By Alan Merry, Alexander McCall Smith
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M. By this time, the doctors concerned had been working for almost 24 hours without rest. The patient was handed over to intensive care staff and the doctors departed. Shortly afterwards, cardiac arrest occurred and the patient died. The postmortem examination con®rmed that the cause of death was bleeding into the thorax from the damaged carotid artery. At the coroner's hearing (presided over by a district court judge), the expert witness gave evidence that the actual insertion of the CVC had been entirely competent, and that the problem which had occurred was a recognised complication of CVC insertion.
13 It is not our position that these errors should be accepted ± indeed, much greater effort is warranted to reduce their occurrence. However, given the frequency of drug errors overall, the conclusion does seem inescapable that the factor which plays the greatest role in the allocation of blame for these errors is their outcome. It is the result that is being judged, not the action. In other words outcome bias is compounding the effect of moral luck ± phenomena to which we shall return in chapters 6 and 7.
Furthermore, it could reasonably have been predicted that the failure to follow such precautions might eventually result in a disaster. There are grounds for suggesting, therefore, that the case of Dr Yogasakaran was an accident, while that of Dr Morrison was not. In spite of this, it seems harsh to place the entire responsibility for the event on Dr Morrison, partly because of the contribution of a second person (the radiologist), but more importantly because the evidence points to the lack of a properly de®ned procedure for radiologists administering such an injection at the time.