National Legislation on Medical Liability: The Experience of Australia, China, Japan, South Korea and Singapore

As more and more medical service is provided by hospital, a new basis of medical liability, hospital’s organizational duty, has arisen. Hospital typically differentiates various parts of medical service and allocates them to different departments. The division of labor enhances the efficiency and professionality of the service and enables a service which could not have been provided otherwise. It poses, however, new risk that nobody in the organization has a comprehensive understanding of and control over the process. Patients might be unattended by anybody at some point of the process. This risk should be coped with or compensated by the new duty to organize the structure and cooperation in the hospital adequately. In many jurisdictions including Germany, France, the United States and South Korea, this new duty has been acknowledged by legislation and more importantly by jurisprudence. All those show similar landscapes: Hospital’s organizational duty has a function to enlarge hospital’s (civil) liability and/or concentrate medical (civil) liability to the hospital so as to provide the victim, the patient, a better way to be compensated and to preserve the rapport between the attending physician and the patient. It also has a function to lessen the burden of proof from the patient’s side, especially in the context of hospital contagion. It poses a new problem of the influence of the existence and weight of hospital’s own liability for the defective organization upon the individual physician’s medical liability. Last, but not least, there is the problem of the implication of the existence of organizational duty upon the medical criminal liability. This issue has not been addressed thus far perhaps because there are few cases in criminal justice practice. It’s theoretical importance can hardly be exaggerated, though, as it shows dramatically the structural transposition of modern medical service provision and its possible influence on the overall regime of modern medical liability. South Korea has already a few cases that show this issue can arise anytime in practice.

Medical Professional Liability Insurance and its Relation to Medical Error and Healthcare Risk Management for the Practicing Physician

The article is devoted to the analysis of the features of the development of the Ukrainian legal mentality, in the process of introducing digital innovations into the national legal system and preserving legal traditions that were formed under the influence of historical, cultural, social and political factors. The author considers the national legal mentality as a set of deep ideas, values, beliefs and stereotypes about justice, law, state, which are inherent in the Ukrainian people, formed historically and embodied in its culture, language, religion, traditions and behavior. Thus, the researcher outlines the features of the Ukrainian legal mentality: a close connection with spirituality, individualism, compliance with liberal values, nihilism combined with idealism. The study proves that legal mentality is of great importance for understanding the peculiarities of the functioning of the legal system, the social behavior of citizens and the formation of legal culture, because it is a reflection of the way of thinking, the system of values, norms and beliefs that determine a person’s attitude to law, law and justice; it reflects the deep level of legal consciousness, which is the result of the long-term influence of historical, cultural and social factors on society. Considering these positions, the author argues that legal mentality can be considered as an integrative category that covers both the individual and collective levels of legal consciousness. During the study, the author also draws attention to the conceptual differences between the concepts of “legal mentality” and “legal mentality”. Thus, through legal mentality, the deep level of legal consciousness is revealed (perceptions, beliefs, attitudes and stereotypes that determine the attitude to law at the collective or individual level); static historical and cultural features of society are reflected. Instead, legal mentality appears as a system of ideas that determines the attitude of society or an individual to law, legality and legal institutions, but in a more dynamic aspect (as a reaction to social transformations, reforms, educational programs and the impact of globalization); reflects the current state of legal consciousness and culture; covers the current level of knowledge about law, readiness to act in the legal sphere and the ability to adapt to new legal conditions (global processes of digitalization). In view of this, the author pays special attention to the problems of modern trends in updating the legal system, in particular, to the means and methods of integrating legal systems through the use of digital technologies. The study emphasizes that the integration of AI into the national legal system changes the traditional understanding of jurisprudence, legal practice, and the role of a lawyer. In particular, AI raises ethical questions regarding responsibility for decisions made by algorithms and the transparency of such decisions, since the lack of clarity of algorithms undermines trust in the legal system. The author emphasizes that the introduction of AI into the national legal system should take into account the specifics of the national legal culture, which is based on the ideas of the rule of law and social justice. However, there are risks that the globalization of technologies may displace national legal peculiarities. Key words: legal mentality, legal mentality, artificial intelligence, legal system, legal consciousness, legal traditions, globalization.

This article examines the critical role of Healthcare laws in addressing healthcare malpractice within the Indian legal system. It defines medical malpractice, distinguishing it from medical negligence and diagnostic errors, as a breach of the standard of care by healthcare professionals/providers/facilities resulting in patient injury or death. The study elucidates the three core characteristics of medical malpractice: deviation from accepted standards of care, demonstrable patient injury, and significant damages stemming from the injury. It emphasizes that medical malpractice liability is primarily rooted in the 'Tort of Negligence' within common law of Jurisprudence. Furthermore, the article highlights the significance of informed consent, where a lack of proper disclosure regarding potential consequences can lead to liability, even without direct medical error. By exploring the legal elements required to prove medical malpractice – duty of care, breach of duty, causation, and resulting damages – the paper provides a comprehensive overview of the legal framework for addressing healthcare malpractice in India. It further analyzes the types of errors that commonly lead to malpractice claims, such as misdiagnosis, incorrect procedures, premature discharge, and medication errors. The study also acknowledges the role of private healthcare and its impact on malpractice. Finally, by referencing landmark judgments like P. Shanta vs Indian Medical Association, it reinforces the status of patients as consumers under Indian law, further solidifying their right to seek redressal for medical negligence and malpractice. Legal reforms should adopt a comprehensive approach, recognizing the interdependence of political, social, and economic factors. Fostering political stability and commitment is crucial, as a stable political environment characterized by strong leadership and dedication to legal reform provides the necessary foundation for sustained reform efforts. Increasing awareness and public participation by promoting information campaigns, civic education, and opportunities for public engagement to expand the rights and opportunities of citizens. Inculcating the public's sense of ownership and responsibility towards legal reform processes and active involvement of civil society organizations can bring diverse perspectives and contribute to inclusive decision-making. Promoting the rule of law and anti-corruption measures by establishing an independent and impartial judicial system, improving legal and judicial education, and cultivating a culture of integrity. Addressing socioeconomic inequality, ensuring that legal changes benefit all segments of society, including marginalized and vulnerable groups. Strengthening international cooperation and exchange of best practices in legal reform. The Law Commission of India has also played a crucial role in proposing changes to electoral laws to enhance transparency and fairness in the election process, identifying and recommending the repeal of numerous outdated laws, and suggesting various reforms to the Indian Penal Code and the Code of Criminal Procedure. Modernizing criminal laws aims to ensure justice resonates with society’s changing needs, and giving teeth to the existing laws for proper implementation for better outcome.

The aim of this paper is to analyze the cultural, social and political factors that can influence the mergers and acquisition (M&As) decision. Our study analyze if the investors perception towards investment in an economy can be influenced by these factors. The results show that social factors like public spending with health, literacy rate or people skills and abilities, cultural factors like the perception of the bureaucracy and new businesses or political factors like tax rates and democratic development are key determinants of M&As decision. These factors can be also explained in terms of investors' behaviour in making new investments in a specific economy.

As summarized in several previous Circulation Mini-Reviews1–3 and elsewhere,4 the United States is experiencing a growing deficit in cardiovascular physicians that is made worse as cardiovascular diseases become more prevalent. Important contributors to this deficit in the cardiovascular workforce and other specialty workforces are the high and rising costs of malpractice premiums in the majority of our states.5 As cardiovascular specialists in Florida (cardiothoracic surgery and cardiology), we are at the center of this crisis. In the present review, we will examine the problem along with recent activities related to this crisis in Florida and discuss their implications. The American Medical Association stated in June 2002, that the majority (>40) of our states had major problems in that members of high-risk specialties were leaving or considering leaving their practices. Then–AMA President, Richard F. Corlin, MD, stated, “doctors are disappearing from American communities on a regular basis because of skyrocketing medical liability insurance premiums and an out-of-control legal system. As insurance becomes unaffordable or unavailable, and the legal system produces multi-million dollar jury awards on a regular basis, physicians are forced to limit services, leave practices, or relocate—all of which seriously impede patient access to high quality health care.” Florida (along with Georgia, Mississippi, Nevada, New Jersey, New York, Ohio, Oregon, Pennsylvania, Texas, Washington, and West Virginia) was among the 12 states considered to be at crisis level. According to the Department of Insurance in Florida, in 1975, total indemnity payments for professional liability cases were $10 271 090. By 2001, this had increased 3074% to a total indemnity payout of $326 052 228. A survey of comparative 2002 malpractice insurance premiums revealed that an invasive cardiologist in Los Angeles paid $16 148 for $1 000 000 coverage, whereas the same specialist in Miami paid $106 497, highest …

AMA hopes streamlined agenda will boost membership

Objectives: In this study we present data which describe a large cohort of closed cardiovascular medical professional liability claims. The purpose of this report is to provide information for cardiologists which will be useful in improving the quality of cardiovascular care and in reducing the incidence of patient injury and the consequent frequency of medical professional liability claims. Background: In 1985 The Physician Insurers Association of America (PIAA) established the Data Sharing Project, a registry of medical professional liability claims. This registry contains data voluntarily submitted by participating PIAA member professional liability insurance companies describing 239,756 closed claims through 2008. The registry is maintained for educational programs to improved quality of care and to reduce patient injury and consequent medical professional liability claims. Methods: Descriptive techniques are used to present summary information for the medical cardiovascular claims in the PIAA registry. Results: Of 239,756 closed claims, 4,527 (1.9%) involve cardiologists. Of the 4,527 closed claims, 836 (18.5%) resulted in an indemnity payment, and the average indemnity payment for these cases was $251,024. In the entire database, 29.5% of closed claims were paid, and the average indemnity payment was $209,156. The most prevalent allegation among cardiovascular closed claims was diagnostic error (931 cases, 20.6% of all closed claims), and the most prevalent diagnosis was acute myocardial infarction, representing 105 of 931 cases of diagnostic error (11.3% of diagnostic error closed claims.) The average indemnity paid for errors in diagnosis was $306,273. Aortic aneurysms and dissections, while relatively infrequent as clinical events, represent a substantial medical professional liability diagnostic error risk because of the high percentage of paid claims (38.2%), and the high average indemnity payment of $444,859. Conclusions: Medical professional liability issues are common and are important to all practicing cardiologists. Detailed knowledge of risks associated with liability claims should assist practicing cardiologists in improving quality of care, reducing patient injury and reducing the incidence of claims.

The first section of the chapter gives an overview of the judicial and normative situation of medical liability in Spain, including an analysis of extra-judicial institutions and operative roles. It defines the diverse cases of mala praxis from the point of view of doctors and healthcare professionals acting as “free professionals” and those who are functionally dependent upon a private healthcare institution, also discussing cases in which the healthcare institution itself acts defendant. This section also discusses out-of-court settlements and criminal medical liability, providing some statistical data concerning claims of medical liability. The second section of the chapter focuses on the ascertainment methodology in living persons and cadavers, expert ascertainment in professional liability and clinical information obtained before and after a potentially liable act. The third section deals with the evaluation criteria for living patients and cadavers. This chapter ends with a discussion of future perspectives and the possible reforms that may occur in Spain concerning medical liability.

Reflecting on Medical Liability in Colombia

The relevance of the study is due to many social and legal factors. In modern conditions of the development and functioning of various systems for the protection of medical professionals and their patients, the concepts and grounds of medical professional liability are undergoing significant changes. The research of the conditions for the implementation of professional activities by medical professionals and their professional liability is determined by both scientific and practical considerations, since society needs orderliness and predictability of relations in areas of life directly related to the life and health of the patient on the one hand, and the business reputation of the medical professional on the other hand. With the emergence and expansion of professional activities types as integral attributes of social, economic and legal relations, a number of questions have arisen regarding a) improving the legal regulation of the professional activities of medical professionals; b) determining the goals of the medical professional liability; c) determining the medical professional liability grounds. The source base for the research is the valid legislation of Ukraine, laws and by-laws, research and comparison of which requires a systematic approach and various research methods, such as: dialectical, logical-legal, system-structural, forecasting and comparative law methods, as well as materials judicial practice. The article, first of all, concludes that the medical professional liability is applied to an individual entrepreneur (private practitioner) or a legal entity (health care institution) that provides medical services to the population, in accordance with a business license activities in medical practice, in case of causing harm to patients due to non-performance or improper performance of their professional duties, measures of government coercion in the form of sanctions (additional encumbrances) aimed at restoring the violated rights and interests of the patient. Secondly, it has been set that the medical professional liability shall arise only under the following grounds: wrongfulness of the medical professional, damage caused to the patient, causation and regardless of the medical professional guilt.

The Medicolegal Sidebar column addresses issues that orthopaedic surgeons may face at the intersection of law and medicine. One of the goals of the column is to assist orthopaedic surgeons in making legally sound clinical and business decisions. In doing so, the column focuses on legal issues, avoiding the public debate on whether our current malpractice system favors providers or patients. Accordingly, our column will periodically publish articles by distinguished guest commentators to express their personal opinions on the current status of our malpractice system. The goal of these commentaries is to stimulate discussion among our readers and others who have an interest in malpractice litigation. Our first distinguished commentator is attorney Christopher Stombaugh. Mr. Stombaugh is an accomplished trial attorney, a faculty member of The Gerry Spence Trial Lawyers College and Past President of The Wisconsin Association of Justice. —B. Sonny Bal MD, JD, MBA, Lawrence H. Brenner JD While physicians and trial lawyers in the medical liability system may speak the same language, they really misunderstand each other. Physicians and lawyers, like the United States and Great Britain, are ‘‘[t]wo nations divided by a common language’’ [5]. A clear example of this disconnect is when we discuss medical negligence claims and medical liability reform. The common impression among many physicians is that a claim for medical negligence is, in essence, a claim that a physician is a ‘‘bad doctor.’’ Worse yet, verdicts against physicians can result in those physicians being reported to the national databank, and even unsuccessful claims have to be reported to future hospitals when one seeks employment. Litigation, therefore, can adversely affect a physician’s reputation and livelihood. Trial lawyers in the medical liability system, however, would submit that the issue should not be the fear of litigation, rather the fear of carelessly injuring patients. The latest statistics (August 2015) from the New York Law School’s Center for Justice and Democracy reveals that medical negligence cases made up Note from the Editor-in-Chief: We are pleased to publish the next installment of ‘‘Medicolegal Sidebar’’ in Clinical Orthopaedics and Related Research. The goal of this quarterly column is to encourage thoughtful debate about how the law and medicine interact, and how this interaction affects the practice of orthopaedic surgery. We welcome reader feedback on all of our columns and articles; please send your comments to eic@clinorthop.org. The author certifies that he, or any member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. C. D. Stombaugh JD (&) Stombaugh, Smith & Co., 600 Washington Ave., Towson, MD 21204, USA e-mail: chris@stombaughsmith.com Medicolegal Sidebar Published online: 28 October 2015 The Association of Bone and Joint Surgeons1 2015

The doctrinal analysis of the implementation of international standards in national judicial legislation is an important aspect of ensuring that the domestic legal order complies with generally accepted principles and norms of international law. International standards in the field of justice cover various aspects, including human rights, fair trial principles, independence and impartiality of courts, and case procedures. The implementation of these standards into national legislation is a complex and multifaceted process that includes the adaptation of national legal norms to international requirements, the integration of new procedures and mechanisms into the judicial system, and the provision of appropriate education and training for judges and other judicial officers. In doing so, it is important to take into account national peculiarities of legal systems, traditions and existing judicial practice. One of the main challenges in this process is to strike a balance between international standards and national legal traditions. The opinions of legal scholars on the implementation of international standards in national legislation are extremely relevant in the context of modern globalization processes and Ukraine’s integration into the international legal community. By considering three key areas - the role of the judiciary, the constitutional basis for the administration of justice, and the specifics of foreign experience in modernizing national judicial systems - one can better understand and assess the challenges and prospects for reforming the national legal system. Thus, thedoctrinalanalysisoftheimplementation of international standards in national legislation on the judiciary is an important tool for studying and improving legal systems, promoting the rule of law and protecting human rights. It helps to identify problems and shortcomings in the implementation process, develop recommendations to overcome them, and ensure that national justice systems meet the highest international standards.

The main statutes that govern medical practice in South Korea (hereinafter “Korea”) are the Medical Service Act, the Emergency Medical Service Act, and the National Health Insurance Act. But the medico-legal system in Korea refers to all the legal areas related to medical practice, including administrative, civil and criminal law. The legal basis of medico-legal claims against a medical practitioner or medical institution is mainly contractual liability, such as non-performance of obligations and tortious liability. Liability attaches for torts or non-performance of contractual terms when there is a breach of the duty of care in medical treatment, a generation of damage and a causal relationship between the breach of the duty of care and the damage caused. In recent years, a patient’s right to self-determination and a doctors’ duty of explanation have become increasingly more important. Violations of a doctor’s duty to explain are independently becoming a large part of medical liability. The Act on Remedies for Injuries from Medical Malpractice and Mediation of Medical Disputes was enacted. This Act stipulates the matters related to mediation and arbitration of medical disputes, so as to promptly and reliably relieve damages caused by medical accidents and to create a stable medical environment for health care workers. To understand the medical liability in one country, it is necessary to consider the medical community, the historical and cultural background and the medical technology. It is also necessary to apply and interpret the rules while considering the medical, legal and social status of Korea.KeywordsMedical liabilityMedical service actNational health insurance systemMediation of medical disputeSouth Korea

The study of medical law issues is topical, confirmed not only by external factors such as the full-scale war with the Russian Federation, the martial law regime, and the unwavering course towards European integration, but also by the internal dynamics of the medical field's development. This dynamic encompasses the introduction of new technologies, the expansion of private medical practice, and the urgent need to adapt national legislation to international standards. The article highlights the problem of determining the place of medical law in Ukraine's national legal system, its sources, and ensuring a proper balance between protecting patients' rights and establishing fair liability for medical professionals. Particular attention is paid to the challenges facing medical law in wartime, including the destruction of medical infrastructure, resource limitations, and threats to the lives of medical personnel and patients. Issues related to the application of new technologies, such as artificial intelligence and telemedicine, and the associated legal aspects of patient rights protection are also considered. The article substantiates the need for a profound scientific understanding and practical improvement of the mechanisms of medical law. It emphasizes the necessity of revising existing legal norms and creating new mechanisms for regulating medical services, especially in wartime when traditional approaches prove insufficient. The importance of creating effective mechanisms for the realization and protection of patients' rights is also justified, particularly considering the challenges of martial law and the need to rebuild an effective healthcare system. The research methods included the analysis of normative legal acts, particularly the Constitution of Ukraine, the Law of Ukraine "Fundamentals of the Legislation of Ukraine on Health Care," the Civil Code of Ukraine, and the Criminal Code of Ukraine, the Code of Ukraine on Administrative Offenses; the study of scientific works by domestic and foreign scholars; the analysis of judicial practice, including decisions of the European Court of Human Rights and national courts; and a systemic approach to studying medical law as a comprehensive branch of law. The article analyzes the formation and development of medical law in Ukraine, its place in the national legal system, the system of medical law sources, fundamental patient rights, and the institute of legal liability of medical professionals (civil, criminal, administrative, and disciplinary). It examines the current challenges facing medical law in the context of war and technological development, particularly the problems of telemedicine application. International approaches to adapting legal systems in healthcare and the role of monitoring healthcare providers by the National Health Service of Ukraine (NHSU) are also considered. The authors of the article believe that in modern Ukrainian realities, it is extremely important not to only theoretically comprehend the place of medical law and patients' rights but also to actively work on creating effective mechanisms for their realization and protection, especially considering the challenges of martial law and the need to rebuild an effective healthcare system. An effective medical law system should ensure not only mechanisms for accountability but also conditions for preventing medical errors. The work concludes that medical law in Ukraine is increasingly asserting itself as an independent comprehensive branch of law, a science, and an academic discipline. Its subject matter includes legal relations in medical activities, the legal status of subjects, and legal liability. The system of medical law sources is complex. Fundamental patient rights are legislatively enshrined, and medical professionals bear civil, administrative, or criminal liability for violations. Modern challenges, particularly war and technological development, exacerbate problems in the field of medical law. Particular attention is paid to concepts such as: medical law as a branch of law, science, and academic discipline; the system of medical law sources; patients' rights (to health care, information, confidentiality, quality medical care); legal liability of medical professionals (civil, criminal, administrative, disciplinary); quality of medical care and healthcare standards; telemedicine. The expediency of further improving healthcare legislation, clearly defining and regularly updating medical care standards, developing a system of professional liability insurance for medical workers, and raising the level of legal awareness among patients and medical professionals has been established. The authors propose their own suggestions for improving the functioning of medical law in Ukraine by: improving the normative legal framework, including the possible development of a Medical Code of Ukraine and special legislation on new technologies; regularly updating medical standards; strengthening the role of clinical expert commissions and developing mediation for out-of-court dispute resolution; raising legal awareness of the parties; developing special protocols for wartime conditions; strengthening cybersecurity of medical data; introducing professional liability insurance for medical professionals. Keywords: medical law, patients' rights, liability of medical professionals, sources of medical law, quality of medical care, telemedicine, martial law, legal liability, healthcare standards, legislative improvement.