Had to come on here as my blood is boiling (again) after the GF read out to me a few of the complaints on here regarding GPs failing to see that those with pernicious anaemia are given the necessary treatment.
A plan was formulated in anticipation of my GF being refused her monthly B12 injections in favour of three-monthly jabs, and that plan was to threaten a court claim. That wasn't needed in the end but I thought it might be useful to tell you what that plan was.
OK, so refusing the monthly jabs would have been negligent due to a professor at a top hospital stating that monthly injections were necessary - their opinion would trump that of a less qualified person, such as a GP. That negligence would have resulted in B12 having to be procured from elsewhere, which would have cost money. Any money so spent would be due to the GP's negligence and therefore damages could be claimed for costs of the B12 and syringes.
A letter would have been written to the surgery stating that a court claim would be the result of failing to administer the necessary monthly injections. The intention of the letter would have been to put pressure on the surgery and make sure they did provide the essential jabs monthly. It may or may not have worked, but the thinking was that given the low cost of the B12, contrasted with the high cost of litigation, it might just be a lot cheaper and easier to provide the jabs.
Had this failed a court claim would have been made, which under the small claims procedure is not at all complicated or expensive, though the losing side can be ordered to pay the legal costs of the other party (but you probably wouldn't be pursued for them in a case like this). Benefit claimants or those on low income can get fee remission for the cost of issuing court documents, including the N1 Claim Form, which should amount to no more than £25/£35.
Were the claim not settled before a hearing then a judge would decide the matter - and that would be that.
You might win, you might lose, but in the meantime there has been a few grand spent on defending the claim, which will never be recovered in most instances (but please note that wage earners could potentially be subject to deductions from pay, and that house owners could potentially end up with a charge on their property).
This why the first letter may have worked - providing the injections when needed easily and cheaply solves any future problems which may be caused by a court claim being made or won. A win would allow others to do the same - not that any precedent is set, just that similar claims in the future would be known to have legal merit.
On the other hand I have been told that the NHS will take over any legal proceedings, which leaves less pressure on the individual doctor or surgery perhaps. But still, your Letter Before Claim will have to be dealt with by the surgery somehow, and if it looks like you are serious they may change their minds.
Desperate situations call for desperate measures and there was nothing to lose in this situation. For those in similar situations it's something to think about or look into.
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SnappySam
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The GP would point out that the BCSH guidelines, which they are probably told they must follow, say that treatment should be as described in the BNF - every 2 or 3 months. More frequent treatment would be off-license.
They would probably be able to persuade any judge that the BCSH trumps any single professor.
That's a very good point fbirder, but the guidelines may also provide evidence in support of any claim, such as this for instance:
"These guidelines aim to provide an evidence based approach to diagnosis and management. However, such evidence, particularly in the form of randomised controlled trials, is lacking. As a result, these guidelines provide a pragmatic approach to testing and treatment of cobalamin and folate disorders, with recommendations based, as far as possible, on the GRADE system (Appendix 1: gradeworkinggroup.org/index.... In the majority of situations, the recommendations inevitably rely more on clinical judgement and consensus than objective laboratory data."
I see here an argument that a thorough examination, diagnosis and medical prescription from a professor would override a doctor's decision based merely on dubious 'recommendations'. I am sure there will be other documents and literature out there which may be useful.
If it were known for a fact that such legal action has never worked in the past, then it would be fair to say that doing it again would probably be a waste of time. If no such action has been tried and tested the outcome is uncertain and therefore it might be worth the effort.
The example discussed is one thing, and perhaps there is a good defence, but I believe that one member on here was told two different stories as to why their B12 had ceased - neither being reliant on the guidelines needing to be followed. That, to me, is negligence of a similar kind, and also actionable - but possibly with the defence of following the guidelines not being available.
"Healthcare professionals may have more responsibility to accurately prescribe an unlicensed medicine or an off-label medicine than when they prescribe a medicine within the terms of its licence."
and this:
"...there are clinical situations when the use of unlicensed medicines or use of medicines outside the terms of the licence (ie, ‘off-label’) may be judged by the prescriber to be in the best interest of the patient on the basis of available evidence'
it could be argued that a GP is not required to blindly follow the dosage recommendations. And it's a fact that many of them routinely don't. A cursory look suggests that there is some ammunition in the legislation and guidelines.
Yes, I posted something similar a few weeks back, arguing for off-label usage of B12 jabs.
However, to play devil's advocate, I can imagine that the phrase 'usage outwith the terms of the drug's license' will carry a lot of weight with a judge.
I think a legal case may stand a better chance in a situation where a patient requests more frequent injections and is refused, then writes to the GP asking about the possibility of degeneration of the spinal cord secondary to PA. If the GP's reply is on paper, then they would be open to an accusation of professional misconduct when the patient did develop such a problem.
Plaintiff: Yes, your honour, I wrote to him and ask him if I was at risk of degeneration of the spinal cord if I didn't have more frequent treatment.
Judge: And what was his reply?
Plaintiff: Here is the letter from him wherin he states "You are at no risk of degeneration of the cord if you follow the regimen outlined in the BNF."
Judge: And you say that you have subsequently developed this condition?
Plaintiff: Yes, here is a report from Professor Brainy, consultant neurologist at Bighospital, after he ran various tests including MRI, in which he states that I clearly have degeneration of the cord caused by low levels of B12.
Judge: I find in favour of the plaintiff. Damages, for loss of earnings and quality of life, shall be paid to the sum of twenty million pounds.
Thank you very much for posting this! Without the condition you are able to think clearly, like most of us used to!
I wish we could get a coordinated, water--tight test case that would set a precedent to stop so much suffering in so many people. I believe those who do get a diagnosis are only the tip of the iceberg.
If diabetics were treated like this there would be a major outcry but B12d is just as debilitating and ultimately deadly.
Interesting to read your post SnappySam. I too wish someone was able to make a claim like this in order to set a precedent.
I think those with an actual diagnosis of PA or B12 deficiency have some advantage over those of us who remain undiagnosed. Without a diagnosis, litigation won't work.
From the little I know of people using litigation against the NHS I believe it is very difficult to win. I know people who have made a fuss and have then been labelled as difficult patients.
I would suggest that putting things in writing to GPs and Consultants and keeping copies of letters and any replies received might be helpful and provides evidence if litigation is necessary in future. I also think that it is a good thing to take someone to appts especially if a patient thinks they're likely to have injections cancelled or reduced. It is so difficult as denisemilden above mentions to argue your case with a foggy brain. Another person is a witness to what is said or could take notes. In my opinion, medics are sometimes kinder when another person is present.
How lovely that you are supportive of your GFs condition. It can be very hard to keep on fighting without support.
" I believe those who do get a diagnosis are only the tip of the iceberg. "
Denise, I agree with your comment. I have been ill for many years and am highly symptomatic and have responded to self treatment.
I reckon there are probably hundreds of thousands of sufferers maybe even millions especially if you include those with other causes of b12 deficiency besides PA.
It might possibly work Sam - I was told by a GP that her surgery was not allowed to prescribe B12 injections because they were afraid of being sued for overdosing !
I believe this is also why hypothyroid patients are having their thyroxine dose cut and constantly warned they are in danger of heart problems when, in fact, they are at more risk from the oroblems caused to the heart, liver and other organs from insufficient thyroxine....
It could also be pointed out that there are now questions being asked in the House of Lords:
As sleepybunny says - get things in writing, take witnesses. Maybe bring a voice recorder. Note everything that is said. The GP mentioned by polaris seems to have made a dodgy statement, and that's the kind of thing that could be made a big deal out of.
I do appreciate that going against the NHS in court won't be easy, but going to court isn't necessarily the aim. The threat of litigation may get results; the making of a claim may get results; if a defence is filed, and it looks good, you could always drop the claim.
My GF had nothing to lose by litigating it, whereas the other side could only lose a lot more than they could ever possibly gain by refusing the monthly injections. They may have backed down just to save the bother, even if legally they were in the right.
Were it to have gone all the way to court then I would have been confident in seeing a fair hearing as County Court judges are generally reliable. It would be a mistake to believe that a judge would automatically favour the NHS. For one thing the claimant usually has the upper hand at the start - after all, they are aggrieved and have a genuine complaint and will elicit some amount of sympathy. The Defendant is being accused and is 'making excuses', and will be under scrutiny. Judges will not usually kow-tow to the other side just because they are a large authority. It would also be a mistake to believe that their legal team can do a better job than you can do. If you have the will to win that's half the battle.
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