Medical Malpractice and Compensation in Global Perspective (eBook)

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Ken Oliphant, Institute for European Tort Law, Vienna, Austria; Richard W. Wright, Chicago-Kent College of Law, Chicago, USA.

Medical Malpractice and Compensation in Global Perspective: Introduction 19
I. Issues Addressed 20
A. Overall Scheme 20
B. Details of the Applicable Liability and Compensation Systems 21
C. Empirical Data 22
D. Attitudes, Concerns, and Prospects 22
II. Aims 22
Medical Malpractice in Austria 25
Introduction 25
I. The Insurance Framework 26
A. Social Insurance in Austria 26
B. The Role of Private Insurance 27
1. First-Party Insurance 27
2. Liability Insurance 28
II. The Regulatory Framework 28
A. Professional Law 28
B. Criminal Law 29
C. Contract Law 30
D. Tortious and Contractual Liability 31
1. Tortious and Contractual Liability Not Mutually Exclusive 31
2. Tort Law in General 32
3. Damage 32
4. Causation 32
5. Wrongfulness and Fault 35
6. Multiple Persons Involved 36
7. Informed Consent 39
8. Remedies 42
III. Compensation claims in practice 46
A. General Remarks 46
B. Patient Advocacies 47
C. Conciliation Bodies 48
D. Compensation Funds 49
E. Outlook 50
A Bridge over troubled Waters: The Development of Medical Malpractice Litigation in Brazil 53
Introduction 53
I. The Brazilian Legal System 57
II. The Structure of the Brazilian Legal System 58
III. The influence of the Consumer’s Defense Code 61
A. Informed Consent, the Duty to Inform, and Informed Choice 63
B. Moral Damages and the Inversion of the Burden of Proof As Patient’s Basic Rights 67
IV. The Changes Brought by the New Civil Code 68
Conclusion 70
Canadian Medical Malpractice Law in 2011: Missing the Mark on Patient Safety 73
Introduction 73
I. The Canadian Malpractice Context 75
rvice Delivery, Regulation and Liability Insurance 77
II. State and Quality of the Canadian Health Care System 78
A. Medical Malpractice in the Domain of Privately Financed Care 84
III. Redressing Adverse Events through the Courts 85
A. Canadian Medical Malpractice Liability in Context 87
B. Empirical Trends on Medical Liability Claims 88
C. Black Letter of Canadian Tort Law 90
1. Battery by Physicians 91
2. Negligence by Physicians 91
3. Hospital Liability 99
4. Government Liability 101
5. Damages 102
6. Ongoing Issues and Avenues of Reform 104
IV. Preventing Adverse Events: Professional and System Reform 105
A. Reforms at the Level of the Professions 106
1. Alternative Complaint Mechanisms 106
2. Revalidation/Recertification 107
3. Apology Legislation 108
B. Systemic Reforms 109
1. Accreditation of Facilities 109
2. Canadian Patient Safety Institute 110
3. Improved Information Gathering and Dissemination 110
Conclusion 112
Yangge Dance: the Rhythm of Liability for Medical Malpractice in the People’s Republic of China 115
Introduction 115
I. The Wider Healthcare Context 117
II. The Early P.R. China: Medical Services as Social Welfare (1949–1987) 120
III. The Administrative Liability Regime 123
A. The Medical Accident Rules 1987 123
1. Context 123
2. Main Features of the Administrative Liability Regime, 1987–2002 124
B. The Medical Accident Regulations 2002 126
1. Context 126
2. Main Features of the Administrative Liability Regime, 2002 onwards 126
IV. The Tort Liability Regime 129
A. Recourse to the General Principles of Civil Liability 129
B. Elements of the Tort Liability Regime 131
1. Cause of Action 131
2. Burden of Proof 131
3. The Identification Process 132
4. Assessment of Damages 133
C. Effect on the Administrative Liability Regime 134
V. Reform of Medical Liability under the Tort Liability Law of 2009 135
A. Antecedents 135
1. Increasing Disputes between Doctors and Patients 135
2. Concerns about Defensive Medical Treatments 136
3. The Chaos Resulting from the Dual Dystem of Medical Liability 137
B. Legislative History 138
C. Four Dimensions of the TLL 139
1. Basis of the Cause of Action 139
2. Burden of Proof 142
3. The Identification Procedure 144
4. Assessment of Damages 144
VI. Another Step Backwards on Its Way? 145
Conclusion 148
Medical Malpractice and Compensation in France 149
Part I: The French Rules of Medical Liability since the Patients’ Rights Law of March 4, 2002 149
Introduction 149
I. General Conditions of Medical Liability 152
A. Facts Likely to Justify the Physician’s Responsibility 153
1. Liability Based on Fault 154
2. Strict Liability 161
B. The Causal Link 166
1. Causation Criterion 166
2. Causation Proof 167
C. The Victim’s Harm 172
II. Administration and Adjudication of claims based on liability rules 174
A. Adjudication Through Conciliation Commissions 175
B. Adjudication Through Courts 177
Part II: Compensation Based on National Solidarity 181
Introduction 181
I. Typology of Cases Covered by National Solidarity 182
A. Medical Hazards 182
B. Hospital-Acquired Infections 184
C. Blood Transfusions Infections 185
1. HIV Infection 185
2. Hepatitis C Infection 186
3. Additional Grounds 186
II. Administration and Adjudication of Claims Based on National Solidarity 187
A. Administrated Claims 187
B. Procedural Routes to ONIAM 189
C. Adjudication Proceedings in Front of ONIAM 191
D. Regulatory Principles Applying to Rights of Recourse 192
III. Awarded Compensation 193
Medical Malpractice and Compensation in Germany 197
Introduction 197
I. The Potential Legal Consequences of Medical Injury 199
A. Criminal Law 199
B. Professional and Disciplinary Sanctions 200
C. Fault-Based Compensation in Private Law 201
D. Strict Liability and No-Fault Compensation for Medical Product Injury 204
E. Social Security, Insurance, and Subrogation Issues 205
II. The System of Private Law Compensation 207
A. Treatment Malpractice Claims 207
1. Faulty Treatment 207
2. Causation 210
3. Proof Issues 211
B. Disclosure Malpractice Claims 214
1. Background 214
2. Standard of Disclosure 215
3. Causation 216
C. Damages and Liability Insurance Issues 217
D. The Medical Arbitration Boards 219
III. Assessment of the Current Situation 220
A. Empirical Data 220
B. Evaluation of the Private Law Redress Rules 223
C. Patient Safety Initiatives 225
Conclusion 226
Addendum 227
Medical Malpractice: The Italian Experience 229
Introduction 229
I. The Problematic Nature of Medical Liability 231
II. The Assignment of the Burden of Proof Between Parties 239
A. Proving Fault 239
B. Proving Causation-In-Fact 244
C. Proving Causation Under the Criminal Law and Under the Civil Law 247
D. The Role of Informed Consent 250
Conclusion 253
The Law of Medical Misadventure in Japan 257
Introduction 257
I. Prosecutions and Their Consequences 260
A. Prosecutions in Medical Cases 260
B. Response by the Health Ministry and the Medical Profession 264
C. One Prosecution Too Many: The Medical Professionals’ Counterattack and the String of Acquittals 267
II. Civil Liability 269
A. Substantive Law of Medical Malpractice 270
1. Theories of Recovery 270
2. Standard of Care 271
3. Level of Proof 272
4. Informed Consent and Related Actions 275
5. Damages 276
B. Key Aspects of Procedural Law and Practice 278
1. In General 278
2. Discovery of Peer Review Findings 279
3. Judicial Administration Reforms 280
4. Settlement Practices, Overall Claiming Levels, and Malpractice Insurance Premiums 281
5. Plaintiffs’ Attorney Fees and Court Filing Fees 285
III. The No-Fault Compensation System for Obstetrical Injury 286
Conclusion 289
Addendum 291
Treatment Injury in New Zealand 293
Introduction 293
I. The New Zealand Accident Compensation Scheme 294
A. The Woodhouse Report 294
B. Implementation 296
C. Developments to 2010 297
D. Relationship with the Common Law 301
E. Cover 303
1. Categories of Cover 303
2. Personal Injury 304
3. Residual Actions for Damages 305
F. Claimants 306
G. Benefits 306
H. Claims Process 308
I. Funding 309
J. Administration 310
II. Medical Injuries 310
A. Cover 313
B. Treatment Injury 314
1. Proof of Cause 314
a. Atkinson and Ambros 315
b. Modification of Ordinary Rules? 319
2. Nature of Treatment Injury 322
3. Treatment Injury in Operation 325
4. Costs 328
C. Professional Accountability 329
1. Reporting of Medical Risks 330
2. Complaints 331
3. Actions for Damages 332
a. Clinical Trials 332
b. Stillbirths 333
c. Pregnancy and Unwanted Births 334
d. Informed Consent Cases 335
e. Mental Injury 336
f. Miscellaneous 336
g. Exemplary Damages 336
Conclusion 337
A. Adequate Compensation? 337
B. Defensible Boundaries? 337
C. Administratively Efficient? 339
D. Disincentive to Safety-Conscious Behavior? 340
E. Overview 342
Medical Malpractice and Compensation in Poland 345
Introduction 345
I. Grounds for Civil Liability 349
II. Liability Based on Fault 362
III. Burden of Proof and Causation 369
IV. Compensation 374
V. Professional Liability of Doctors 388
Conclusion 390
Addendum 391
Malpractice in Scandinavia 395
Introduction 395
I. The Overall Scheme for Preventing and Redressing Medical Errors and Adverse Events 397
A. Regulatory Methods in the Nordic Health Care Systems 397
B. Compensation Systems 398
C. Liability Systems 399
D. The Relationship Between the Systems 400
II. The Details of the Applicable Liability and Compensation Systems 401
A. Patient Injury Compensation Systems 401
1. Introduction 401
2. Basis for Compensation 401
a. The Experienced Specialist Standard 401
b. The Failure of Apparatus 403
c. The Alternative Treatment Rule 404
d. The Reasonableness Rule 404
e. “Accidents” 405
f. Wrong Diagnosis 406
g. Infection 406
3. Causation 406
a. The Concept of Causation in Scandinavian Law 406
b. The Problems of Causation in Malpractice Law 410
c. Relaxation of Evidence 410
d. Assessment of Damages 411
III. Available Empirical Data 412
Conclusion 413
Medical Malpractice and Compensation in South Africa 415
I. The Overall Scheme for Preventing and Redressing Medical Errors and Adverse Events, Including Regulation, Criminal and Civil Liability, and Social and Private Insurance, and the Relationships Among These Various Systems 415
A. Regulatory Methods 415
1. Government Licensing Authorities for Doctors and Hospitals 415
2. Medico-Ethical Codes of Conduct 419
3. Reporting of Medical Errors and Adverse Events to the Health Profession Council of South Africa 420
B. Liability Systems 421
1. Contract 421
2. Delict (Tort) 424
3. Criminal Law 424
4. Relationship Between the Liability Systems 426
C. Compensation Systems 427
1. Sufficient Insurance Cover To Be Required for Private Health Establishments 431
2. Private Indemnity (Medical Protection Society) 432
D. Relationships Among the Compensation Systems, the Liability Systems, and the Regulatory Systems 433
II. The Details of the Applicable Liability and Compensation Systems 436
A. Criteria Defining Qualification for Compensation 436
1. Liability Based on Fault 436
2. The Role of the South African Constitution, 1996 438
3. Nature of Damages and Compensation 439
B. Causation and “Loss of Chance” 441
1. General Rules on Causation 441
2. “Loss of a Chance” 443
C. Liability for Failure to Obtain Informed Consent 444
D. Matters of Proof and Gathering of Evidence 445
1. Matters of Proof 445
a. General 445
b. Gathering of Evidence 449
III. Available Empirical Data on Medical Errors and Adverse Events, the Operation of the Systems Designed to Prevent and/or Redress such Errors and Events, and the Prevalence and Impact of Measures Designed to Reduce Medical Errors and Adverse Events, Im 450
IV. Attitudes and Concerns About the Liability and Compensation Systems 453
Medical Malpractice and Compensation in the UK 457
Introduction 457
I. The Context of Medical Malpractice Liability 458
II. Recent Empirical Evidence on the Numbers and Funding of Claims 460
A. England 460
B. Scotland 463
C. Summary 464
III. NHS Redress Act 2006 464
IV. Patients’ Rights Bill in Scotland: The No-Fault Compensation Review Group Report (McLean Report) 466
V. Basis of Liability for Medical Injury 469
A. Contract, Tort, and Delict 469
B. The Requirements of Negligence 469
C. Duty of Care 470
D. Standard of Care 470
E. Causation 472
1. Difficulties in Proving Causation in Clinical Negligence Cases 473
2. The Burden of Proof 474
3. The “But For” Test 474
4. Cumulative Causation 475
5. Material Increase in Risk 475
6. Alternative Causation 475
7. Reinstating McGhee: Fairchild 476
8. The Scope of Fairchild and Clinical Negligence Cases 477
9. Loss of a Chance 480
VI. Reforming the Costs of Civil Litigation in England and Wales: Implications of the Jackson Report for the Costs of Clinical Negligence and the Ministry of Justice Reform of Legal Aid 484
A. Jackson Report 484
B. Reform of Legal Aid in England and Wales 487
Conclusion 488
Medical Malpractice and Compensation in Global Perspective: How Does the U.S. Do It? 491
Introduction 491
I. Details of the Applicable Regulatory and Liability/Compensation Systems 494
A. Regulating the Delivery of Medical Care 494
B. Liability/Compensation Systems 495
1. Fault-Based (Negligence) 495
2. No-Fault Liability (Strict Liability) 501
C. Limitations on Liability/Contracting out of Liability 501
D. Immunity from Liability 503
II. Empirical Data on Medical Errors/Adverse Events and Malpractice Litigation 504
A. How Common Are Medical Errors and Adverse Events? 504
B. Malpractice Litigation 505
1. Claiming Frequency (relative to rate of medical error/adverse events) 506
2. Compensation Patterns and Time Trends 507
3. Impact of Caps on Non-Economic Damages 514
4. Accuracy of the Liability System 517
5. Frivolous Lawsuits 519
6. Cost of Medical Errors/Adverse Events 520
7. Cost of the Liability System 521
III. Attitudes and Concerns About the Liability and Compensation Systems 523
IV. Why Do Things Look the Way They Do? 524
V. What Have We Learned by Studying Texas? 525
A. Who Decides Malpractice Cases? 525
B. Does it Matter How Much the Jury Awards in a Malpractice Case? 526
C. How Much Coverage Do Physicians Have? 526
D. Do Changes in the Tort System (i.e., increases in the number of claims, or payouts per claim) Help Explain the Malpractice Crises that Hit the United States in 2000–2003? 527
E. Impact of Tort Reforms on Claim Frequency and Payouts 528
Conclusion 528
Medical Malpractice and Compensation: Comparative Observations 531
Introduction 531
I. Making Sense of Diversity 534
A. A Diversity of Legal Mechanisms 534
1. Liability systems 534
2. Alternative compensation systems 539
3. Other regulatory and complaints mechanisms 541
B. The Wider Context 544
1. The substantive legal context 544
2. The wider litigation process 545
3. The health care context 548
C. Comparative Functional Analysis 551
II. Assessment of Liability-Based Approaches 553
A. Compensation 553
1. Mechanisms for dealing with organizational complexity 554
2. Adaptation of the Requirements of Causation and Proof 557
3. Patients’ Rights and Disclosure Duties 560
B. Prevention 565
1. The deterrent effect of liability rules 565
2. Pushing prevention too far? Defensive medicine and related issues 567
C. Accountability 568
D. Weighing the Evidence 569
1. Public controversy and narratives of crisis 569
2. Empirical evidence 570
III. Assessment of No-Fault Alternatives 573
A. Introduction 573
B. New Zealand: an exclusive no-fault regime 573
C. The Nordic Patient Insurance Schemes 575
D. France: Compensation on the Basis of National Solidarity 576
E. Comparison and Evaluation 577
Conclusion 579
Publications 531