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Clinical Negligence Reform: Lessons from France?

Published online by Cambridge University Press:  17 January 2008

Simon Taylor
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Extract

On 4 March 2002, the French legislature enacted the ‘Patients’ Rights & Quality of the Health System Act’ which introduces reforms in the relationship between the medical profession and the patient.1 As part of this wider reform, Part IV of the Act establishes a new system for the compensation of victims of medical accidents. The new legislation retains the traditional liability rules but puts in place a parallel system which aims to guarantee compensation for serious accidents, whether or not the accident is caused by negligence, without the need to resort to litigation in these cases. The new French rules are of considerable interest in view of the current debate in the United Kingdom on clinical negligence reform.

Type
Shorter Articles, Comments, and Notes
Information
International & Comparative Law Quarterly , Volume 52 , Issue 3 , July 2003 , pp. 737 - 747
Copyright
Copyright © British Institute of International and Comparative Law 2003

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References

1 loi no. 2002–303 du 4 mars 2002 relative aux droits des malades et à la qualité du systéme de santé.

2 The Report of the Public Inquiry into Childrens' Heart Surgery at the Bristol Royal Infirmary 1884–1995: Learning from Bristol, CM 5207(1), July 2001 (‘The Kennedy Report’), 103, referring to Vincent, C, Neale, G and Woloshynowch, M, ‘Adverse events in British hospitals: preliminary retrospective overview, BMJ 2001, 517–19CrossRefGoogle Scholar. Adverse events are defined as ‘unintended injuries caused by medical management rather than the disease process’.

3 National Audit Office, Handling Clinical Negligence Claims in England, May 2001, 5.

4 Ibid.

5 Ibid.

6 Select Committee on Health 6th report, Nov 1999, paras 21 et seq; Kennedy Final Report Bristol Royal Infirmary Inquiry, para 26.25; Lord Woolf Access to Justice: Final Report to the Lord Chancellor on the Civil Justice System in England and Wales HMSO 1996, ch 15.

7 Woolf, Lord ‘Are the courts excessively deferential to the Medical profession?’ (2001) Medical Law Review, 1, at 3Google ScholarPubMed. Also on this point, Margaret Brazier and Jose Miola ‘Bye-Bye Bolam: A Medial Litigation Revolution?’ (2001) Medical Law Review, 85, at 112.

8 [1998] AC 232.

9 Bolitho v City and Hackney Health Authority [1997] 4 All ER 771; Marriott v West Midlands Health Authority [1999] Lloyd's Rep Med 23. Where it can be demonstrated that the professional opinion is not capable of withstanding logical analysis’, Lord Browne-Wilkinson in Bolitho, at 778.

10 Margaret Brazier and José Miola, above, 100.

11 Civil Procedure Rules 1998 (SI 1998, no 3132). Lord Woolf Access to Justice: Final Report to the Lord Chancellor on the Civil Justice System in England and Wales, HMSO 1996.

12 Lord Woolf, article above, 15.

13 The CEDR (centre for dispute resolution) mediated almost 300 cases in 1998–9, but only 4 per cent related to clinical negligence. A mediation pilot scheme carried out by the Department of Health in 1995–7 also found that only a small number of cases were referred to mediation. Select Committee of Health, 6th report, para 127–9.

14 The Royal Commission on Civil Liability and Compensation for Personal Injury, HMSO 1978. At the time, the medical profession itself was heavily in favour of retaining the tort system, arguing that ‘Liability was one of the means whereby doctors could show their sense of responsibility and, therefore, justly claim professional freedom’. Pearson Report, at para 1342.

15 6th report.

16 Clinical Negligence: What are the Issues and Options for Reform?, Department of Health, Aug2001.

17 On the Swedish and Danish schemes, see Rapport du service ties affaires européennes du Sénat ‘L'indemnisation des victims d'accidents thérapeutiques’, La documentation française, Nov 2000. The Danish system, for example, compensates victims of medical accidents occurring in public hospitals where the physical harm suffered is valued at more than 10,000 Crowns and either (1) an experienced doctor would have acted otherwise; (2) the injury was caused by the use of defective equipment; (3) the use of other methods or techniques would have avoided injury; or (4) the complication is very rare, or much more serious than could have been anticipated. On the Finnish scheme, see Lahti, Raimo ‘The Finnish Patient Injury Compensation Scheme’ in Sheila, McLean (ed), Law Reform and Medical Injury Litigation (Dartmouth), 1995, 147.Google Scholar

18 Tribunal des Conflits, 25 Mar 1957, Rec CE, 816.

19 George Méméteau, Cours de droit medical (Les Etudes Hospitalieres), 2000, 243. Liability is considered to be based on Arts 1135 and 1147 of the civil code.

20 The administrative courts: M et Mme V., CE, 10 Apr 1992, JCP 1992.11.21881, note J Moreau. The civil courts: Mercier, Chambre civile Cour de cassation, 20 May 1936, D. 1936.1.88, concl Matter, rapp Josserand, note EP.

21 Mercier, Chambre civile Cour de cassation, 20 May 1936, D. 1936.1.88, concl Matter, rapp Josserand, note EP.

22 George Memeteau, Cours de droit medical (Les Etudes Hospitalieres), 2000, 262; Yvonne Lambert-Faivre Dommage Corporel, Precis Dalloz 2000, 681; Bell, , Boyron, , and Whittaker, , Principles of French Law (Oxford: Oxford University Press, 1998), 340.Google Scholar

23 Conseil d'Etat, 10 Apr 1992, JCP 1992.11.21881, note J Moreau. The administrative courts formerly made liability for the acts of medical practitioners dependant on proof of a ‘faute lourde’, meaning a particularly serious fault, caused by grave negligence or recklessness. This was reversed by the 1992 decision of the Conseil d's claim.

24 CE 9 Dec 1988, Cohen, Rec CE 1988.431; CE 1 Mar 1989, Bailly, RCA 1989, no 199.

25 Cass Civ Ire, 29 June 1999, JCP 1999.11.10138, rapport Sargos, Gaz Pal 29–30 Oct 1999, 37.

26 Cass Civ lre, 9 Nov 1999, Responsabilite civile et assurance 2000, no 61.

27 Cass Civ 26 June 1972, JCP 1972.IV.60; Cass Civ lre, 25 May 1983, JCP 1984.11.20281, note Dorsner-Dolivet.

28 Cass Civ lre, 27 Feb 1997, Gaz Pal 27–29 April 1997, 22, rapport Sargos; CE 5 Jan 2000, JCP 2000.11.10271, note Moreau.

29 Damages will be calculated as a percentage of the actual loss suffered. Yvonne Lambert-Faivre, Dommage Corporel, 706, who criticises the use of the loss of chance principle in this context; Bell, Boyron, and Whittaker Principles of French Law, 394, where the operation of the loss of chance principle is referred to in another context.

30 On the notion of risk in French administrative law, see Brown, and Bell, , French Administrative Law (Oxford: Clarendon Press, 1998), 184, 289.Google Scholar

31 Bianchi, 9 Apr 1993, Rec CE, 127, concl M Dael; JCP G 1993, II, 22061, note J Moreau; and also Conseil d'état 3 Nov 1997, JCP 1998.11.10016, note Moreau.

32 Tournier, Cass lre civ 8 Nov 2000, D.2000, IR, 292. See Yvonne Lambert-Faivre, ‘La réparation de l‘accident médical. Obligation de sécurité: oui; aléa thérapeutique: non’ Le Dalloz (2001) chronique, 570. There are several reasons for this reluctance. The civil courts are bound to work within the provisions of the civil code. The articles of the code which could be used to found liability in these cases (Arts 1135 and 1147) would not allow the courts to limit liability to cases where the harm suffered by the patient is of a serious nature. The burden of liability placed on medical practitioners, and hence on their insurers, would also be very heavy. The civil courts perhaps also fear that it will be extremely difficult to define the notion of ‘ aléa thérapeutique’ to keep it within tight boundaries. There is perhaps a danger of the principle of liability for fault being eroded by an ever wider definition of ‘aléa’. Pierre Sargos (adviser to the Cour de Cassation) ‘L'aléa thérapeutique devant le juge judiciaire’, 2000 JCP I, 202.

33 See, eg, Christian Larroumet, ‘L'indemnisation de l'aléa thérapeutique' (1999) Recueil Dalloz, Chronique, 33; Pierre Sargos ‘L'aléa thérapeutique devant le juge judiciaire’ (2000) La Semaine Juridique, 189; Evin, Claude, ‘L'indemnisation des accidents médicaux’ (2001) Revue Générate de droit medical, 71Google Scholar; Yvonne Lambert-Faivre, ‘L'indemnisation du prejudice des victimes d'accidents médicaux. N'est ce pas temps d'adopter un systeme d'indemnisation coherent et stable?’ (2001) Gazette du Palais, 13; Viney, G and Jourdain, Patrice, ‘L'indemnisation des accidents médicaux: que peut faire la Cour de Cassation?’, (1997) La Semaine Juridique, 181.Google Scholar

34 A no-fault compensation fund for medical accidents in France was first suggested by André Tune at the 2nd international conference on medical ethics in 1966. This was followed by various reports commissioned by the government in the 1980s and 1990s and a number of private member bills. For a brief history of French proposals for reform, see Evin, Claude, ‘L'indemnisation des accidents médicaux’ (2001) Revue generate de droit medical, 71.Google Scholar

35 ‘Reparation des consequences des risques sanitaires.’

36 A health professional is defined broadly to include a wide range of professions. Hence, the list includes, amongst others, doctors, dentists, midwives, pharmacists, nurses, physiotherapists, radiologists, dieticians. Art 1142–1 Code de la santé publique, referring to the professions mentioned in Part 4 of the same code.

37 Art L.I 142–1.

38 A ‘medical product’ (‘produit de santé’) is defined in the fifth book of the Public Health Code as including medicines, cosmetics, poisonous substances and preparations, contraceptives, certain dietary products and various regulated medical devices and products.

39 Loi no. 98–389, 19 May 1998.

40 Art L.434–2 of the Social Security code.

41 M Lorrain, Senate debates, 6 Feb 2002.

42 L.1142–2

43 Art L.I 142–5.

44 Dominique Thouvenin ‘Reparation des risques sanitaires: analyse des régles votées en premiére lecture par L'Assemblée Nationale’, unpublished paper, 2002.

45 Art L.1142–4.

46 Art L. 1142–6 Code de la sante publique.

47 The Act establishes a new national list of medical experts. Any expert used must be drawn from this list. Articles L. 1142–11 to L. 1142–12.

48 Art L.1142–14.

49 Art L.1142–14.

50 Art L.1142–10.

51 Art L. 1142–28. This new limitation period therefore replaces the limitation period for contract actions of 30 years from the knowledge of the damage (Art 2262 Code civil), and of 4 years for actions in the administrative courts.

52 ArtL. 1142–7.

53 The exclusion of the less seriously injured has been heavily criticised by academic commentators. See Lambert-Faivre, Y, ‘La loi n° 2002–303 du 4 mars 2002 relative aux droits des malades et á la qualité du systéme de santé. L'indemnisation des accidents médicaux’ (2002) Le Dalloz, 1367, 1370Google Scholar; Christophe Radé, ‘La ré médicale aprés la loi du 4 mars 2002 relative aux droits des malades et á la qualité du systéme de santé’, Responsabilité civile et assurances, May 2002, 4, 5.

54 Lambert-Faivre, Y., ‘La loi n° 2002–303 du 4 mars 2002 relative aux droits des malades et á la qualité. L'indemnisation des accidents médicaux’ (2002) Le Dalloz, 1367, 1371Google Scholar. Statistics taken from the Fédération Française des Sociétés d’Assurances (FFSA) 2000.

55 Dominique Thouvenin, ‘Reparation des risques sanitaires: analyse des regies votées en premier lecture par l'Assemblée Nationalee’ (2002), unpublished paper.

56 Since the Act only makes a medical organisation strictly liable.

57 Dominique Thouvenin, above. This point is also considered by Mistretta, Patrick ‘La loi no. 2002–303 du 4 mars 2002 relative aux droits des maladies et à, la qualite du systéme de santé. Réflexions critiques sur un droit en mutation’ (2002) La semaine juridique, 1075, 1081.Google Scholar

58 Cerebral palsy and brain damage cases account for 80 per cent of outstanding claims by value. National Audit Office, Handling Clinical Negligence Claims in England (2001), 1.