Intensive Care

Intensive Care (ICU) disputes

Given the complexity of decision-making in Intensive Care Units (ICUs), it is unsurprising that disputes arise about the medical treatment of the critically and terminally ill patients in their care. Disputes are sometimes about treatment and diagnosis already received but can also be about what comes next – the proposed treatment or palliative care. These disputes usually arise when a patient is incapacitated or unconscious and unable to communicate their wishes for themselves and are usually between the patient’s relatives and the clinical team.

Sometimes, a patient may have previously provided instruction on how they would like to be treated in the event of serious illness and loss of mental capacity. Very often, however, no such instructions are available. In these circumstances, doctors determine the course of medical treatment based on what they reasonably believe to be in the best interests of the incapacitated patient.

Understandably, the main concern of family members is often to prolong the life of the patient by whatever means available. With advances in modern medicine, there are now many interventions that can be used to sustain the life of an unconscious patient for a long period. The medical team, however, might propose to discuss ‘end of life’ palliative care on the basis that further treatment would be inappropriate. Conflicts arise when there is a prolonged disagreement about the best interests of the patient. For the resolution of ‘Best Interests’ disputes, click here.

Independent Evaluations – independent of the NHS

No matter what the nature of the dispute, whether it is a claim about past treatment or a dispute about proposed treatment, we believe that in order for any dispute resolution process to work effectively for ICU disputes, it must be completely independent of the NHS. Independent Evaluation is the ideal dispute resolution process because our Evaluators practice independently of the NHS, as well as having vast experience in medical cases.

Bespoke model for ICU Evaluations

The difficulty of trying to resolve ICU disputes through the courts is widely recognised. The prolonged court process causes relatives pain and uncertainty in what are already very distressing circumstances. Anxiety increases because the longer the delay, fewer treatment options will remain available to the patient concerned. The eventual Court ruling can also leave one of the parties feeling that justice has not been served.

In response to the demands of ICU disputes, we have adapted the process of Independent Evaluation to create ICU Evaluations, using the same model as Best Interests Evaluations. ICU Evaluations use the same, proven IE process but they are conducted by two top tier Evaluators rather than one. This is because we believe that in order to achieve a forensically accurate assessment of any ICU dispute, the process must draw on top level intensive care (ICU) consultant expertise, as well as top tier legal expertise. ICU Evaluations are therefore evaluated jointly by two Evaluators, one legal, one medical, both of whom are completely independent of the NHS.

Together with IE’s Best Interests Evaluations, these are the only forms of early neutral evaluation in the UK that are conducted jointly by both legal and medical Evaluators.

Why refer an ICU dispute to Independent Evaluation (IE)?

  • IE is recognised by senior members of the judiciary as one of the best and quickest forms of dispute resolution.
  • IE has a highly successful track record in resolving difficult disputes in which opposing parties have become entrenched.
  • ICU Evaluations are conducted by two Evaluators – a top tier QC or Judge with vast experience in medical disputes and a top tier medical Consultant with specialist expertise in the Intensive Care (ICU) environment.
  • ICU Evaluators (legal and medical) practice independently of the NHS.
  • The IE process allows the parties to have private face to face discussions with the Evaluators in a way that is impossible in Court.
  • This creates conditions that are far more conducive to achieving an optimal settlement, whilst also protecting any ongoing therapeutic relationship.
  • IE is cost effective. The cost of the Evaluation, which is born by the hospital trust, is much lower than the cost of litigation/going to court. With IE, there is no cost at all to the patient or relatives, so private means or crowd-funding are not necessary.

Best possible chance of resolution

Independent Evaluation is designed to provide the best possible chance of resolving Intensive Care disputes to the satisfaction of all involved. The bespoke IE process enables relatives and clinicians to gain a better understanding of each other’s position, and, assisted by the Evaluators, to agree a resolution. The process also helps to restore relations between patient/relatives and clinicians, enabling them to resume a positive and mutually respectful relationship.

What to do next

If you are involved in an ICU dispute, whether you are a relative of the patient, the solicitor representing the patient/relative, or a solicitor representing NHSR or an NHS Trust, please contact us at Independent Evaluation. We believe we offer the best chance of resolving your dispute and allowing all parties to move forward.

For more information or to refer your dispute for Evaluation, please call Jonathan Bishop on 020 3383 1000 or complete our enquiry form.