Long-term distress was assessed in 29 patients who had suffered an injury during surgery, a failure of diagnosis or other incorrect treatment, and who had taken legal action as a result. Psychological distress reported over four years after the incident was severe: 38 per cent of those interviewed were identified as ‘cases’ for anxiety, 41 per cent for depression and 55 per cent for both on the Hospital Anxiety and Depression Scale, using the conservative cut-off criteria of 11 for caseness. Scores on the Impact of Events Scale indicated higher levels of intrusive memories and posttraumatic distress than have been previously reported for serious life-events and other accidents. Early and ongoing psychosocial interventions would benefit many victims of medical accidents. Clinical psychologists have an important role to play in providing psychological treatment where appropriate and in re-establishing a relationship of trust and confidence in health care professionals.