Medical Law Conference

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Medical Law Conference

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About

Over the last year, a number of questions have been raised by both the public and practitioners on the role that DHBs play and the rights of patients in the medical treatment process; with the government and public asking for increased transparency and accountability of processes to ensure a high standard of quality and value for dollar.

The 11th Annual Medical Law Conference examines the responsibilities of DHBs, practitioners and clinical ethical committees.

Focusing on the thought-provoking topics of:
• DHB liability: To what extent should they be held responsible when an incident occurs?
• Complaints process and defensive practice: Is the complaints process benefiting practitioners and improving the quality of patient care?
• Ethics committees: Why do we need them and how should they influence medical treatment and legal proceedings?
• Informed consent: What are the challenges in obtaining legally valid consent?
• Genetic engineering of the next generation: What are the boundaries of genetically engineering the unborn?

We invite you to join your peers to discuss the latest topics and challenges in the medico-legal field.

Agenda

Day 1

8.30

Registration & Coffee

9.00

Opening remarks from the Chair

Peter Skegg, Professor of Law, University of Otago

9.10

Keynote Address: The importance of the Mental Health Act

The Mental Health (Compulsory Assessment and Treatment) Act 1992 is now 18 years old. Since the MH(CAT) Act was introduced there have been changes made to the legal, clinical and consumer contexts in which this legislation operates. In this presentation, Dr David Chaplow discusses the reasons for a review of the Act and the Ministry’s explorations on the appropriateness of the current threshold for compulsory care in the Act.

Dr David Chaplow, Director of Mental Health and Chief Advisor (Mental Health), Ministry of Health

9.50

Legal update: Adverse events and breaches in trust

This presentation provides an update on significant medical legal cases and rulings in the past year by the Health and Disability Commission.

Nicola Sladden, Chief Legal Advisor, Health and Disability Commissioner
Dr Cordelia Thomas, Senior Legal Advisor, Health & Disability Commissioner
Helen Sims, Legal Advisor, Health & Disability Commissioner

10.30

Morning tea

10.45

Liability of DHBs for the actions of providers

DHBs fund services that are provided by a wide range of providers and are also responsible for monitoring, and in some cases, auditing them. How far does the responsibility of DHBs extend when things go wrong with these providers? This session will consider the liability that DHBs have for what happens in rest homes, primary health settings, NGOs, and other provider organisations.

Dr Jonathan Coates, Partner, Buddle Findlay

11.30

Effect of ACC’s open disclosure legislation on practitioners and incidence reporting

The updating of the ACC legislation including the duty of open disclosure and concept of ‘no blame’ was to enable clinicians to review and acknowledge adverse events without fear of finger pointing. This presentation presents evidence on whether the updates have brought about change and examines the relationship between primary and secondary health care providers and their roles, responsibilities and legal obligations.

Laurence Malcolm, Professor Emeritus and Consultant, Aotearoa Health

12.15

Defensive Practice and the impact of complaints processes on providing quality patient care

Defensive practice implies a deviation from sound medical practice in a desire to avoid complaints. The complaints process can be very stressful for doctors, impact on the doctor-patient relationship and if not properly handled lead to defensive practice.
• The nature of defensive medicine and its effect on doctors and ethical patient centred care
• Is the legal complaints process out of step with the current paradigm of patient care?
• Is the current complaints system publically encouraging systemic improvements while privately encouraging defensive practice?

Dr Wayne Cunningham, Senior Lecturer, University of Otago

1.00

Lunch

1.45

Practitioner responsibility and advanced directives in the event of human error

Human error can lead to potentially life threatening consequences in an already complicated medical situation. This presentation looks at advanced directives and responsibility in the event of human error or iatrogenic illness.
• When revival or treatment means a worse situation
• Who should be held accountable? Who should assume responsibility for the patient?
• Can the practitioner be held responsible when the effects of treatment were not known at the time?

Fiona McCrimmon, Principal, McCrimmon Law

2.30

Impact of clinical ethical committees on ethical and legal practice

What role should clinical ethics committees and their rulings play in New Zealand? This presentation looks at the legal and ethical implications of forming a clinical ethics network and the impact of committee rulings on future treatment decisions.
• Should clinical ethics committee be a legal requirement or will this stifle innovation and grassroots commitment?
• Who should be on a ethical committee? Should ethical committee rulings influence legal proceedings and future treatment of patients?

Alastair MacDonald, Consultant Renal Physician, Capital & Coast DHB

3.15

Afternoon tea

3.30

Defending the genetic supermarket: The law and ethics of selecting the next generation

Reproductive technology has reached a point where parents are now able to select which candidate embryo out of several to be born. In this presentation based on his book, Professor Gavaghan examines the reasons why New Zealand should continue to move towards a pro-choice assumption and why family of the new ‘person to be’ should make the choice.
• Pre-implantation genetic diagnosis and the ethics of choice
• Non-identity principal and harm
• What is our moral responsibility to future generations and society?

Dr Colin Gavaghan, Director, The Centre for Law and Policy in Emerging Technologies

4.15

Panel Discussion: Should genetic engineering be on the open market?

Following from the previous presentation, this panel discussion will examine the implications of the ‘genetic supermarket’.
• What moral responsibility do parents and society hold in designing the next generation?
• What should the borders of the open market be?

Dr Colin Gavaghan, Director, The Centre for Law and Policy in Emerging Technologies
Dr Cordelia Thomas, Senior Legal Advisor, Office of the Health and Disability Commissioner; Former Senior Legal Advisor, Toi te Taiao: the Bioethics Council
Dr John Hutton, Professor of Reproductive Medicine, Fertility Associates Wellington
Professor Sylvia Rumball, Chair, Advisory Committee on Assisted Reproductive Technology
Alison Douglass, Barrister & Convener of the Health Law Committee, New Zealand Law Society

5.00

End of day one & networking drinks

Day 2

9.00

Opening remarks from the Chair

Nicola Sladden, Chief Legal Advisor, Health and Disability Commission

9.05

Problems surrounding informed consent

Informed consent is a core element in the provision of health services. This paper will present an update on the law in relation to informed consent. A number of problematic areas relating to obtaining legally valid consent will be illustrated by recent court cases.

Wendy Beverley, Senior Solicitor, Buddle Findlay

9.45

Streamlining the informed consent process: Case studies

This presentation will look at a number of case studies encountered by the Auckland DHB around informed consent and will look at ways the consent process can be streamlined to ensure the legal requirements of informed consent are met.

Peter Le Cren, Legal Advisor, Auckland District Health Board

10.20

Morning tea

10.35

Panel Discussion: Crossed Wires: Informed consent and communication issues for special groups and minorities

Medical terms and treatment options can be difficult to explain to and grasp for the average person. We look at the problem of consent when communicating treatment options to groups such as the mentally ill, the intellectually disabled and migrants with a low level command of English.
• Can advanced directives be created and to what level?
• What issues arise out of having family, friends or translators involved in the decision-making process?
• How do you develop trust with a person for whom there are communication difficulties?

Ben Gray, GP with expertise in Cross Cultural Care, Newtown Union Health Service
Cindy Johns, National Manager, People First New Zealand Inc.
Dr David Chaplow, Director of Mental Health and Chief Advisor (Mental Health), Ministry of Health

11.15

“When is enough, enough.....”: The ethical and legal debate when managing palliative care

In many situations, active medical treatment proposed may offer little hope of success or at best may prolong life by very little at the expense of quality of life. Dr Peter Kirk former Director of the Division of Palliative Care, University of British Columbia, will share his experiences with the ethical and legal debates around palliative care and provide a framework to be used in any situation where there is an ethical dilemma.
• Quantity vs quality of life
• Suggesting palliative care and legal issues arising from high-risk treatment
• Who decides when the patient can’t?

Dr Peter Kirk, Palliative Care Specialist, Waikato District Health Board

12.00

Health Practitioners Competence Assurance Act: Reviewing the complaints and disciplinary process

In the last review of the Act, the Director-General of Health identified several areas that require changes, relating in particular to streamlining the complaints and disciplinary process. In light of the increase in the number of disciplinary charges, this presentation will cover:
• The main recommendations of the review and draft amendment
• Emerging trends in disciplinary charges and cases, procedurally and substantively and in the Courts
• Australian developments in this area with the establishment of a national framework

Paul Radich, Partner, Minter Ellison Rudd Watts
Katie Elkin, Senior Associate, Minter Ellison Rudd Watts

12.40

Lunch

1.20

Patient records and legal proceedings: the limits of patient confidentiality

There is a perception in the health profession and the general public that the confidentiality of patient records translates into protection in the course of legal proceedings. In fact, this is not the case, but the point is rarely tested. More recent case law has begun to address the issue, following the changes brought about by the Evidence Act 2006 and in the context of search warrants.
• Does “medical privilege” exist in New Zealand legal proceedings? If so, what are its limits?
• How might this affect public expectations of doctor-patient confidentiality?

Anna Adams, Partner, Meredith Connell

2.10

Human Tissue Act: Weighing public good vs individual rights

The Human Tissue Act 2008 replaced the older Act of 1964 providing an updated legal and ethical framework for the use and collection of human tissue. Parts of the Act however stipulate that tissue can be used for purposes other than designated for when the public good outweighs individual rights.
• Clarifying the exceptional circumstances covered in the Act
• Does the Act meet its purpose of serving the public?
• Are changes and clarifications required?

Paul White, Barrister

2.50

Afternoon tea

3.05

Coroners Act Update: Is the Coroner Services elevating public safety?

Part of the New Zealand Coroner Services is to provide recommendations and draw the public’s attention to prevent further deaths.
• Progress made in improving public health and safety
• Could the Coroner’s Service being doing more to improve public safety?
• Issues around exchange of information with other agencies

Judge Neil MacLean, Chief Coroner, Coronial Services of New Zealand

3.45

The right to biological privacy

Biological samples such as blood samples contain the most intimate details of people. In the modern era, the questions surrounding biological information security is more crucial than ever before particularly when biological information (such as blood spot cards) can be retained, retrieved and used without a patient’s knowledge.
• Which third parties could have access to your biological information?
• What are the current legal protections around biological privacy and what security measures should be required both online and offline?

Sebastian Morgan-Lynch, Policy Advisor (Health), Office of the Privacy Commissioner

4.25

Closing remarks from the Chair and end of conference

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