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US court begins first phase of BP oil spill trial

Deepwater Horizon.

The New Orleans court in the US has initiated first phase of trial over the BP Gulf of Mexico oil spill accident that leaked up to 4.1 million barrels of oil into the Gulf of Mexico and killed 11 people in 2010.

The US government is seeking the highest possible penalties and damages for wilful misconduct or gross negligence of BP that caused the accident.

BP, however, rejected the allegation citing that the disaster had involved multiple causes and multiple companies.

Michael Underhill, lead prosecutor of the US Department of Justice, said that even if any individual action by BP staff might not amount to wilful misconduct, the accumulation of actions that caused the disaster reached that standard.

“The evidence will show BP put profits before people, profits before safety, and profits before the environment,” Underhill added.

BP’s chief lawyer, Mike Brock, responded that wilful misconduct or gross negligence were high standards for the government to prove.

The department alleges that BP knew or should have known that its decisions would lead to an accident.

If the court finds wilful misconduct then it could fine BP up to $17.6bn under the Clean Water Act.

Lawyers for the US government, private sector plaintiffs and the states of Alabama and Louisiana, which have claimed more than $34bn, also argued that BP’s contractors Transocean and Halliburton acted with gross negligence.

Rejecting the allegations, Transocean said its staff had been working under the direction of BP, while Halliburton said there was a no problem with its cement that was used to seal the well.

Underhill focused on a critical test intended to show whether the well was safely sealed with cement.

Brock responded that BP’s acceptance of a mistake by its employees means that “this does not reflect gross negligence, want of care [or] intentional wilful conduct …. These people were trying to get it right; trying to do the right thing.”

Luther Strange, the attorney-general of Alabama, argued that coastal states affected by the spill were seeking damages from BP and the other firms involved.

The second phase of trial is planned in September 2013.

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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide