英国医患纠纷诉讼前调解议定书(英文版)

Pre-ActionProtocolfortheResolutionofClinicalDisputes英国医患纠纷诉讼前调解议定书CONTENTSINTRODUCTION概述EnforcementoftheProtocolandsanctions议定书及批准的执行LitigantsinPerson诉请当事人THEAIMSOFTHEPROTOCOL本议定书的宗旨THEPROTOCOL议定书Rehabilitation弥补措施LetterofNotification通知函LetterofClaim诉状LetterofResponse答辩状EXPERTS专家意见ALTERNATIVEDISPUTERESOLUTION可选性纠纷处理方式STOCKTAKE备选解决方案Annexes附录ILLUSTRATIVEFLOWCHART AFORMFORREQUESTINGMEDICALRECORDS BTEMPLATESFORLETTERSOFNOTIFICATION,CLAIMANDRESPONSE C1INTRODUCTION概述ThisProtocolisintendedtoapplytoallclaimsagainsthospitals,GPs,dentistsandotherhealthcareproviders(bothNHSandprivate)whichinvolveaninjurythatisallegedtobetheresultofclinicalnegligence.Itisnotintendedtoapplytoclaimscoveredby—thePre-ActionProtocolforDiseaseandIllnessClaims;thePre-ActionProtocolforPersonalInjuryClaims;thePre-ActionProtocolforLowValuePersonalInjuryClaimsinRoadTrafficAccidents;thePre-ActionProtocolforLowValuePersonalInjuryLiabilityandPublicLiability)Claims;orPracticeDirection3D–MesotheliomaClaimsThisProtocolisintendedtobesufficientlybroad-basedandflexibletoapplytoallsectorsofhealthcare,bothpublicandprivate.Italsorecognisesthataclaimantandadefendant,aspatientandhealthcareprovider,mayhaveanongoingrelationship.Itisimportantthateachpartytoaclinicaldisputehassufficientinformationandunderstandingoftheother’sperspectiveandcasetobeabletoinvestigateaclaimefficientlyand,whereappropriate,toresolveit.ThisProtocolencouragesacards-on-the-tableapproachwhensomethinghasgonewrongwithatreatmentortheclaimantisdissatisfiedwiththattreatmentand/ortheoutcome.ThisProtocolisnowregardedbythecourtsassettingthestandardofnormalreasonablepre-actionconductfortheresolutionofclinicaldisputes.ThisProtocolsetsouttheconductthatprospectivepartieswouldnormallybeexpectedtofollowpriortothecommencementofanyproceedings.Itestablishesareasonableprocessandtimetablefortheexchangeofinformationrelevanttoadispute,setsoutthestandardsforthecontentandqualityoflettersofclaimandsetsstandardsfortheconductofpre-actionnegotiations.Thetimetableandthearrangementsfordisclosingdocumentsandobtainingexpertevidencemayneedtobevariedtosuitthecircumstancesofthecase.WhereoneormorepartiesconsiderthedetailoftheProtocolisnotappropriatetothecase,andproceedingsaresubsequentlyissued,thecourtwillexpectanexplanationastowhytheProtocolhasnotbeenfollowed,orhasbeenvaried.TheProtocolprovidesforadefendanttobegivenfourmonthstoinvestigateandrespondtoaLetterofClaimbeforeproceedingsareserved.Ifthisisnotpossible,theclaimant’ssolicitorshouldgiveasmuchnoticeoftheintentiontoissueproceedingsasispracticable.ThisProtocoldoesnotalterthestatutorytimelimitsforstartingcourtproceedings.Ifaclaimisissuedaftertherelevantstatutorylimitationperiodhasexpired,thedefendantwillbeentitledtousethatasadefencetotheclaim.IfproceedingsarestartedtocomplywiththestatutorytimelimitbeforethepartieshavefollowedtheproceduresinthisProtocol,thepartiesshouldapplytothecourtforastayoftheproceedingswhiletheysocomply.Thepartiesshouldalsoconsiderwhetherthereislikelytobeadisputeastolimitationshouldaclaimbepursued.EnforcementoftheProtocolandsanctions议定书及批准的执行WhereeitherpartyfailstocomplywiththisProtocol,thecourtmayimposesanctions.Whendecidingwhethertodoso,thecourtwilllookatwhetherthepartieshavecompliedinsubstancewiththeProtocol’srelevantprinciplesandrequirements.Itwillalsoconsidertheeffectanynon-compliancehashadonanyotherparty.Itisnotlikelytobeconcernedwithminorortechnicalshortcomings(seeparagraph4.3to4.5ofthePracticeDirectiononPre-ActionConductandProtocols).LitigantsinPerson诉请当事人Ifapartytoaclaimdoesnotseekprofessionaladvicefromasolicitortheyshouldstill,insofarasisreasonablypossible,complywiththetermsofthisProtocol.InthisProtocol“solicitor”isintendedtoencompassreferencetoanysuitablylegallyqualifiedperson.Ifapartytoaclaimbecomesawarethatanotherpartyisalitigantinperson,theyshouldsendacopyofthisProtocoltothelitigantinpersonattheearliestopportunity.THEAIMSOFTHEPROTOCOL本议定书的宗旨ThegeneralaimsoftheProtocolare–tomaintainand/orrestorethepatient/healthcareproviderrelationshipinanopenandtransparentway;toreducedelayandensurethatcostsareproportionate;andtoresolveasmanydisputesaspossiblewithoutlitigation.Thespecificobjectivesare–toencourageopenness,transparencyandearlycommunicationoftheperceivedproblembetweenpatientsandhealthcareproviders;toprovideanopportunityforhealthcareproviderstoidentifywhethernotificationofanotifiablesafetyincidenthasbeen,orshouldbe,senttotheclaimantinaccordancewiththedutyofcandourimposedbysection20oftheHealthandSocialCareAct2008(RegulatedActivities)Regulations2014;toensurethatsufficientmedicalandotherinformationisdisclosedpromptlybybothpartiestoenableeachtounderstandtheother’sperspectiveandcase,andtoencourageearlyresolutionoranarrowingoftheissuesindispute;toprovideanearlyopportunityforhealthcareproviderstoidentifycaseswhereaninvestigationisrequiredandtocarryoutthatinvestigationpromptly;toencouragehealthcareproviderstoinvolvetheNationalHealthServiceLitigationAuthority(NHSLA)ortheirdefenceorganisationsorinsurersatanearlystage;toenablethepartiestoavoidlitigationbyagreeingaresolutionofthedispute;toenablethepartiestoexploretheuseofmediationortonarrowtheissuesindisputebeforeproceedingsarecommenced;toenablepartiestoidentifyanyissuesthatmayrequireaseparateorpreliminaryhearing,suchasadisputeastolimitation;tosupporttheefficientmanagementofproceedingswherelitigationcannotbeavoided;todiscouragetheprolongedpursuitofunmeritoriousclaimsandtheprolongeddefenceofmeritoriousclaims;topromotetheprovisionofmedicalorrehabilitationtreatmenttoaddresstheneedsoftheclaimantattheearliestopportunity;andtoencouragethedefendanttomakeanearlyapologytotheclaimantifappropriate.ThisProtocoldoesnot—provideanydetailedguidancetohealthcareprovidersonclinicalriskmanagementortheadoptionofriskmanagementsystemsandprocedures;provideanydetailedguidanceonwhichadverseoutcomesshouldtriggeraninvestigation;orrecommendchangestothecodesofconductofprofessionalsinhealthcare.THEPROTOCOL议定书AnillustrativeflowchartisattachedatAnnexAwhichshowseachofthestagesthatthepartiesareexpectedtotakebeforethecommencementofproceedings.ObtaininghealthrecordsAnyrequestforrecordsbytheclaimantprovidesufficientinformationtoalertthedefendantwhereanadverseoutcomehasbeenseriousorhashadseriousconsequencesormayconstituteanotifiablesafetyincident;beasspecificaspossibleabouttherecordswhicharerequiredforaninitialinvestigationoftheclaim(including,forexample,acontinuouscopyoftheCTGtraceinbirthinjurycases);andincludearequestforanyrelevantguidelines,analyses,protocolsorpoliciesandanydocumentscreatedinrelationtoanadverseincident,notifiablesafetyincidentorcomplaint.Requestsforcopiesoftheclaimant’sclinicalrecordsshouldbemadeusingtheLawSocietyandDepartmentofHealthapprovedstandardforms(enclosedatAnnexB),adaptedasnecessary.Thecopyrecordsshouldbeprovidedwithin40daysoftherequestandforacostnotexceedingthechargespermissibleundertheAccesstoHealthRecordsAct1990and/ortheDataProtectionAct1998.Paymentmayberequiredinadvancebythehealthcareprovider.TheclaimantmayalsomakearequestundertheFreedomofInformationAct2000.Attheearliestopportunity,legiblecopiesoftheclaimant’smedicalandotherrecordsshouldbeplacedinanindexedandpaginatedbundlebytheclaimant.Thisbundleshouldbekeptuptodate.Intherarecircumstancesthatthedefendantisindifficultyincomplyingwiththerequestwithin40days,theproblemshouldbeexplainedquicklyanddetailsgivenofwhatisbeingdonetoresolveit.Ifthedefendantfailstoprovidethehealthrecordsoranexplanationforanydelaywithin40days,theclaimantortheiradvisercanthenapplytothecourtunderrule31.16oftheCivilProcedureRules1998(‘CPR’)foranorderforpre-actiondisclosure.Thecourthasthepowertoimposecostssanctionsforunreasonabledelayinprovidingrecords.Ifeithertheclaimantorthedefendantconsidersadditionalhealthrecordsarerequiredfromathirdparty,inthefirstinstancetheseshouldberequestedbyorthroughtheclaimant.Thirdpartyhealthcareprovidersareexpectedtoco-operate.Rule31.17oftheCPRsetsouttheprocedureforapplyingtothecourtforpre-actiondisclosurebythirdparties.Rehabilitation弥补措施Theclaimantandthedefendantshallbothconsiderasearlyaspossiblewhethertheclaimanthasreasonableneedsthatcouldbemetbyrehabilitationtreatmentorothermeasures.Theyshouldalsodiscusshowtheseneedsmightbeaddressed.Animmediateneedsassessmentreportpreparedforthepurposesofrehabilitationshouldnotbeusedinthelitigationexceptbyconsent.LetterofNotification通知函AnnexC1tothisProtocolprovidesatemplatefortherecommendedcontentsofaLetterofNotification;thelevelofdetailwillneedtobevariedtosuittheparticularcircumstances.Followingreceiptandanalysisoftherecordsand,ifappropriate,receiptofaninitialsupportiveexpertopinion,theclaimantmaywishtosendaLetterofNotificationtothedefendantassoonaspracticable.TheLetterofNotificationshouldadvisethedefendantthatthisisaclaimwhereaLetterofClaimislikelytobesentbecauseacaseastobreachofdutyand/orcausationhasbeenidentified.AcopyoftheLetterofNotificationshouldalsobesenttotheNHSLAor,whereknown,otherrelevantmedicaldefenceorganisationorindemnityprovider.OnreceiptofaLetterofNotificationadefendantshould—acknowledgetheletterwithin14daysofreceipt;identifywhowillbedealingwiththematterandtowhomanyLetterofClaimshouldbesent;#considerwhethertocommenceinvestigationsand/ortoobtainfactualandexpertevidence;considerwhetheranyinformationcouldbepassedtotheclaimantwhichmightnarrowtheissuesindisputeorleadtoanearlyresolutionoftheclaim;andforwardacopyoftheLetterofNotificationtotheNHSLAorotherrelevantmedicaldefenceorganization/indemnityprovider.ThecourtmayquestionanyrequestsbythedefendantforextensionoftimelimitsifaLetterofNotificationwassentbutdidnotpromptaninitialinvestigation.LetterofClaim诉状AnnexC2tothisProtocolprovidesatemplatefortherecommendedcontentsofaLetterofClaim:thelevelofdetailwillneedtobevariedtosuittheparticularcircumstances.If,followingthereceiptandanalysisoftherecords,andthereceiptofanyfurtheradvice(includingfromexpertsifnecessary–seeSection4),theclaimantdecidesthattherearegroundsforaclaim,aletterofclaimshouldbesenttothedefendantassoonaspracticable.AnyletterofclaimsenttoanNHSTrustshouldbecopiedtotheNationalHealthServiceLitigationAuthority.Thislettershouldcontain—aclearsummaryofthefactsonwhichtheclaimisbased,includingtheallegedadverseoutcome,andthemainallegationsofnegligence;adescriptionoftheclaimant’sinjuries,andpresentconditionandprognosis;anoutlineofthefinanciallossincurredbytheclaimant,withanindicationoftheheadsofdamagetobeclaimedandthescaleoftheloss,unlessthisisimpracticable;confirmationofthemethodoffundingandwhetheranyfundingarrangementwasenteredintobeforeorafterApril2013;andthedisciplineofanyexpertfromwhomevidencehasalreadybeenobtained.TheLetterofClaimshouldrefertoanyrelevantdocuments,includinghealthrecords,andifpossibleenclosecopiesofanyofthosewhichwillnotalreadybeinthepotentialdefendant’spossession,e.g.anyrelevantgeneralpractitionerrecordsiftheclaimant’sclaimisagainstahospital.Sufficientinformationmustbegiventoenablethedefendanttofocusinvestigationsandtoputaninitialvaluationontheclaim.LettersofClaimarenotintendedtohavethesameformalstatusasParticularsofClaim,norshouldanysanctionsnecessarilyapplyiftheLetterofClaimandanysubsequentParticularsofClaimintheproceedingsdiffer.Proceedingsshouldnotbeissueduntilafterfourmonthsfromtheletterofclaim.IncertaininstancesitmaynotbepossiblefortheclaimanttoserveaLetterofClaimmorethanfourmonthsbeforetheexpiryofthelimitationperiod.If,foranyreason,proceedingsarestartedbeforethepartieshavecomplied,theyshouldseektoagreetoapplytothecourtforanordertostaytheproceedingswhilstthepartiestakestepstocomply.Theclaimantmaywanttomakeanoffertosettletheclaimatthisearlystagebyputtingforwardanofferinrespectofliabilityand/oranamountofcompensationinaccordancewiththelegalandproceduralrequirementsofCPRPart36(possiblyincludinganycostsincurredtodate).Ifanoffertosettleismade,generallythisshouldbesupportedbyamedicalreportwhichdealswiththeinjuries,conditionandprognosis,andbyascheduleoflossandsupportingdocumentation.Thelevelofdetailnecessarywilldependonthevalueoftheclaim.Medicalreportsmaynotbenecessarywherethereisnosignificantcontinuinginjuryandadetailedschedulemaynotbenecessaryinalowvaluecase.LetterofResponse答辩状AttachedatAnnexC3isatemplateforthesuggestedcontentsoftheLetterofResponse:thelevelofdetailwillneedtobevariedtosuittheparticularcircumstances.ThedefendantshouldacknowledgetheLetterofClaimwithin14daysofreceiptandshouldidentifywhowillbedealingwiththematter.Thedefendantshould,withinfourmonthsoftheLetterofClaim,provideareasonedanswerintheformofaLetterofResponseinwhichthedefendantshould—iftheclaimisadmitted,saysoinclearterms;ifonlypartoftheclaimisadmitted,makeclearwhichissuesofbreachofdutyand/orcausationareadmittedandwhicharedeniedandwhy;statewhetheritisintendedthatanyadmissionswillbebinding;iftheclaimisdenied,includespecificcommentsontheallegationsofnegligenceand,ifasynopsisorchronologyofrelevanteventshasbeenprovidedandisdisputed,thedefendant’sversionofthoseevents;ifsupportiveexpertevidencehasbeenobtained,identifywhichdisciplinesofexpertevidencehavebeenrelieduponandwhethertheyrelatetobreachofdutyand/orcausation;ifknown,statewhetherthedefendantrequirescopiesofanyrelevantmedicalrecordsobtainedbytheclaimant(tobesuppliedforareasonablecopyingcharge);providecopiesofanyadditionaldocumentsreliedupon,e.g.aninternalprotocol;ifnotindemnifiedbytheNHS,supplydetailsoftherelevantindemnityinsurer;andinformtheclaimantofanyotherpotentialdefendantstotheclaim.3.25IfthedefendantrequiresanextensionoftimeforserviceoftheLetterofResponse,arequestshouldbemadeassoonasthedefendantbecomesawarethatitwillberequiredand,inanyevent,withinfourmonthsoftheletterofclaim.Thedefendantshouldexplainwhyanyextensionoftimeisnecessary.Theclaimantshouldadoptareasonableapproachtoanyrequestforanextensionoftimeforprovisionofthereasonedanswer.Iftheclaimanthasmadeanoffertosettle,thedefendantshouldrespondtothatofferintheLetterofResponse,preferablywithreasons.Thedefendantmayalsomakeanoffertosettleatthisstage.AnyoffermadebythedefendantshouldbemadeinaccordancewiththelegalandproceduralrequirementsofCPRPart36(possiblyincludinganycostsincurredtodate).Ifanoffertosettleismade,thedefendantshouldprovidesufficientmedicalorotherevidencetoallowtheclaimanttoproperlyconsidertheoffer.Thelevelofdetailnecessarywilldependonthevalueoftheclaim.Ifthepartiesreachagreementonliability,orwishtoexplorethepossibilityofresolutionwithnoadmissionsastoliability,buttimeisneededtoresolvethevalueoftheclaim,theyshouldaimtoagreeareasonableperiod.Ifthepartiesdonotreachagreementonliability,theyshoulddiscusswhethertheclaimantshouldstartproceedingsandwhetherthecourtmightbeinvitedtodirectanearlytrialofapreliminaryissueorofbreachofdutyand/orcausation.FollowingreceiptoftheLetterofResponse,iftheclaimantisawarethattheremaybeadelayofsixmonthsormorebeforetheclaimantdecidesif,whenandhowtoproceed,theclaimantshouldkeepthedefendantgenerallyinformed.EXPERTS专家意见Inclinicalnegligencedisputesseparateexpertopinionsmaybeneeded—onbreachofduty;oncausation;onthepatient’sconditionandprognosis;toassistinvaluingaspectsoftheclaim.Itisrecognisedthatinclinicalnegligencedisputes,thepartiesandtheiradviserswillrequireflexibilityintheirapproachtoexpertevidence.Thepartiesshouldco-operatewhenmakingdecisionsonappropriatemedicalspecialisms,whetherexpertsmightbeinstructedjointlyandwhetheranyreportsobtainedpre-actionmightbeshared.Obtainingexpertevidencewilloftenbeanexpensivestepandmaytaketime,especiallyinspecialisedareasofmedicinewheretherearelimitednumbersofsuitableexperts.Whenconsideringwhatexpertevide