Interview by Susan Field
Dr Shabbir Choudhury joined the MDU’s claims team in 2014 after seven years in general practice. He tells the journal what is involved in defending the reputations of MDU members.
As a former GP, Dr Shabbir Choudhury knows that day-to-day clinical practice can be enough of a challenge, without the additional time and worry of responding to a clinical negligence claim. 'A medical claims handler's role is to relieve the burden from the MDU member,' he observes.
Shabbir currently handles a portfolio of claims on behalf of MDU members and takes on usually one new claim each day. Each claim is allocated to a member of the 40-strong claims handling team by the head of claims, Jill Harding. The most clinically complex claims are passed to a senior medically qualified case handler. The increasing number of claims means that every new claims handler expects to build up their caseload and the MDU continues to recruit new claims handlers to meet growing demand.
The rate of new claims is not a sign of declining standards, stresses Shabbir, but reflects factors such as developments in the world of personal injury litigation. In fact, almost 80% of the medical claims closed last year were successfully defended with no damages or claimant costs paid and this trend has continued in 2015.
We have one month to respond to a letter requesting clinical records and four months to respond in full to a letter of claim.
While many claims eventually prove to be without merit, every notification requires a considered response and Shabbir emphasises the need to act swiftly. 'It's not a good idea to leave a solicitor's letter on a pile of papers being ignored because the civil litigation process runs to a strict timetable,' he says. 'We have one month to respond to a letter requesting clinical records and four months to respond in full to a letter of claim. That might seem a long way ahead but time is always pressing because of the need to seek expert advice, instruct solicitors and on occasion to meet the member to obtain a statement.
'It's even better if members let us know when they have the first inkling of legal action. We can then assemble the necessary records and statements which will give us a head start if a claim is initiated.' He advises doctors who are notified about a claim to call the MDU on 0800 716 646 and send in the requested notes and other documents straight away.
When a new claims file is passed to Shabbir, his first task is to review the relevant documents and determine the strength of the doctor's position. 'Sadly, claims are now a fact of life for doctors even if their clinical management has been exemplary,' comments Shabbir. 'However, it is easier to refute common allegations such as delays in diagnosis or failure to obtain valid consent if the clinical records are supportive. This highlights the importance of recording relevant findings, differential diagnosis and steps taken to exclude it and the information provided to patients as part of the consent process.'
Receiving a claim is a difficult, and sometimes upsetting, experience for any doctor so another priority for Shabbir is to contact the member to confirm that the MDU will now manage the process on their behalf. 'Members are understandably concerned about what happens next and whether it will get to court,' he says. 'It's not uncommon for claims to be dropped after an initial request for records but even if the claimant pursues the case, I reassure them that less than 1% of claims ever reach a courtroom. I also ensure they know how to contact me if they want to discuss any aspect of their defence.'
Another essential aspect of Shabbir's job is to liaise with a claimant's solicitor as part of a process known as the pre-action protocol, which encourages defendants and claimants to reach early agreement and avoid formal legal proceedings. This can be challenging, as he explains: 'Letters of claim are supposed to give a detailed description of the allegations and the injury that resulted, but some are quite vague. When this happens I have to explain why the letter doesn't comply with the pre-action protocol, which isn't always appreciated.'
As well as liaising with members and claimants' representatives, Shabbir oversees the day-to-day paperwork involved with the claim, such as notifying the Compensation Recovery Unit within the Department of Work and Pensions (the DWP can reclaim sick pay and benefits which arise from a settled claim). 'There is quite a lot of admin involved in claims, which is my least favourite part,' he admits.
'On the other hand, the best aspect is that I have the support of a really good team. If I need help, I can always call on expertise from more experienced claims handlers or our in-house legal department. When I was a practising GP, I was essentially making decisions on my own, but claims management is much more collaborative effort and I never feel I'm working in isolation.'
Dr Shabbir Choudhury
Photo credit: Alice Whitby
Shabbir also frequently presents cases to one of the MDU's committees which meet each week. He explains: 'These are panels of experienced and respected doctors from a range of specialties who discuss the facts of a case and guide our decision-making. If a committee concludes that a claim cannot be successfully defended, I will talk to the member and seek their consent to negotiate a settlement and make admissions if necessary. In my experience, doctors are realistic enough to recognise when evidence is overwhelming and accept that there is no point in defending the indefensible. But our guiding principle is that the MDU defends claims whenever they are defensible and will never settle on purely economic grounds. To do otherwise would set a damaging precedent and would be detrimental to other MDU members. However if a claim needs settling then that should be done at an early stage.
'In fact, most members want me to defend their reputation as far as possible and are willing to attend case conferences at the MDU's offices - or closer to their home - where they have the opportunity to discuss their case with their MDU-appointed solicitor and to meet instructed experts. However, in practice I do all I can to ensure the case doesn't become a headache for them. Most claims are discontinued or settled pre-trial following the exchange of expert reports and statements but in the very unlikely event that a case gets to court, the MDU will assist them through every step and provide the best possible support and legal representation.'
Shabbir has personal experience of the difference that the MDU can make. 'I didn't have a claim,' he says, 'but I did seek both help with a patient complaint and advice on a tricky situation while I was in practice and I was very impressed with the service and advice I received. I had developed an interest in medical law after studying in that area, and I jumped at the opportunity to apply for a position as a claims handler. The MDU was the organisation I turned to when I needed help and I'm very happy that I now play a part in providing that support for other doctors.'