatment to this area, the danger of the sort of complication our client experienced and the need for titanium (or other effective) eye protectors for any IPL treatment in proximity to the eyes (our client was given paper 'protectors').
 
This case raises concern quite apart from for our poor client who is left permanently disfigured. As with many such cases, the treatment was provided by a beautician, and at present we have no idea as to her training/qualifications (other than suspicions from the way the treatment was performed).
 
This seems clearly another area of 'cosmetic' medicine, crying out for better regulation.