Submission by Council of The Bar of Ireland to the Minister for Justice &

Equality in response to the Statutory Consultation on Pre-Action Protocol for

Clinical Negligence Actions

21st September 2017

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INTRODUCTION

The Council of The Bar of Ireland (the Council) is the accredited representative body of theindependentreferralBarinIreland.TheindependentreferralbararemembersoftheLawLibraryandhasacurrentmembershipofover2,200practisingbarristers.TheBarofIrelandwelcomestheopportunitytoshareandrepresentitsmembers’viewsinresponsetothisconsultation.Thememberswhohavecontributedtothissubmissionrepresentplaintiffsanddefendants inmedicalnegligenceactionsan,webelieve,are inapositiontoofferpractical insightregardingtheproposedproceduralchanges.Apre-actionprotocolforclinicalnegligenceactionswhichreducescostsandincreasestheefficiencyandeffectivenessofproceduresbothpre-commencementandpostcommencementiswelcomedbythe Council. However, significant concerns arise from the draft pre-action protocol for clinicalnegligenceactions(theDraftProtocol)whichwasprovidedtotheBarCouncilundercoverofletterof1August2017fromtheDepartmentofJustice,EqualityandLawReform.GENERALOBSERVATIONS1. Ingeneralterms,thereisconcernthattheDraftProtocolasdraftedisunworkableparticularly

withinthetimeconstraintofastricttwoyearlimitationperiodandinthecontextofthemannerin which clinical negligence proceedings are currently funded – plaintiff practitionerspredominantlyworkingonthebasisofpaymentmadebythedefendantfollowingasuccessfulconclusionoftheligation,thesocalled‘nofoalnofee’approachtofundinglitigation.Wearealsoof theviewthat the letterofclaimmechanism it isoverlydetailedappearing to requirelitigants to set out by way of pre-action correspondence as much, if not more, detail thancurrentlyrequiredtobesetoutbywayofpleadingsinamedicalnegligencecase.Forinstance,inadditiontorequiringaclaimanttosetoutthefactsonwhichtheclaimisbased,particularsofnegligence,causal link, injuriesarising,conditionandprognosis, thetemplateLetterofClaim(Form5)alsorequiresaclaimantto:

• “setoutwhatinvestigationshavebeencarriedouttodatee.g.informationfromthe

claimantandwitnesses,anycomplaintandoutcome”;and

• “inmore complex cases” to set out a chronology of the relevant events aswell asreferencing“anyrelevantdocument”andtoenclosecopiesofsamewherepossible.

2. TheaboverequirementsgowellbeyondthepleadingrequirementsoftheSuperiorCourtRules

which,saveinexceptionalcircumstances,donotrequirethepleadingofevidence.Theyalsogobeyondthediscoveryobligationoflitigantswhichlimitthedocumentstobeproducedtothosewhicharenotonlyrelevantbutalsonecessary.

3. TheDraftProtocolsuggestsaformoftrialbycorrespondenceand/oranattempttointroducea

formoflitigationthatisnotinplaceinthisjurisdiction.EveninEnglandandWaleswherethe

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civilprocedurerulesprovideforsomerelianceonaffidavitevidenceoforalevidenceattrial,itisofnotethattheequivalentProtocoloperatinginthatjurisdictiondoesnotrequireclaimantstosetoutorreferenceeitherwitnessevidenceordocumentaryevidenceatthepre-issuestage.Thissubmissionaddressesthisfurtherbelow(sections8and9).

4. Of importance, it seems likely that extremely detailed Letters of Claim followed by equally

detailedLettersofResponsethenreproducedinsubsequentproceedingsaspleadingswillresultinincreasedcosts.GiventhattheintentionbehindmostPre-ActionProtocolsistosimplify,notcomplicatematters, a process limited to an outline or summary of themain points in eachparties’casewouldmoreeffectivelymeettheintentionbehindtheintroductionofpre-actionProtocols,namelythatthepartiesmightbeinformedofeachother’scasepriortotheformalcommencementofproceedingsandthatsettlementmightbepromoted.

5. Moreover,clinicalnegligencecasesareoftencomplexandrequirespecialisedlegalandmedical

advicetobeproperlylitigated.Oftenseparateexpertopinionsareneededoneachofbreachofduty,causation,conditionandprognosisandspecialdamage.Thesereportsareexpensiveandtaketimetoobtainnotonlybecauseofthelimitednumberofexpertsavailable(especiallyinspecialisedareasofmedicine)butalsobecausetheyoftenhavetobeobtainedfromanexpertoutside the jurisdiction. The lack of any legal aid or other funding mechanism for clinicalnegligence cases in Ireland is a significant hurdle for many potential claimants. It can beextremelydifficulttogetsufficientinformationtodraftaPersonalInjurySummonswithinthealreadyshorttwo-yearlimitationperiodallowedforissuingproceedingsandoftenproceedingsareissuedwithonlytheminimuminformationrequired.Thisisgenerallynotforawantoftryingbutratherduetoaninabilitytomovethecasefasterduetoon-goinginjuryonthepartoftheplaintiff, insufficientfundsforexpertreportsandlackofavailabilityofexpertstoadviseortoadviseinatimelyfashion.

6. TheDraftProtocolissilentonhowthespecialisedadvicenecessarytoachievethedetailrequired

byitistobepaidforbyplaintiffs.Forinstanceifproceedingsdonotissue,taxationofcostsdoesnotarise.Ifproceedingsdoissue,pre-issuemattersdealtwithbyCounseldonottax(alwaysstated to be ‘solicitor/client’). In both cases how is the cost of any work carried out to bemeasured and payment of same enforced by plaintiffs, the majority of whom in clinicalnegligencecaseshave, todate, reliedon the taxationofcosts topay their legalandmedicaladvisors.

7. Atpresentplaintiffshavetheprotectionofknowingthatonceproceedingsissue,draftingcanbe

carriedoutbyspecialisedCounselwhosecostswillthenfrompartofthecostsoftheactiontobepaidbythedefendantwhetherbyagreementortaxation.TheyalsohavetheprotectionofknowingthattheycanreceiveadvicesfrombothJuniorandSeniorCounsel,thecostofwhichwillalsoformpartofthecostsoftheaction.Ifthematterswhichtodatehavebeenrequiredtobedealtwithpostissuearenowrequiredtobedealtwithpre-issue,itisvitalforplaintiffsthatarrangements bemadewith regard to the funding of same and in particularwith regard tofundingrepresentationequaltothatavailabletothehealthserviceproviders.Unlessspecialisedcounsel(andsolicitors)aretobepaidfullyfortheworkcarriedoutatthisstage(whichifacaseistosettlewillbesignificant)theywillnotbeinvolvedatthisstagewhichisprejudicialtothe

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rightsofplaintiffs. Whilesettlementistobeencouraged,anysettlementmustbefairtotherightsofplaintiffsandtheremustbeequalityofarmsintermsofrepresentation.Thehealthserviceprovidershavespecialisedsolicitorsandinsurancefirmsrepresentingtheirinterestswithapanelofspecialisedbarristersandexpertsavailabletoassistallofwhomareorcanbepaidbytherelevantindemnifier(inmostcasestheStateClaimsAgency)regardlessoftaxation.Thisisnotthecasewithplaintiffsandthisisanissuewhichneedstobeaddressedbeforecompellingallplaintiffstocomplywithaprotocoltheymaybeillequippedtodealwith.

MORESPECIFICOBSERVATIONS

Section2–Definitions8. Theterm“healthserviceprovider”(hereinafter“HSP”)asdefinedinsection2doesnotinclude

ahealthcareinstitution/hospital(asopposedtoamedicalpractitioner).1TheProtocolshouldbe expressly stated to apply to all claims against hospitals, medical practitioners, nursingpractitioners,dentistsandotherhealthcareproviders.ThedefinitionascribedtothetermHSPisalsoimportantwhenconsideringtheissueof“thirdpartyrecords”atsection6oftheDraftProtocolandwhatinfactconstitutesa“thirdparty”(seefurtherbelow).

9. Whilethissectionascribesadefinitiontotheterm“records”theremainderoftheDraftProtocol

(includingtherelevanttemplateforms)referscontinuouslyto“clinicalormedicalrecords”asopposed to “records” within the meaning of the definition section. This requiresclarification/amendmentasitseemstheremaybesomeunintendedrestrictiononthetypeofrecords which are to be provided under the exchange of information regime. The fact that“medicalrecords”and“clinicalnotes”areindividuallylistedinthedefinitionof“records”clearlysuggests that there is a restriction on the records to be exchanged or furnished in that therecordsaretobeconfinedtoclinicalormedicalnotesandrecords.Byexclusionthismeansthatadministrativerecords,nursingnotes,observations,CTGtracingsandalltheotherdocumentsidentified in the definition section are not to be included in the exchange of informationprotocol.Thefactthatsection4(2)(a)providesthatthehealthserviceprovidermustprovideanestimate in respectof the reasonable costof “providing relevant scansand x-rays”whenrespondingtoarequestfor“copiesofclinicalormedicalrecords”suggeststhatitisenvisagedthat the term“medical and clinical records” includesall thedocuments referencedbybulletpointsunder thedefinitionof“records”. Inaddition,assuming thebroaderdefinitionappliesthroughouttheDraftProtocol,themeaningofthewords“includingbutnot limitedto”whendefiningtheterm“records”furthercomplicatestheissue.

10. Intheeventthattheaboveisasimpledraftingerrorandthatthedocumentstobeexchanged

are all the documents listed under the definition of “records” then there should be somemisgivings as to the typeof recordswhichmust be exchanged. In particular the categoryof“correspondence” is extremely broad and could conceivably cover correspondence that is

1Section32AoftheCivilLiabilityandCourtsAct2004isinsertedbytheLegalServicesRegulationAct2015definesaHSPas“apersonwhosenameison–(a)theregisterofmedicalpractitioners,(b)aregistermaintainedbytheDentalCouncil,etc

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privileged “for a variety of reasons” or documents which would offend the data protectionlegislation.

11. Concerns also arise with the breadth of the risk documentation records “to include all

investigations,communications,memos,statements,reports.”Thereisnotonlyarealpossibilitythatdocumentswithinthatcategoryareprivilegedbutalsotheremaybeconfidentialityanddata protection issues arising. It is assumed that in including in the definition of recordsinvestigations“carriedoutatanystage”and“documentationfromriskmanagementtoincludeallinvestigations,communications,memos,statements,reports”thatsamedoesnotincludeanysuchdocumentswhicharecoveredbylitigationprivilege.Wewouldsuggestputtinginasaverin clause 2 to the effect that “save insofar as any such documents are covered by legalprofessionalprivilege”.

Section3–ExchangeofInformation12. Wenoteinrespectofsection3“Exchangeofinformation”thataprocedureissetoutforthe

provisionofcopiesofrecords.Inparagraph3(1)theDraftProtocolrefersto“clinicalormedicalrecords”. This appears to be a narrower definition than the definition of “records” in thedefinitionssection.Itmaybethatincertainclinicalnegligenceclaims,forexample,nursingnotesarealsorequiredaswellasmedicalandclinicalrecords.Regardingsection3andtherequestforcopiesofrecords,theprovisionshouldbemadeforthatrequesttoincludearequestforanyrelevantguidelines,protocolsorpolicies.2Asstatedabove,clarityisneededonthisissueandwhilethedefinitionofrecordsoughtnotbelimitedtomedicalandclinicalrecordscautionneedsto be exercised in relation to, for example, risk management records from a privilege,confidentialityanddataprotectionperspective.

13. Thecategoryof“person”whomaymakearequestforrecordstothehealthserviceprovider

undersection3isstrangelyrestricted.Itprovidesat3(1)(a)that“aperson”canmakearequestforrecordsonbehalfof“thatperson”i.e.himself/herself.Italsoprovidesat3(1)(b)fourothercategoriesof“aperson”whocanmakesucharequestonbehalfof“thatperson”.Noneofthefourcategoriesincludeasolicitoractingonbehalfof“thatperson”.

14. Separately, there should be a provisionwithin section 3 or indeed section 4 that provides a

validationperiodorprocess if therequest ismadebyapersonother thanthepatient.Foravariety of reasons ranging from confidentiality to data protection, a health service providershouldobtainprooffromapersonwhoclaimstobewritingonbehalfofaparticularpatientthatthepersoninquestionhastheappropriateauthorisationtodoso.Thetimeperiodforsuchanenquirybythehealthserviceproviderastothestatusofthepersonmakingarepresentationonbehalf of a patient, the response thereto and subsequent validation by the health serviceprovider should not “eat into” the timeperiod prescribed for the health service provider torespondtotherequest.

2ThesearedocumentswhicharereferencedintherecentlyupdatedcorrespondingprotocolinEnglandandWales–PreActionProtocolfortheResolutionofClinicalDisputes(effective6April2015)

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15. Aside fromprovidingbasic factual information suchasname, address, dateof birth, dateof

incident(ifknown)andnameofthehospitalinwhichthepersonwasatthematerialtime,thebalanceoftheinformationrequiredbysection3(2)andinForm1isunnecessarilyonerousandinsomecasesnotcapableofbeingprovidedbya laypersonintheabsenceofexpertopinionfollowingreviewofthemedicalrecords.Forinstanceinmanycasesapersonwillnotbeabletoidentifythedateortimewhen“possibleclinicalnegligencetookplace”andwillrequiredetailedcausation evidence to assist in that regard. It is not clear how a layperson can identify therecordsthatheneedsto investigatehisclaimasrequiredbysection3(2)(b). Inmostcasesalaypersonwillnotbeabletoidentifytheclinicalormedicalrecordsherequiresbeyondstatingthatherequireshisclinicalrecordsheldbythehospitaltobefurnishedtohim.SimilarlyForm1isunduly lengthyandcomplicatedandplacesanonusona laypersontoprovide informationwhich cannot be given in the absence of medical records and expert opinion – e.g. therequirementthatthepersonsetout“thenatureoftheclaim”againstthehospitalthatisbeingconsidered,somethingwhichcannotbeansweredintheabsenceofexpertmedicalandlegaladvicefollowingreviewoftherecordswhicharesought.ThelevelofdetailrequiredbytheDraftProtocolistobecontrastedwiththeequivalentProtocoloperatinginEnglandandWaleswhichsimplyrequiresapersontosetoutbasicdetailssuchasname,addressanddateof incident.Thatisallthatshouldberequiredatthisstageofaclaim.AnysubsequentLetterofNotificationwillprovidethenecessaryinformationtocommenceinvestigationofapossibleclaimifsameisanticipated by the patient after consideration of the records. Prior to consideration of hisrecordsapatientmaywellnotbeinapositiontoarticulatethenatureofhisclaimandatsuchanearlystageheshouldnotberequiredto.

Section4–ResponseofHSP16. Withrespecttosection4“Responseofhealthserviceprovider”subparagraph(1),otherthan

forwardingtherequiredrecordswithinaperiodof11weeksthephrase“provideasubstantivereply”isnotclear.Ifitisenvisagedthatotherthanacoverletterenclosingtherelevantrecordsamorefulsomereplyofsomenatureisrequiredwithin11weeks,thenthatshouldbestatedclearlyinsection4(1).

17. Regarding section 4(1), a period of 11 weeks to provide medical records is unduly lengthy

particularlyinthecontextofatight,non-extendabletwo-yearlimitationperiod.InEnglandandWalestheCourtsretainadiscretiontoextendthelimitationperiodand/orsamecanbedoneonconsentofthepartiesandthisisexpresslyreferencedintheirprotocol.

18. Regardingsection4(2),anattemptshouldbemadetospecifythecoststhatcanapplytoany

requestforrecordsasopposedtoleavingittotheHSPtoseta“reasonable”costs.AlimitationinlinewiththecostsprovidedforintheDataProtectionlegislationmightbeappropriate.

19. Itseemsthatsection4(2)(a)envisagesthehealthserviceproviderfurnishingtheactualscans

andx-raystothepersonrequestingrecords.Therearesomescansandx-rayswhichmaynotbecapableofbeingreproduced.Similarlywithcertainpathology/microbiologyrecords/slidestherecan be a difficultywith reproduction and either the originals have to be givenor inspection

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facilities given. In a litigation or pre-litigation setting there would generally be a solicitor’sundertakinginrelationtothecustodyandreturnofsuchrecords.AmodeltodevelopthisaspectoftheDraftProtocolmaybefoundintheFreedomofInformationprocess.

20. Inaddition,section4(4)(andthecorrespondingsection5(4))appearontheirfaceunworkable–

ifapersoncannotlocatearecord,howcantheythenindicatewhentheywillbeinapositiontodoso?

21. Insofar as sections 4(5) and 5(5) are concerned theDraft Protocol should set out the lawful

reasonsuponwhichtheHSPorclaimantmayrelyonfornotproducingaparticularrecord.22. TheDraftProtocolshouldprovideamechanismwherebyintheeventofafailureonthepartof

theHSPtoprovidetherecordsoranexplanationforanydelaywithintheallocatedtimeperiod,applicationcanbemadetotheCourtforanOrderforpre-actiondiscovery,withnecessarycostconsequences for not compliance. Medical records are fundamental to any properconsiderationofapotentialclinicalnegligenceclaimandfrequentlythereisanissuewiththeprovisionofrecordsorcompleterecords. This isexpresslyprovidedfor intheUKequivalentprotocol.

Section5-RequestforrecordsbyHSP23. Section5shouldonlyapplyifandwhenaLetterofNotificationissentbyaclaimantandthis

shouldbeexpresslystatedinthebodyofsection5(1).PriortointimationofapossibleclaimaHSPcanhavenorightofaccesstoaprivatecitizen’sclinical/medicalrecords.

24. Thereisafundamentalmistake,orsoitappears,atsection5(3).Itisassumedthatthereference

to“healthserviceprovider”attheendofthatsentenceshouldinfactread“theperson”.Inasimilarveinthereferencetosub-paragraph6atsection5(4)appearstobeinerrorandshouldpresumablyrefertosub-paragraph1.Form3alsocontainserrorswithpart1referringtotheHSPasopposedto“theperson”.

Section6-ThirdPartyRecords25. TherearesomeveryfundamentaldifficultieswiththissectionoftheDraftProtocol.

26. Themandatoryobligationatsection6 (3)ofa thirdpartyprovidingrecordstoapatientora

patient’s representative, solely by reason of the fact that the health service provider hasidentifiedthatsuchdocumentsareinthepossessionofathirdparty,isoffensivetotherightsofthatthirdparty.Thereisnoroomintheprovisionsforthethirdpartytochallengetherequestmadeanditisalltooeasytoenvisagecircumstanceswheredocumentationheldbyathirdparty,whocouldbeanyonefromtheStateClaimsAgencytoanemployerofapatienttoarelativeofapatient,beingcompelledtofurnishdocumentationinbreachofthatthirdparty’srights.Thereis also nomechanismwithin the protocol for that imperative placed on a third party to beenforced.Inanyevent,itwouldbeimpossibletoimposesuchanonerousobligationonapartyentirelyinnocenttowhateverissueexistsbetweenapatientandahealthserviceprovider.

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27. Separately,isnotedthatwherethehealthserviceproviderrequiresrecordsfromathirdparty

that“inthefirstinstance[therecordsheldbyathirdparty]berequestedbyorthroughthepersoninquiring intopossible clinical negligence.”However, theDraft Protocol doesnot proceed topermitthehealthserviceprovider,shouldthethirdpartynotprovidetherecordstothepersoninquiringintopossibleclinicalnegligence,tothenrequestfromthethirdpartyitselftheprovisionoftherecords.Inthatregard,section6oftheDraftProtocolappearstobeincomplete.Therecould,potentially,ariseasituationwhereahealthserviceproviderisprejudicedbynotbeingable to obtain third party records other than via the person inquiring into possible clinicalnegligenceandconsiderationshouldbegiventopermittinganapplicationtoCourtbytheHSPforpre-actiondiscoveryfromtheclaimant/ThirdParty.

28. In addition, arising from the issues regarding the definition of a HSP above, clarification is

requiredastowhetheranotherhospitalunderthecontrolofe.g.theHSEorwithinthesamehospitalgroupistobedefinedasathirdpartyortheHSP.

Section7–LetterofNotification29. Withreferencetosection7,anumberofmattersarise:

• Withregardtosection7(1)presumablythelettershouldbesentassoonaspracticableafter receipt of themedical recordsand, if appropriate, the initial supportivemedicalreportandnotsimplyafterreceiptofthemedicalrecords?

• The reference at section 7 (2) (a) to an “action” should presumably refer to a“contemplatedaction”.

• Thenecessityofsection7(2)(a)and(b)isunclearandappearstoconflictwiththetemplate

LetterofNotificationat Form4.Paragraph6of the template requires the claimant toconfirmthat“thisisacasewhichisproceeding,butthatitisprematurefortheClaimanttosendaLetterofClaim”whereassection7(2)(a)statesthattheLetterofNotification“mustinformtheHSPthatfurther investigationisrequiredtodetermineiftheactionisproceeding”. A claimantmightwell be satisfied from an early stage that an action isproceedingbutmightnotbeinpossessionofthetotalityoftheinformationrequiredtoserveaformalLetterofClaim.IfthepurposeoftheLetterofNotificationistonotifythedefendantofthepossibilityofaclaim,itissubmittedthatatthisstagetheclaimantshouldberequiredtodonomorethanadvisethatinitialinvestigationsidentifyapossibleclaiminnegligenceandthereafterinvitethedefendanttocommencetheirowninvestigationsi.e.section7(1)shouldsuffice.

• Similarly,with regard to section7(2)(c)– this ispossibly a typographicalerror,butas

draftedthere isamandatoryrequirementto informaHSPthattheclaimantmayhavereasonable needs that could bemet with rehabilitation treatment or otherwise. Weassumethatwhatwasintendedwasthatiftheclaimanthassuchneedsthiscanbeset

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out. Rehabilitation treatmentand theneedsof claimants aredealtwithbywayof astandalonesectionintheUKprotocolwhichmightbeamoreappropriatewaytoproceed.

• Section7(3)requiresaplaintifftosendthesamelettertoanumberofpartiesincludingany “identified third party”. Clarification is required as to what parties might beanticipatedherebutasdraftedthenecessityforsucharequirementisnotclear.WhywouldaLetterofNotificationbesenttoathirdparty?

• Section 7(4) suggests that reference might be made in the Letter of Notification to

entering intosettlements,meetings,negotiationanddiscussion. While it isnotedthatthis is a discretionary element to the letter,we are of the view that consideration ofsettlementatsuchanearlystagemustbeseenasprematureandshouldnotbeincludedinthissectionoftheProtocol.TheLetterofNotificationonlycomesintoplaywhenthereisapossibilityofacasebutpriortoaclaimantbeinginapositiontosaythattherearegroundsforaclaimbasedonmedicalandlegaladvice.IfitisthecasethataclaimantisnotinapositiontoserveaLetterofClaimwecannotseehowanyplaintiff(ortheirlegaladvisors)wouldbeinapositiontoconsiderorthereafterentersettlementtalks–howcanaclaimantdecidetosettleaclaimtheydonotknowtheyhaveortheextentofwhichisunknowntothem?Alawyercouldnot(orshouldnot)adviseaclaimanttosettleacaseinsuchcircumstancesandwhileaninjuredpersonmaywellbeattractedbytheconceptof an early settlement, to do so in the absence of even the basic information that isrequiredtoserveaLetterofClaimwould,inourview,bedisadvantageoustothatperson.Thereareaddeddifficultiesdealingwith therarercasesofa litigant inperson. APre-ActionProtocolshouldnotendorsethenotionofaninjuredpersonbeingabletosettleaclaim,thebasisandextentofwhichinunknowntothem.

• It is not uncommon inmedical negligence cases for issues to arisewith regard to the

identityoftheappropriatedefendanttoanyproceedings.ItissubmittedthatintheLetterofNotificationtheclaimantshouldidentifythepartyorpartiesbelievedtobethecorrectdefendantinrespectofthetreatmentprovidedandcallupontherecipientofthelettertoprovideadditionalinformationregardingthelegalidentityofthecorrectdefendantifnotagreed.

• Withreferencetosection7(5)andtheresponsebytheHSPtoaLetterofNotificationthe

followingpointsaremade:

- ItisnotclearwhyaresponsefromboththeHSPanditsindemnifierarerequired–asingleresponsewouldsimplifymatters

- TheProtocolshouldexpresslydirect thatonreceiptofaLetterofNotificationtheHSPshouldforwardthistotheirindemnityprovider/SCA.

- TheProtocolshouldalsoprovidethatiftheletteracknowledgingreceiptoftheLetterofNotification issentbytheHSPasopposedtohis indemnityprovider, the lettershouldidentifywhethertheHSPhasindemnitycoverandidentifytheprovider.

- TheletteracknowledgingreceiptshouldidentifytowhomanyLetterofClaimshouldbesent.

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• Withregardtosection7(6)andForm4–paragraph9referencesa“subsequentapplication

foranextensionoftimefortheLetterofResponse”.TheDraftProtocolmakesnoreferencetorequestsorapplicationsbydefendantsforextensionsoftimetorespond,somethingwhichisexpresslydealtwithinthebodyofthecorrespondingUKprotocol.Ifextensionsoftimearecontemplated,thisshouldberectifiedandexpresslyreferencedinthebodyoftheProtocol.

Section8–LetterofClaim30. Withreferencetosection8(2),theDraftProtocolsuggeststhatthedetailtobeprovidedinthe

LetterofClaimisalmostidenticaltothattobeprovidedinanylaterPersonalInjurySummonsand the template Letter of Claim at Form 5 appears to go further (see comments above rewitnessanddocumentaryevidenceabove).TherealsoappearstobeaninconsistencybetweenthebodyoftheDraftProtocolandtheTemplateLetter.Thelatterrequiresaclaimanttosetout“anoutlineofthemainallegationsofnegligence”and“anoutlineofthecausallinkbetweentheallegationsandtheinjuriescomplainedof”whereassection8(2)appearstogofurtherrequiringtheclaimanttosetout“theallegationsofbreachofdutyandcausallinkwithinjuries”.Weareoftheviewthattheobligationshouldnotbetodraftparticularsinlinewiththosewhichwouldbe contained in a Persaonl Injuries Summons and that ifwording is to be used in theDraftProtocol (rather than simply referencing the template letter which would be the morestraightforwardapproach)itshouldbethesameasthatusedinthetemplatei.e.clarificationisrequiredthatwhatshouldbesetout isanoutlineofthemainallegationsbeingadvancedasopposedtothefullparticularsofclaim.

31. AsinEnglandandWales,theDraftProtocolshouldexpresslymakeclearthatLettersofClaim

are not intended to have the same formal status of particulars of claim (or Personal InjurySummonses)andshouldexpresslystatethatsanctionsshouldnotnecessarilyapplyiftheLetterofClaimandanysubsequentparticularsofclaimintheproceedingsdiffer(Seeparagraph3.19oftheupdatedEnglishProtocol)

32. FurtherissuesarisingwithregardtotheLetterofClaim:

• Thereferenceto“reasonablecosts”atsection8(2)(i)isunclear–isthistreatmentcosts,legal

costsorothercosts?Iflegalcosts,theneedforanestimationofsameattheLetterofClaimstageisunclearandoverlycumbersome.Itissubmittedthatthisshouldonlybecomeanissuerequiring consideration if the parties agree to mediate/or enter into ADR. To requireconsiderationofthisissuebeforeanyLetterofClaimissentisunnecessaryandfurtheraddstotheadministrativecostsarisingtoaclaimant.

• Regardingsection8(2)(j)-theneedtoprovidetheinformation(andwhatthatinformation

mightbe)isunclearbutclarificationisrequiredastowhyplaintiffsshouldberequiredtosetoutinnarrativeformwhatinvestigationshavebeencarriedoutgiventhataLetterofClaimcanonlybesentonceappropriatelegalandmedicaladvicehasbeentaken.Torequiremoreofaplaintiffarguablybreachestheprincipalsof legalprofessionalprivilege. ThetemplateLetter of Claim expressly refers to witness statements etc and appears to contemplate a

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narrativeaccountoftheevidenceproposedtobegivenbeingsetoutintheletter.Thisisnotappropriate and any suggestion that claimants should be required to advise a potentialdefendantofpotentialwitnessevidenceshouldberemovedfromtheProtocol.ItisnotedthatnosimilarrequirementifmadeofdefendantsrespondingtotheLetterofClaimandthereneeds to be parity in this regard. If, contrary to what is set out above, it is considerednecessarytorequireaclaimanttosetoutwhatinvestigationshavebeencarriedoutbyhimthensection9(ResponsetoLetterofClaim)shouldexpresslystipulatethatincircumstanceswhereaHSPdisputesordeniesordoesnotadmittheallegationsmadebytheclaimant,ittooshouldsetoutwhatinvestigationsithascarriedoutintotheallegedlynegligenttreatmenttoincludereferencetowitnessevidenceanddocumentaryevidenceandexpertevidence.Weare,however,oftheviewisthatneitherpartyshouldberequiredtodothis.

• Section8(4)seemsoverlycumbersome.Itisunclearwhat“thirdparties”arecontemplatedasnecessaryrecipientsofaLetterofClaimandclarificationisrequiredbutweareoftheviewthatitshouldbesufficienttosendtheLetterofClaimtoeithertheHSP(whocanthenforwardit tohis/her indemnifier in theusualway) or to anyother entity identifiedby it in earliercorrespondenceasthepersontowhomtheLetterofClaimshouldbesent(e.g.SCA).

• The template Form 5 Letter of Claim has a section entitled “funding information”. TherelevanceofthisinanIrishcontextisunclearandclarificationisrequired.

• Likewise(assetoutabove)wedonotthinkitnecessarytosetoutcostsarisingtodateunless

anduntilADR/mediationisenteredinto.

Section9–ResponsetoLetterofClaim33.Withreferencetosection9,anumberofmattersarise.Turningfirsttosection9(2)thetimeframeoffourmonthsfromreceiptoftheletterofclaimforahealthserviceprovidertoprovidearesponseisanundulyshorttimeperiod.Thereasonsareasfollows:

• In respect of subparagraph 3(b) four months is an unduly short time period in order toascertainwhethertheeventsspecifiedintheletterofclaimaredisputed.Thiswillrequireadetailedreviewofallthemedicalandclinicalrecordsaswellasinterviewingthedoctorsandnursingstaffinvolvedintheallegedevents.

• More fundamentally, the requirement in subparagraph3(e) that therebea“statement, inclear terms,whichallegedbreachesofdutyandcausationareadmittedordeniedandthereasons for theadmissionordenial;”will, inpractical terms,be impossible toachieve inaperiodoffourmonthsfromreceiptoftheletterofclaim.Admittingordenyingbreachesofdutyrequiresexpertadvice.Issuesofliabilityandcausationareusuallyhighlycomplexandrequirenotonly reports fromoneexpertbut fromanumberofexperts indifferent fields.Suchadvicesareprocuredfromleadingmedicalpractitionersintheirparticularfields.Often,suchpractitionershaveheavyclinicalpracticeworkloadsanditcantakesometimetoobtainthe relevant expert reports. It is submitted that the period of four months is simplyunworkableifwhatisrequiredisanadmissionofbreachofdutyorcausation.

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• Therealsoappears tobean inconsistencybetweensubparagraph(e)andsubparagraph(f)

where(f)statesthatthestatementindicatingwhetheradenialofallegedbreachofdutyandcausationisbasedonindependentexpertevidence.Asmattersstand,indeliveringaDefenceadenialofbreachofdutycannotbeincludedwithoutanindependentexpertverifyingsame.WhenreviewingForm6itisclearinparagraph4that:

“Abaredenialwillnotbesufficient.Specificresponsestotheallegationsofbreachofduty and causation should be given. If the health service provider has otherexplanationsforwhathappened,theseshouldbesetoutasfullyaspossible;”

Responsestosuchallegationsofbreachofdutyandcausationcannotbegiveninadvanceofobtainingindependentexpertevidence.Therefore,thereisaclearinconsistencyinparagraph4ofthedraft letterofresponsewherethesubsequentbulletpointasksthehealthserviceprovidertoconfirmwhetheranydenialisbasedonreceiptofindependentexpertevidence.

• The requirement thatanoffer to settle thematterby thehealth serviceproviderwhen inreceiptofaletterofclaim“must”besupportedbyamedicalreportdoesnotmakesense.Anoffertosettleattheearliestpossibleopportunitywouldbeintheinterestsofallpartiesandtosuggestthatthehealthserviceprovidermustawaitareportonconditionandprognosisbefore offering to settle a case not only increases costs but also unnecessarily delaysresolutionofthematter.Itmayalsobethecasethataparticularpatientwillrefusetoundergoa medical examination or it may not be in the interest of the patient to have a medicalexaminationperformed. In suchcircumstances it seems that thehealth serviceprovider isprecludedbytheregulationsfromeverofferingtosettlethecase.

• Inasimilarveintotheabovethestipulationatregulation9(5)thatthehealthserviceprovider

mustfurnishascheduleoftheclaimant’s losses isobviouslyunrealisticas it is incapableofbeingcompliedwithbyahealthserviceprovider.Thissectioncanthereforebeinterpretedasmeaningthatanoffertosettlethecasecannotbemadeunlesssuchascheduleisfurnished.

• Equallyasregards(4)theremaybeinstanceswhereitwouldbeinappropriatetoprovideanapologyinadvanceofobtainingexpertadviceastowhetherornotahealthserviceproviderhadbeennegligentorinbreachofduty.

• Ingeneral,thestipulationthatanadmissionofliabilityoranapologymustbeaccompanied

byareasonforsuchanadmissionorapologyisunnecessaryandunhelpful.Therearemanycaseswhereinjuryoccursduetoanumberoffactorsandalsomanycaseswhereaparticulardoctor may not accept responsibility even in the face of an unsupportive expert witnessreport.Toinsistthatthehealthserviceprovidershouldspecifythereasonwhyitisadmittingliabilityorapologisinginsuchcasesmaybecounterproductiveandinfactleadtoareluctancetoadmitliabilityorofferanapology.

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• With respect to (5) it is not clear how the health service provider could have obtained amedicalreportontheconditionandprognosisoftheclaimantinaperiodoffourmonthsfromthedateofreceiptoftheletterofclaim.Aconditionandprognosisreportrequiresaclaimanttobeexaminedbyrelevantexpertoroftenmorethanoneexpert.

• Theobligationplacedonthehealthserviceprovidertorespondtotheletterofclaimatsection

9shouldclarifythatthehealthserviceprovider’sinsurerortheStateClaimsAgentscandosoonitsbehalf.

• Inclinicalnegligencecasesitcanbedifficulttoascertainthecorrectlegalentitytonameinproceedingse.g.GPpractices–practicenameveveryGP,independentvpureHSEhospital,privatevpublicpatients,nomineevhospitalname,privatepracticestradingunderbusinessnames. Withregardtosection9(3)detailingthecontentsoftheResponsetotheLetterofClaim,weareoftheviewthatthereshouldbeanexpressdirectiontotheeffectthattheLetterinResponseshould:

(a)identifytheappropriatedefendant(s)againstwhomproceedingsshouldissue;and(b)advisetheclaimantofanyotherpotentialdefendantstotheClaim.ThisshouldalsoformpartoftheTemplateLetter(Form6)

• ThereshouldalsobeanexpressprovisiontotheeffectthatiftheclaimanthasmadeanoffertosettleinhisLetterofClaim,thedefendantshouldrespondtothatofferintheLetterofResponse(withreasons).

• Paragraph 1 of the Template Letter (Form 6) refers to the defendant asking for

“further instructions” – the meaning and import of this is unclear and clarity isrequired.

• Incircumstanceswhere,inaccordancewithsection13oftheDraftProtocol,noncompliance

willbetakenintoaccountwhendeterminingliabilityforcostsintheeventthatproceedingsareissued,incircumstanceswhereitwillbeinpracticaltermsimpossibleforahealthserviceprovidertoobtainanexpertreportandadmitbreachofdutywithinfourmonthsofreceiptofaletterofclaimitseemsundulyprejudicialasagainstahealthserviceprovider.

• ThereismeritinadirectionintheProtocoltotheeffectthatfromanearlystagetherebeanagreedsetofindexedandpaginatedmedicalrecordsforusebythepartiesandtheirexperts.Partiesworkingoffanumberdifferentsetsofmedicalrecordsisconfusingandinefficient.Anagreedsetfromanearlystagewouldbeineaseofallparties,theirexpertsandultimatelytheCourt (oramediator). Thismightperhapsonly come intoplayoncea LetterofResponsekeepingliabilityinissueissent.

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Section11–ADR/Mediation34.Thedirectionswithregardtosection11areoverlyprescriptiveanddonotreflecttherealityofwhatishappeningonthegroundinrelationtothemediatingofclinicalnegligenceclaims.35.Inthefirstinstancetherequirementthatapartymustrespondtoanofferofmediationshouldhaveaprescribedtimeperiod.Thereisnotimeperiodprovidedat11(2)withinwhichthepartytowhomanofferofmediationhasbeenmademustrespondtothatoffer.Itmustalsoberecognised,andunfortunatelyso,thatwhereamediation isofferedataveryearlystage it isgenerallyturneddownfornovalidreason.Inthecircumstanceswesuggestthatwheremediationisdeclinedandasprovidedforat11(2)(b)thereshouldbeanobligationonthepartydecliningmediationtosetoutindetailthereasonwhytheofferisbeingrefused.36.Themattersinrespectofwhichagreementshouldbereachedbetweenthepartiesandasprovidedforat11(3)ignoretheinvolvementofthemediator.Thevastmajorityoftheelementssetoutaremattersthatshouldbeagreedinconjunctionwiththemediatororalternativelyshouldbestipulatedbythemediator.There isarealpossibility thatbyprovidingacheck listofmatters thatshouldbeagreed between the various parties that agreement will not be reached and thusmediation notachieved.37.Therequirementthat“theterminationofthemediation”shouldbeagreedinadvanceat11(3)(f)reallyunderminesamediation.Amediationshouldbeopen-endedandwithoutanytimelimitation.Themediatordecideswhentofinishthemediationandisgenerallyempoweredbyhis/hermediationagreementtokeepthepartiesengageduntilsuchtimeasasolutionisreachedorthemediator,inhis/herdiscretion,believesthereisnopointincontinuingwiththematter.Accordinglyitwouldbetotallycounterproductivetosuggestthatthepartiesagree,inadvanceofgoingtomediation,atimeperiodwithinwhichthemediationshouldbeconducted.38.Further,theimportofsection11(4)isunclearandoughttobeclarified.Section12–Issuingofproceedings39.Wehavesignificantconcernsthatthebarormoratoriumonissuingproceedingsasenvisagedatsection12maybeunconstitutional.40.Followingonfromthetighttimelimitsandthenon-extendablelimitationperiodoperatinginthisjurisdiction,aclaimantmaywellfindhimselfinapositionwherehehascompliedwiththedetailedrequirementsoftheProtocolonlytohavetoissueproceedingspriortothedefendanthavingdeliveredaLetterofResponse.WhilePart15oftheLegalServicesAct2015insertingasection32CintotheCivilLiabilityandCourtsAct2004contemplatesapplicationtoCourtseekingdirectionsthattheactionshallnotproceed furtheruntil steps requiredby thepre-actionprotocolarecompliedwith, there isnosectionintheDraftProtocoldealingwiththisissue.WenotethatintheUKprotocolitisexpresslystated (paragraph 3.20) that “if, for any reason, proceedings are started before the parties havecomplied,theyshouldseektoagreetoapplytothecourtforanordertostaytheproceedingswhilstthe parties take steps to comply”. We would not advocate an application to stay the plaintiff’s

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proceedingswhilewaitingforaLetterofResponse(unfairtoplaintiffs)butthinkthereshouldbesomeprovision in theProtocolwhichprovides that ifproceedingshave to issuebefore thepartieshavecompliedwiththeProtocol,thepartiesshouldcomplywiththeirobligationsundertheProtocolpriortotakinganyfurtherstepsinthelitigationwithprovisionmadeforapplicationstoCourttocompelthepartiestocomplywithintherelevanttimeperiods.41.Theexceptiontothemoratoriumonissuingproceedingsasprovidedforat12(b) isunfairandprobablyunconstitutional. It provides thatproceedings canbe issuedwhere todo so “wouldbenecessarytoprotecttheinterestsoftheClaimant”.ThisshouldbeextendedtocircumstanceswheresuchcommencementofproceedingswerealsonecessarytoprotecttheinterestoftheDefendant.TheremaywellbecaseswheretheDefendantrequiresthematterbeproceededwithurgentlyandtheregulationsshouldaccommodatesuchaneventuality.Inaddition,thereisnomechanismwherebythe issue as to whether the commencement of the proceedings “was necessary to protect theinterestsoftheclaimant”canbedetermined.TheobviousarbiterofthatissueistheCourtbutthereisnorequirementthataCourtbeconsulted.Section1342. Section 13 (1) appears unduly harsh. It provides that if one party does not complywith anyrequirementof theprotocol then theotherparty is relievedofallobligationsunder theprotocol.AccordinglyifaClaimantorhealthserviceproviderwasadaylateindeliveringaletterorarecordthentheotherpartynolongerhastocomplywiththeprotocol.Theoffendingpartymust,however,continuetocomplywiththeprotocolwhichwouldappeartobeimpossible iftheotherside isnotobligedtodothesame.Abettersolutionwouldbetostipulatethatwhereonepartywasinbreachoftheprotocolthentheotherpartywasnotobligedtocomplywiththeprotocolunlessanduntiltheotherpartybecamecompliant.ThereshouldbeaprovisionthatallowsforapplicationstotheCourtinrespectofallegednon-complianceandobligationsonthepartoftheotherparty

CONCLUDINGREMARKSWhiletheCouncilofTheBarofIrelandisoftheviewthatanyprocesswhichattemptstostreamlinemedical negligence cases is to bewelcomed the Council is nonetheless concerned that the DraftProtocoldoesnotreflecttherealityofwhatishappeningonthegroundwhenitcomestopersonsbringingmedicalnegligencecasesinthisjurisdiction.UnlikeinEnglandandWales(whereasimilaralthoughlessprescriptiveprotocolhasbeeninplaceforsometime)Irishplaintiffsare(currently)operatingwithintheconfinesofanon-extendabletwoyearlimitationperiod.Generally,aplaintiffinaclinicalnegligencecasewillnotseekadviceimmediatelyupontheoccurrenceofanadverseincident(eveniftheyknowofitorsuspectit).Ingeneralthemoreserioustheinjurythemoretimeittakestorecoversufficientlytoseektheadvice.Bythetimetheydo,severalmonthscanhavepassed.Oftentheyseekadvicefromanon-specialisedsolicitorwhothenrequiresadvicefromspecialisedcounseltogetthecasemoving.Allofthisinthecontextofnolegalaidorother fundingmechanisms (bothofwhichapply to clinical negligence cases in Englandand

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Wales)forwhataregenerallycomplexcasesbothmedicallyandlegallynecessitatingspecialisedinputfromarelativelyearlystage.Inmostcasesthelegaladvicetobegiventoaninjuredpersoninthesetypesofcasesisdependantonobtaininganexpertreportwhichgenerallyspeakinghastobeobtainedfromanexpertoutsidethejurisdictionatanotinsignificantcosttotheplaintiff.Invirtuallyallcasesthesereportsarepaidforupfrontandbeforeaplaintiffknowswhethertheyaresupportiveofacaseornot.Ifnotsupportive,asecondopinionmightbesought.Ifsupportiveasecondreportisoftenrequired,sometimesonbreachof duty (e.g. a report from a neo neonatologist is often required to consider the post natal careaffordedtoaplaintiffinjuredatbirthandinrespectofwhichanobstetricreportwillgenerallybethefirstreportobtained)andoftenoncausation(e.g.aneurologistreporttoassistwithtimingofanybirthinjuryarising)withadditionalreportsbeingrequiredforconditionandprognosisandthereafterspecialdamage.Pointshavebeenmaderegardingtheperiodof4monthsbeingtootightforcompliancebyaHSP.Itiscertainlythecasethatvirtuallynoplaintiffwouldbeinapositiontoturnaroundacaseinthattimeperiod.However,ifforargumentssakeyougiveaplaintiffsay12monthstorecoversufficientlyfromtheoccurrenceofanadverseevent,gotoasolicitor,getadviceandthenmakearequestforrecordsetc,allowing11weeks(almost3months)totheHSPtogivehimtherecords,allthatisleftinrealitybeforeproceedingshavetoissueis9monthsofwhichtheHSPneedsmorethan4monthstorespondtoaletterbeforeclaim.If6monthsweretobegiven,workingbackwards,thatwouldleaveonly3monthstotheplaintifftogettheletterofclaimoutwhichisnotgoingtowork.Inaddition,noneofthisleavetimesforthemediation/settlementprocessenvisagedasacentralpartoftheprotocol.ItalsoseemstotheCouncilthatthelevelofdetailrequiredisoverlyambitiousandoutofkeepingwithwhatcanrealisticallybeachievedparticularlyonthepartofplaintiffsoperatingwithinextremelytightandoftendifficultfinancialconstraints. InsteadoffocusingonanexchangeofcorrespondenceandthecontentofthatcorrespondenceinthisregarditwouldbebetterifmoreemphasisandafocuswasplacedonearlyexchangeofexpertwitnessreportsasitisreallyonlywhenthathappensthatbothsidesareinapositiontotrulyconsidertheirpositionsTheDraftProtocolservestoactivatelegaldraftingandtheseekingoflegalopinionatamuchearlierstagethanwhenproceedingshavebeencommencedandalthoughthisisobviouslytobewelcomeditmaywellprovedifficulttodosowithinthevarioustimeconstraints.Thisincreasestheamountofworkwhichwillneedtobecarriedoutbylegaladvisorspriortocommencementofproceedings.Atpresent,thereisnomechanismformeasuringthecostofthisworkassamehasnotpreviouslybeensubjectedtothetaxationsystem.Anysuchdramaticincreaseinworkloadbylegalrepresentativeswillultimatelybepassedontotheclaimantorbornebythehealthserviceprovider.ItissubmittedthatamechanismforaddressingthecostsassociatedwiththeDraftProtocolshouldbedevisedandsenttostakeholdersforcommentpriortoimplementationoftheDraftProtocol.Forallofthereasonsoutlinedabove,theCouncilcannotendorsetheDraftPre-ActionProtocolinitscurrentform.RepresentativesoftheCouncilareavailabletoengageinfurtherdiscussionwiththeDepartmentonanyaspectofthissubmission.

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