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小宝日记

——一个消保主义者的生活与故事

 
 
 

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关于我

这是“消保主义者”王小宝的博客。“小宝”,是“消保”(消费者权益保护)的谐音。王小宝本科学习商品检验,后改修法学,获得法学博士,天府大学法学院教授。王小宝对侵害消费者权益的行为疾恶如仇,主张依法维护消费者权利。

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参编新书出版:Medical Malpractice and Compensation in Global Perspective, Ed. by Oliphant, Ken / Wright, Richard W. De Gruyter (2013)  

2013-11-19 17:47:30|  分类: 学术著作 |  标签: |举报 |字号 订阅

  下载LOFTER 我的照片书  |

Medical Malpractice and Compensation in Global Perspective, Ed. by Oliphant, Ken / Wright, Richard W. De Gruyter (2013)

Tort and Insurance Law Vol. 32

Table of Contents

Ken Oliphant and Richard W. Wright

Medical Malpractice and Compensation in Global Perspective:

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

I. Issues Addressed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

A. Overall Scheme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

B. Details of the Applicable Liability and Compensation Systems . . 3

C. Empirical Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

D. Attitudes, Concerns, and Prospects . . . . . . . . . . . . . . . . . . 4

II. Aims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Bernhard A. Koch

Medical Malpractice in Austria . . . . . . . . . . . . . . . . . . . . . . . 7

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

I. The Insurance Framework . . . . . . . . . . . . . . . . . . . . . . . . 8

A. Social Insurance in Austria . . . . . . . . . . . . . . . . . . . . . . 8

B. The Role of Private Insurance . . . . . . . . . . . . . . . . . . . . . 9

1. First-Party Insurance . . . . . . . . . . . . . . . . . . . . . . . 9

2. Liability Insurance . . . . . . . . . . . . . . . . . . . . . . . . 10

II. The Regulatory Framework . . . . . . . . . . . . . . . . . . . . . . . . 10

A. Professional Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

B. Criminal Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

C. Contract Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

D. Tortious and Contractual Liability . . . . . . . . . . . . . . . . . . 13

1. Tortious and Contractual Liability Not Mutually Exclusive . . 13

2. Tort Law in General . . . . . . . . . . . . . . . . . . . . . . . . 14

3. Damage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

4. Causation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

5. Wrongfulness and Fault . . . . . . . . . . . . . . . . . . . . . 17

6. Multiple Persons Involved . . . . . . . . . . . . . . . . . . . . 18

7. Informed Consent . . . . . . . . . . . . . . . . . . . . . . . . . 21

8. Remedies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

III. Compensation claims in practice . . . . . . . . . . . . . . . . . . . . . 28

A. General Remarks . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

B. Patient Advocacies . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

C. Conciliation Bodies . . . . . . . . . . . . . . . . . . . . . . . . . . 30

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D. Compensation Funds . . . . . . . . . . . . . . . . . . . . . . . . . 31

E. Outlook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Eduardo Dantas

A Bridge over troubled Waters: The Development of

Medical Malpractice Litigation in Brazil . . . . . . . . . . . . . . . . . . 35

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

I. The Brazilian Legal System . . . . . . . . . . . . . . . . . . . . . . . . 39

II. The Structure of the Brazilian Legal System . . . . . . . . . . . . . . . 40

III. The influence of the Consumer’s Defense Code . . . . . . . . . . . . . 43

A. Informed Consent, the Duty to Inform, and Informed Choice . . . 45

B. Moral Damages and the Inversion of the Burden of Proof As

Patient’s Basic Rights . . . . . . . . . . . . . . . . . . . . . . . . . 49

IV. The Changes Brought by the New Civil Code . . . . . . . . . . . . . . 50

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Colleen M. Flood and Bryan Thomas

Canadian Medical Malpractice Law in 2011: Missing the Mark on

Patient Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

I. The Canadian Malpractice Context . . . . . . . . . . . . . . . . . . . . 57

A. Service Delivery, Regulation and Liability Insurance . . . . . . . . 59

II. State and Quality of the Canadian Health Care System . . . . . . . . . 60

A. Medical Malpractice in the Domain of Privately Financed Care . . 66

III. Redressing Adverse Events through the Courts . . . . . . . . . . . . . 67

A. Canadian Medical Malpractice Liability in Context . . . . . . . . . 69

B. Empirical Trends on Medical Liability Claims . . . . . . . . . . . 70

C. Black Letter of Canadian Tort Law . . . . . . . . . . . . . . . . . . 72

1. Battery by Physicians . . . . . . . . . . . . . . . . . . . . . . . 73

2. Negligence by Physicians . . . . . . . . . . . . . . . . . . . . . 73

3. Hospital Liability . . . . . . . . . . . . . . . . . . . . . . . . . 81

4. Government Liability . . . . . . . . . . . . . . . . . . . . . . . 83

5. Damages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

6. Ongoing Issues and Avenues of Reform . . . . . . . . . . . . . 86

IV. Preventing Adverse Events: Professional and System Reform . . . . . 87

A. Reforms at the Level of the Professions . . . . . . . . . . . . . . . 88

1. Alternative Complaint Mechanisms . . . . . . . . . . . . . . . 88

2. Revalidation/Recertification . . . . . . . . . . . . . . . . . . . 89

3. Apology Legislation . . . . . . . . . . . . . . . . . . . . . . . . 90

B. Systemic Reforms . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

1. Accreditation of Facilities . . . . . . . . . . . . . . . . . . . . 91

2. Canadian Patient Safety Institute . . . . . . . . . . . . . . . . 92

3. Improved Information Gathering and Dissemination . . . . . 92

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

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Zhu Wang and Ken Oliphant

Yangge Dance: the Rhythm of Liability for Medical Malpractice in

the People’s Republic of China . . . . . . . . . . . . . . . . . . . . . . . . 97

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

I. The Wider Healthcare Context . . . . . . . . . . . . . . . . . . . . . . 99

II. The Early P.R. China: Medical Services as Social Welfare (1949–1987) 102

III. The Administrative Liability Regime . . . . . . . . . . . . . . . . . . . 105

A. The Medical Accident Rules 1987 . . . . . . . . . . . . . . . . . . 105

1. Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

2. Main Features of the Administrative Liability Regime,

1987–2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

B. The Medical Accident Regulations 2002 . . . . . . . . . . . . . . . 108

1. Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

2. Main Features of the Administrative Liability Regime,

2002 onwards . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

IV. The Tort Liability Regime . . . . . . . . . . . . . . . . . . . . . . . . . 111

A. Recourse to the General Principles of Civil Liability . . . . . . . . 111

B. Elements of the Tort Liability Regime . . . . . . . . . . . . . . . . 113

1. Cause of Action . . . . . . . . . . . . . . . . . . . . . . . . . . 113

2. Burden of Proof . . . . . . . . . . . . . . . . . . . . . . . . . . 113

3. The Identification Process . . . . . . . . . . . . . . . . . . . . 114

4. Assessment of Damages . . . . . . . . . . . . . . . . . . . . . . 115

C. Effect on the Administrative Liability Regime . . . . . . . . . . . 116

V. Reform of Medical Liability under the Tort Liability Law of 2009 . . . 117

A. Antecedents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

1. Increasing Disputes between Doctors and Patients . . . . . . . 117

2. Concerns about Defensive Medical Treatments . . . . . . . . . 118

3. The Chaos Resulting from the Dual Dystem of

Medical Liability . . . . . . . . . . . . . . . . . . . . . . . . . 119

B. Legislative History . . . . . . . . . . . . . . . . . . . . . . . . . . . 120

C. Four Dimensions of the TLL . . . . . . . . . . . . . . . . . . . . . 121

1. Basis of the Cause of Action . . . . . . . . . . . . . . . . . . . 121

2. Burden of Proof . . . . . . . . . . . . . . . . . . . . . . . . . . 124

3. The Identification Procedure . . . . . . . . . . . . . . . . . . . 126

4. Assessment of Damages . . . . . . . . . . . . . . . . . . . . . . 126

VI. Another Step Backwards on Its Way? . . . . . . . . . . . . . . . . . . . 127

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

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Medical Malpractice and Compensation in France . . . . . . . . . . . 131

Florence G’sell-Macrez

Part I: The French Rules of Medical Liability since

the Patients’ Rights Law of March 4, 2002 . . . . . . . . . . . . . . . . . 131

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

I. General Conditions of Medical Liability . . . . . . . . . . . . . . . . . 134

A. Facts Likely to Justify the Physician’s Responsibility . . . . . . . . 135

1. Liability Based on Fault . . . . . . . . . . . . . . . . . . . . . . 136

2. Strict Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

B. The Causal Link . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148

1. Causation Criterion . . . . . . . . . . . . . . . . . . . . . . . . 148

2. Causation Proof . . . . . . . . . . . . . . . . . . . . . . . . . . 149

C. The Victim’s Harm . . . . . . . . . . . . . . . . . . . . . . . . . . 154

II. Administration and Adjudication of claims based on liability rules . . 156

A. Adjudication Through Conciliation Commissions . . . . . . . . . 157

B. Adjudication Through Courts . . . . . . . . . . . . . . . . . . . . 159

Geneviève Helleringer

Part II: Compensation Based on National Solidarity . . . . . . . . . . 163

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

I. Typology of Cases Covered by National Solidarity . . . . . . . . . . . 164

A. Medical Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

B. Hospital-Acquired Infections . . . . . . . . . . . . . . . . . . . . . 166

C. Blood Transfusions Infections . . . . . . . . . . . . . . . . . . . . 167

1. HIV Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

2. Hepatitis C Infection . . . . . . . . . . . . . . . . . . . . . . . 168

3. Additional Grounds . . . . . . . . . . . . . . . . . . . . . . . . 168

II. Administration and Adjudication of Claims Based on National

Solidarity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

A. Administrated Claims . . . . . . . . . . . . . . . . . . . . . . . . . 169

B. Procedural Routes to ONIAM . . . . . . . . . . . . . . . . . . . . . 171

C. Adjudication Proceedings in Front of ONIAM . . . . . . . . . . . 173

D. Regulatory Principles Applying to Rights of Recourse . . . . . . . 174

III. Awarded Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . 175

Marc S. Stauch

Medical Malpractice and Compensation in Germany . . . . . . . . . . 179

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

I. The Potential Legal Consequences of Medical Injury . . . . . . . . . . 181

A. Criminal Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

B. Professional and Disciplinary Sanctions . . . . . . . . . . . . . . . 182

C. Fault-Based Compensation in Private Law . . . . . . . . . . . . . 183

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D. Strict Liability and No-Fault Compensation for Medical Product

Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186

E. Social Security, Insurance, and Subrogation Issues . . . . . . . . . 187

II. The System of Private Law Compensation . . . . . . . . . . . . . . . . 189

A. Treatment Malpractice Claims . . . . . . . . . . . . . . . . . . . . 189

1. Faulty Treatment . . . . . . . . . . . . . . . . . . . . . . . . . 189

2. Causation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192

3. Proof Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193

B. Disclosure Malpractice Claims . . . . . . . . . . . . . . . . . . . . 196

1. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196

2. Standard of Disclosure . . . . . . . . . . . . . . . . . . . . . . 197

3. Causation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198

C. Damages and Liability Insurance Issues . . . . . . . . . . . . . . . 199

D. The Medical Arbitration Boards . . . . . . . . . . . . . . . . . . . 201

III. Assessment of the Current Situation . . . . . . . . . . . . . . . . . . . 202

A. Empirical Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202

B. Evaluation of the Private Law Redress Rules . . . . . . . . . . . . 205

C. Patient Safety Initiatives . . . . . . . . . . . . . . . . . . . . . . . 207

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208

Addendum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209

Claudia Di Marzo

Medical Malpractice: The Italian Experience . . . . . . . . . . . . . . . 211

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211

I. The Problematic Nature of Medical Liability . . . . . . . . . . . . . . 213

II. The Assignment of the Burden of Proof Between Parties . . . . . . . . 221

A. Proving Fault . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

B. Proving Causation-In-Fact . . . . . . . . . . . . . . . . . . . . . . 226

C. Proving Causation Under the Criminal Law and Under

the Civil Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229

D. The Role of Informed Consent . . . . . . . . . . . . . . . . . . . . 232

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235

Robert B Leflar

The Law of Medical Misadventure in Japan . . . . . . . . . . . . . . . . 239

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

I. Prosecutions and Their Consequences . . . . . . . . . . . . . . . . . . 242

A. Prosecutions in Medical Cases . . . . . . . . . . . . . . . . . . . . 242

B. Response by the Health Ministry and the Medical Profession . . . 246

C. One Prosecution Too Many: The Medical Professionals’

Counterattack and the String of Acquittals . . . . . . . . . . . . . 249

II. Civil Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251

A. Substantive Law of Medical Malpractice . . . . . . . . . . . . . . . 252

1. Theories of Recovery . . . . . . . . . . . . . . . . . . . . . . . 252

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2. Standard of Care . . . . . . . . . . . . . . . . . . . . . . . . . . 253

3. Level of Proof . . . . . . . . . . . . . . . . . . . . . . . . . . . 254

4. Informed Consent and Related Actions . . . . . . . . . . . . . 257

5. Damages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258

B. Key Aspects of Procedural Law and Practice . . . . . . . . . . . . . 260

1. In General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260

2. Discovery of Peer Review Findings . . . . . . . . . . . . . . . 261

3. Judicial Administration Reforms . . . . . . . . . . . . . . . . 262

4. Settlement Practices, Overall Claiming Levels, and Malpractice

Insurance Premiums . . . . . . . . . . . . . . . . . . . . . . . 263

5. Plaintiffs’ Attorney Fees and Court Filing Fees . . . . . . . . . 267

III. The No-Fault Compensation System for Obstetrical Injury . . . . . . 268

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271

Addendum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273

Stephen Todd

Treatment Injury in New Zealand . . . . . . . . . . . . . . . . . . . . . . 275

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275

I. The New Zealand Accident Compensation Scheme . . . . . . . . . . . 276

A. The Woodhouse Report . . . . . . . . . . . . . . . . . . . . . . . . 276

B. Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278

C. Developments to 2010 . . . . . . . . . . . . . . . . . . . . . . . . 279

D. Relationship with the Common Law . . . . . . . . . . . . . . . . . 283

E. Cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285

1. Categories of Cover . . . . . . . . . . . . . . . . . . . . . . . . 285

2. Personal Injury . . . . . . . . . . . . . . . . . . . . . . . . . . 286

3. Residual Actions for Damages . . . . . . . . . . . . . . . . . . 287

F. Claimants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288

G. Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288

H. Claims Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290

I. Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291

J. Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292

II. Medical Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292

A. Cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295

B. Treatment Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . 296

1. Proof of Cause . . . . . . . . . . . . . . . . . . . . . . . . . . . 296

a. Atkinson and Ambros . . . . . . . . . . . . . . . . . . . . . . 297

b. Modification of Ordinary Rules? . . . . . . . . . . . . . . . 301

2. Nature of Treatment Injury . . . . . . . . . . . . . . . . . . . 304

3. Treatment Injury in Operation . . . . . . . . . . . . . . . . . . 307

4. Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310

C. Professional Accountability . . . . . . . . . . . . . . . . . . . . . . 311

1. Reporting of Medical Risks . . . . . . . . . . . . . . . . . . . . 312

2. Complaints . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313

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3. Actions for Damages . . . . . . . . . . . . . . . . . . . . . . . 314

a. Clinical Trials . . . . . . . . . . . . . . . . . . . . . . . . . 314

b. Stillbirths . . . . . . . . . . . . . . . . . . . . . . . . . . . 315

c. Pregnancy and Unwanted Births . . . . . . . . . . . . . . 316

d. Informed Consent Cases . . . . . . . . . . . . . . . . . . . 317

e. Mental Injury . . . . . . . . . . . . . . . . . . . . . . . . . 318

f. Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . 318

g. Exemplary Damages . . . . . . . . . . . . . . . . . . . . . 318

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319

A. Adequate Compensation? . . . . . . . . . . . . . . . . . . . . . . . 319

B. Defensible Boundaries? . . . . . . . . . . . . . . . . . . . . . . . . 319

C. Administratively Efficient? . . . . . . . . . . . . . . . . . . . . . . 321

D. Disincentive to Safety-Conscious Behavior? . . . . . . . . . . . . . 322

E. Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324

Kinga Ba?czyk-Rozwadowska

Medical Malpractice and Compensation in Poland . . . . . . . . . . . 327

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327

I. Grounds for Civil Liability . . . . . . . . . . . . . . . . . . . . . . . . 331

II. Liability Based on Fault . . . . . . . . . . . . . . . . . . . . . . . . . . 344

III. Burden of Proof and Causation . . . . . . . . . . . . . . . . . . . . . . 351

IV. Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356

V. Professional Liability of Doctors . . . . . . . . . . . . . . . . . . . . . 370

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372

Addendum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373

Vibe Ulfbeck, Mette Hartlev and M?rten Schultz

Malpractice in Scandinavia . . . . . . . . . . . . . . . . . . . . . . . . . . 377

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377

I. The Overall Scheme for Preventing and Redressing Medical Errors and

Adverse Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379

A. Regulatory Methods in the Nordic Health Care Systems . . . . . . 379

B. Compensation Systems . . . . . . . . . . . . . . . . . . . . . . . . 380

C. Liability Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381

D. The Relationship Between the Systems . . . . . . . . . . . . . . . 382

II. The Details of the Applicable Liability and Compensation Systems . . 383

A. Patient Injury Compensation Systems . . . . . . . . . . . . . . . . 383

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383

2. Basis for Compensation . . . . . . . . . . . . . . . . . . . . . . 383

a. The Experienced Specialist Standard . . . . . . . . . . . . 383

b. The Failure of Apparatus . . . . . . . . . . . . . . . . . . . 385

c. The Alternative Treatment Rule . . . . . . . . . . . . . . . 386

d. The Reasonableness Rule . . . . . . . . . . . . . . . . . . . 386

e. “Accidents” . . . . . . . . . . . . . . . . . . . . . . . . . . 387

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f. Wrong Diagnosis . . . . . . . . . . . . . . . . . . . . . . . 388

g. Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388

3. Causation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388

a. The Concept of Causation in Scandinavian Law . . . . . . 388

b. The Problems of Causation in Malpractice Law . . . . . . 392

c. Relaxation of Evidence . . . . . . . . . . . . . . . . . . . . 392

d. Assessment of Damages . . . . . . . . . . . . . . . . . . . 393

III. Available Empirical Data . . . . . . . . . . . . . . . . . . . . . . . . . 394

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395

L.C. Coetzee and Pieter Carstens

Medical Malpractice and Compensation in South Africa . . . . . . . . 397

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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397

A. Regulatory Methods . . . . . . . . . . . . . . . . . . . . . . . . . . 397

1. Government Licensing Authorities for Doctors and Hospitals 397

2. Medico-Ethical Codes of Conduct . . . . . . . . . . . . . . . . 401

3. Reporting of Medical Errors and Adverse Events to the Health

Profession Council of South Africa . . . . . . . . . . . . . . . 402

B. Liability Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403

1. Contract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403

2. Delict (Tort) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406

3. Criminal Law . . . . . . . . . . . . . . . . . . . . . . . . . . . 406

4. Relationship Between the Liability Systems . . . . . . . . . . 408

C. Compensation Systems . . . . . . . . . . . . . . . . . . . . . . . . 409

1. Sufficient Insurance Cover To Be Required for Private Health

Establishments . . . . . . . . . . . . . . . . . . . . . . . . . . 413

2. Private Indemnity (Medical Protection Society) . . . . . . . . . 414

D. Relationships Among the Compensation Systems, the Liability

Systems, and the Regulatory Systems . . . . . . . . . . . . . . . . 415

II. The Details of the Applicable Liability and Compensation Systems . . 418

A. Criteria Defining Qualification for Compensation . . . . . . . . . 418

1. Liability Based on Fault . . . . . . . . . . . . . . . . . . . . . . 418

2. The Role of the South African Constitution, 1996 . . . . . . . 420

3. Nature of Damages and Compensation . . . . . . . . . . . . . 421

B. Causation and “Loss of Chance” . . . . . . . . . . . . . . . . . . . 423

1. General Rules on Causation . . . . . . . . . . . . . . . . . . . 423

2. “Loss of a Chance” . . . . . . . . . . . . . . . . . . . . . . . . 425

C. Liability for Failure to Obtain Informed Consent . . . . . . . . . . 426

D. Matters of Proof and Gathering of Evidence . . . . . . . . . . . . 427

1. Matters of Proof . . . . . . . . . . . . . . . . . . . . . . . . . . 427

a. General . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427

b. Gathering of Evidence . . . . . . . . . . . . . . . . . . . . 431

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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, Improve

System Performance, or Reduce System Costs . . . . . . . . . . . . . . 432

IV. Attitudes and Concerns About the Liability and Compensation

Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435

Richard Goldberg

Medical Malpractice and Compensation in the UK . . . . . . . . . . . 439

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439

I. The Context of Medical Malpractice Liability . . . . . . . . . . . . . . 440

II. Recent Empirical Evidence on the Numbers and Funding of Claims. . 442

A. England . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442

B. Scotland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445

C. Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446

III. NHS Redress Act 2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . 446

IV. Patients’ Rights Bill in Scotland: The No-Fault Compensation Review

Group Report (McLean Report) . . . . . . . . . . . . . . . . . . . . . . 448

V. Basis of Liability for Medical Injury . . . . . . . . . . . . . . . . . . . 451

A. Contract, Tort, and Delict . . . . . . . . . . . . . . . . . . . . . . . 451

B. The Requirements of Negligence . . . . . . . . . . . . . . . . . . . 451

C. Duty of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 452

D. Standard of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . 452

E. Causation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454

1. Difficulties in Proving Causation in Clinical Negligence Cases 455

2. The Burden of Proof . . . . . . . . . . . . . . . . . . . . . . . 456

3. The “But For” Test . . . . . . . . . . . . . . . . . . . . . . . . 456

4. Cumulative Causation . . . . . . . . . . . . . . . . . . . . . . 457

5. Material Increase in Risk . . . . . . . . . . . . . . . . . . . . . 457

6. Alternative Causation . . . . . . . . . . . . . . . . . . . . . . . 457

7. Reinstating McGhee: Fairchild . . . . . . . . . . . . . . . . . . . 458

8. The Scope of Fairchild and Clinical Negligence Cases . . . . . . 459

9. Loss of a Chance . . . . . . . . . . . . . . . . . . . . . . . . . . 462

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 . . . . . . . . . . . . . 466

A. Jackson Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 466

B. Reform of Legal Aid in England and Wales . . . . . . . . . . . . . 469

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470

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David A. Hyman and Charles M. Silver

Medical Malpractice and Compensation in Global Perspective:

How Does the U.S. Do It? . . . . . . . . . . . . . . . . . . . . . . . . . . . 473

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473

I. Details of the Applicable Regulatory and Liability/Compensation

Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 476

A. Regulating the Delivery of Medical Care . . . . . . . . . . . . . . 476

B. Liability/Compensation Systems . . . . . . . . . . . . . . . . . . . 477

1. Fault-Based (Negligence) . . . . . . . . . . . . . . . . . . . . . 477

2. No-Fault Liability (Strict Liability) . . . . . . . . . . . . . . . . 483

C. Limitations on Liability/Contracting out of Liability . . . . . . . . 483

D. Immunity from Liability . . . . . . . . . . . . . . . . . . . . . . . 485

II. Empirical Data on Medical Errors/Adverse Events and Malpractice

Litigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 486

A. How Common Are Medical Errors and Adverse Events? . . . . . . 486

B. Malpractice Litigation . . . . . . . . . . . . . . . . . . . . . . . . . 487

1. Claiming Frequency (relative to rate of medical error/adverse

events) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 488

2. Compensation Patterns and Time Trends . . . . . . . . . . . . 489

3. Impact of Caps on Non-Economic Damages . . . . . . . . . . 496

4. Accuracy of the Liability System . . . . . . . . . . . . . . . . . 499

5. Frivolous Lawsuits . . . . . . . . . . . . . . . . . . . . . . . . 501

6. Cost of Medical Errors/Adverse Events . . . . . . . . . . . . . 502

7. Cost of the Liability System . . . . . . . . . . . . . . . . . . . 503

III. Attitudes and Concerns About the Liability and Compensation

Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505

IV. Why Do Things Look the Way They Do? . . . . . . . . . . . . . . . . . 506

V. What Have We Learned by Studying Texas? . . . . . . . . . . . . . . . 507

A. Who Decides Malpractice Cases? . . . . . . . . . . . . . . . . . . . 507

B. Does it Matter How Much the Jury Awards in a Malpractice Case? 508

C. How Much Coverage Do Physicians Have? . . . . . . . . . . . . . 508

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? . . . . . . . . . . . . . . 509

E. Impact of Tort Reforms on Claim Frequency and Payouts . . . . . 510

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 510

Ken Oliphant

Medical Malpractice and Compensation:

Comparative Observations . . . . . . . . . . . . . . . . . . . . . . . . . . 513

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513

I. Making Sense of Diversity . . . . . . . . . . . . . . . . . . . . . . . . . 516

A. A Diversity of Legal Mechanisms . . . . . . . . . . . . . . . . . . . 516

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1. Liability systems . . . . . . . . . . . . . . . . . . . . . . . . . . 516

2. Alternative compensation systems . . . . . . . . . . . . . . . . 521

3. Other regulatory and complaints mechanisms . . . . . . . . . 523

B. The Wider Context . . . . . . . . . . . . . . . . . . . . . . . . . . 526

1. The substantive legal context . . . . . . . . . . . . . . . . . . 526

2. The wider litigation process . . . . . . . . . . . . . . . . . . . 527

3. The health care context . . . . . . . . . . . . . . . . . . . . . . 530

C. Comparative Functional Analysis . . . . . . . . . . . . . . . . . . 533

II. Assessment of Liability-Based Approaches . . . . . . . . . . . . . . . . 535

A. Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535

1. Mechanisms for dealing with organizational complexity . . . 536

2. Adaptation of the Requirements of Causation and Proof . . . 539

3. Patients’ Rights and Disclosure Duties . . . . . . . . . . . . . 542

B. Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 547

1. The deterrent effect of liability rules . . . . . . . . . . . . . . 547

2. Pushing prevention too far? Defensive medicine and related

issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 549

C. Accountability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550

D. Weighing the Evidence . . . . . . . . . . . . . . . . . . . . . . . . 551

1. Public controversy and narratives of crisis . . . . . . . . . . . 551

2. Empirical evidence . . . . . . . . . . . . . . . . . . . . . . . . 552

III. Assessment of No-Fault Alternatives . . . . . . . . . . . . . . . . . . . 555

A. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555

B. New Zealand: an exclusive no-fault regime . . . . . . . . . . . . . 555

C. The Nordic Patient Insurance Schemes . . . . . . . . . . . . . . . 557

D. France: Compensation on the Basis of National Solidarity . . . . . 558

E. Comparison and Evaluation . . . . . . . . . . . . . . . . . . . . . 559

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 561

Publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513

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