Pneumothorax and acupuncture: a point too far?

‘Could this really have been a result of acupuncture, after all the needles are so thin? Surely this wasn’t done by a physiotherapist?’

The CSP had the issue of pneumothorax caused by acupuncture on its radar well before the Ellen White story. Let there be no doubt, PLI notifications made by members for pneumothorax caused by acupuncture are frequent, repeated, and persistent.

Physiotherapists on social media defended the profession suggesting such risk was negligible, or that physiotherapists wouldn’t cause such injury. Another suggestion was that physiotherapists could avoid liability and use disclaimers. This is simply not an option; you cannot absolve your duty of care to a patient via disclaimers. 

If you fail to provide a reasonable standard of care, and cause harm to your patient, you run the risk of a negligence claim being made against you. In most cases claims can be defended. Pneumothorax as a result of acupuncture is a ‘never’ event. This means there is no defence and these notifications always result in a pay-out. The legal costs are always much greater than the compensation, and all are a drain on our PLI scheme. 

The CSP PLI team work closely with our brokers James Hallam to ensure our PLI policy provides value for money, meets the needs of members as far as possible, and has a robust risk-management process in place to address themes within the claims we handle. 

Driving standards

Addressing clinical issues can be challenging: the CSP is not a regulator (that is the role of the HCPC) and we cannot ‘police’ what our members do. For post-registration activities, prescribing is the only HCPC regulated activity. We have a role in educational standards; we set the standards for pre-registration physiotherapy programmes and the training expectations injection therapy, pelvic examinations, and Point of Care Ultrasound. Should we be doing more?

As a professional body we aspire to drive up the quality of physiotherapy practice across the UK and challenge indefensible practice; we take this seriously. However, the resource required to define the content, learning outcomes and competency requirements across any given clinical modality is considerable.

The CSP has no concerns about the safety of acupuncture as a whole, but the risks of pneumothorax associated with its use around the thorax are both foreseeable and preventable; members ought to be fully aware of this. How should we react as individuals, to protect our patients and, as a profession, to protect our reputation? How well do we assure that we have maintained competence; how do we assure we are practicing safely?

Moving forward

This is an opportunity for all members to take a step back and reflect on how they consider their competence in all areas of practice, especially when undertaking activities which have known and serious consequences. From our research into PLI claims as a result of pneumothorax, we believe no claims to date have come from members who are AACP members. Is this a time for members who practice acupuncture to engage with our recognised professional network to seek consistent training and peer support as a means of assuring quality practice? 

We are all impacted by the cost-of-living crisis and seeing our household bills significantly rise. Insurance is no different - when claims are made, we expect our premiums to rise. CSP PLI premiums are no different and persistent indefensible claims impact on us all. We will continue to review and reflect on PLI claims and risk manage our scheme.

Pneumothorax claims are a wakeup call to us all. We all have a part to play. 

• Sara Conroy and Pip White are CSP professional advisers