Bundaberg and beyond: duty to disclose adverse events to patients

Although much excellent work has been done in Australia and elsewhere to improve the safety and quality of health care provision, the practice of medicine is inherently risky--adverse events sometimes occur. In Australia, practical guidelines for the open disclosure of adverse events to patients have been developed and are being implemented. State and Territory medical boards have recently adopted Codes of Conduct which include disclosure provisions, although the Australian Medical Association's Code of Ethics does not yet contain express patient disclosure provisions. There is a dearth of authority concerning legal obligations to disclose known or suspected adverse events. Although many Australian jurisdictions have introduced statutory protection for those who apologise or express regret to patients following an adverse event, there is no corresponding express statutory disclosure obligation, unlike in some parts of the United States. The Bundaberg experience illustrates the complex ethical, practical and legal issues which arise in this area.     

Fiduciary disclosure of medical mistakes: the duty to promptly notify patients of adverse health care events

Fiduciary obligations are imposed by the common law to ensure that a person occupying a societal role with a high potential for the manipulation of vulnerable persons exercises utmost good faith. Australian law has recognised that the doctor-patient relationship, while not wholly fiduciary, has fiduciary aspects. Amongst such duties are those prohibiting sexual or financial abuse of patients or disclosure without express authority of confidential information. One important consequence of attaching such fiduciary duties to the doctor-patient relationship is that the onus of proof falls not upon the vulnerable party (the patient), but upon the doctor (to disprove the allegation). Another is that consent cannot be pleaded as an absolute defence. In this article the authors advocate that the law should now accept that the fiduciary obligations of the doctor-patient relationship extend to creating a legal duty that any adverse health care event be promptly reported to the patient involved. The reasons for creating such a presumption, as well as its elements and exceptions, are explained.     

What you don't know can hurt you: why managed care organizations have a legal duty to disclose the use of financial incentives to limit medical care

This article, winner of the 2000-2001 American Health Lawyers' Student Writing Competition, examines the conflicting policy goals at the heart of managed care--particularly in the use of financial incentives for physicians who limit their use of referrals and expensive diagnostic tests. While conceding the legality of such incentives, the author contends that Managed Care Organizations (MCOs) have a legal duty to disclose their existence to beneficiaries. After analyzing the basis for imposing a duty to disclose, the author proceeds to examine such issues as the proper timing, level, and extent of disclosure.     

浅议医疗事故责任程度的细化

医疗事故鉴定工作的不断深入对责任程度划分提出了更高的要求，本文通过对2个鉴定案例责任程度判定的分析，讨论了细化责任程度的必要性、可行性，提出了细化责任程度要根据案件实际情况，尽量满足委托方的要求，同时应注意统一的表达方式和增强鉴定的科学性。     

浅议医疗事故责任程度的细化

医疗事故鉴定工作的不断深入对责任程度划分提出了更高的要求,本文通过对2个鉴定案例责任程度判定的分析,讨论了细化责任程度的必要性、可行性,提出了细化责任程度要根据案件实际情况,尽量满足委托方的要求,同时应注意统一的表达方式和增强鉴定的科学性。