Advertisement - Hide this advert





Author Topic: Two stage knee procedures - interesting legal stuff  (Read 712 times)

0 Members and 1 Guest are viewing this topic.

Offline kneesurgeonvictim

  • MINIgeek (20-50 posts)
  • **
  • Posts: 28
  • Liked: 0
Two stage knee procedures - interesting legal stuff
« on: July 16, 2012, 08:11:42 AM »
Those considering two stage knee operations (MACI, ACI and others) should be aware that there now may be a legal precedent for surgeons in the UK only have to inform patients of risks of the second stage of a two stage procedure AFTER the first stage operation has taken place. For example, if a patient opts for a two stage procedure, patients can sign a consent form for the first stage to acknowledge risks of arthroscopy and cartilage harvest without having been informed of the risks of the much complex second stage operation, and if the patient decides not to proceed to the second stage after becoming aware of second stage risks the surgeon may be able to successfully argue that all appropriate consents were obtained as cartilage harvest was the only operation actually performed.

Another interesting development is there has recently been a successful legal argument made and possibly precedent set in which evidence of surgeons carrying out these relatively new two stage operations may be preferred to evidence from experienced knee consultants who do not carry out these operations. Fine but for the fact the pool of MACI surgeons is fairly small and experience limited due to the fact the MACI procedure is relatively new. So if highly experienced and highly regarded Consultant Expert A who does not perform MACI operations has an opinion a MACI operation was not appropriate in a particular circumstance and Consultant B who does perform MACI operations says MACI was appropriate in that circumstance, Consultant B's evidence may be likely to be preferred. Also that NICE (National Institute of Clinical Excellence) guidelines that some believe are partly there to help protect patients (amongst other things) do not apply in the field of private medicine. A recent legal case concerning MACI was defended brilliantly by a top QC (Silk) Barrister - one of the best in the country - but I wonder if the result made two stage knee operations such as MACI and ACI and private Knee Clinics safer for patients?

So if things go pear shaped with your two stage knee operation you may have less legal redress than you think even to the extent where you may feel you are up against an entire industry with mega resources who are easily able to afford top Silk QCs. So as someone who chose MACI and was surprised by the pain and loss of mobility experienced after cartilage harvest and by the nature and extent of risks of the 2nd stage operation, in my view two stage operations such as MACI or ACI are most definitely not for beginner knee patients and should only be embarked on, in my view, if all else has failed, and in my view, most definitely not as a first line treatment. I would even go so far as to suggest that one must never rely on a UK knee consultant to inform you of ALL risks of MACI or ACI procedures prior to the 1st stage operation, because legally speaking, they may not have to.
« Last Edit: July 17, 2012, 12:32:00 PM by kneesurgeonvictim »

Offline kneesurgeonvictim

  • MINIgeek (20-50 posts)
  • **
  • Posts: 28
  • Liked: 0
Re: Two stage knee procedures - interesting legal stuff
« Reply #1 on: July 16, 2012, 04:09:09 PM »
And in reply to my own posting, MACI may have also been deemed (in a legal setting) as an appropriate first line treatment for UK patients with asymptomatic knee cartilage defects and no prior history of knee surgery, even though MACI may be recognised as being too new to make any conclusions about long term effectiveness. So new that from the long term point of view, MACI may still be regarded by some as being experimental. This recent legal decision may clear the way for Consultants to recommend and carry out MACI surgery to virtually any knee patient with a cartilage defect regardless of history and not to inform the patient of full MACI risks until after the first stage operation has taken place. Great news for MACI consultants who may ramp up MACI operations with apparently relative legal immunity. May be bad news for unwary knee patients. The involvement of a top QC silk in defending (amongst other things) the merits of MACI treatment in a patient and the apparent demolition of evidence given by highly experienced knee consultants' to the effect that MACI may not be an appropriate treatment in a particular circumstance on the basis they the medical experts do not perform MACI operations may bode ill for the chances of success in a legal environment if MACI operations go wrong. Generally I believe patients should be very wary of novel knee treatments since in the event allegedly poor treatment goes legal, one may find oneself on the wrong side of Top Silks more accustomed to defending multi million pound frauds, cartel price fixing, Middle East sanction busters and Corporate Manslaughter cases - and these QCs are impressive - the Federers of the legal world. the medical industry is worth hundreds of millions of pounds a year, and those involved in developing new treatments through and beyond the experimental stage may have the resources to defend themselves, big time.
« Last Edit: July 18, 2012, 12:45:56 AM by kneesurgeonvictim »