Reforming clinical negligence in England: lessons about patients' and providers' values from medical injury resolution in New Zealand and the United States of America

Article Figures & Data

Table 1.

Functions, processes and remedies of torts and the Accident Compensation Corporation

	Torts	Accident Compensation Corporation
Jurisdictional focus	Substandard healthcare causing harm to patient	Injuries (including medical injuries)
Cases handled	Negligence claims	Claims from the public submitted by injured people or their health providers
Compensation standard	Negligence	No fault
Adjudicator	Jurisdiction specific; judge or jury	Administrator
Process	Judicial (but alternative dispute resolution is possible)	Administrative (but appeal to the courts is possible)
Experts	Hired by litigants	Internal to system
Role of lawyers	Integral	Optional
Remedies	Monetary damages/compensation	Compensation, rehabilitation and prevention / patient safety

Case vignette 1

Facts^a	52-year-old man. Heart attack. Stent was inserted. ‘No one told me the stent could block up.’ ‘A few months later, the stent occluded.’ ‘It felt like a knife had been stabbed right through my heart.’ ‘I was told that I was “imagining things” and “I was ignored and got treatment very late.”’ ‘I ended up having another heart attack.’
Primary relevant law	Section 32 of the Accident Compensation Act 2001.
Opinions on causation	A senior cardiologist was asked for his expert opinion. His opinion was that 80% of the injury was caused by the errors and delayed treatment. Whereas, ACC argued that the second heart attack was not caused by the treating team, but by my underlying cardiac issues from the first heart attack.
ACC determination	The patient's injury was caused by his underlying health condition. Therefore, he did not qualify for cover, compensation or rehabilitation.
Evaluation	The patient's needs were not met. Reinforces commentators’ critique that the statutory provisions about causation have reintroduced negligence-style criteria, which are an anathema to a no-fault scheme.