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FDA urged to defer donations by UK residents
POLICY AND PEOPLE
Spanish law on lawsuits against doctors changed n important legal reform to health-professional responsibility was launched on Dec 14 in Spain. Its main consequence is that the most common process to bring a lawsuit against doctors, the civil process, has been tightened up. Possible damages to patients will be judged in contentious courts and against the health authority rather than doctors. 70% of lawsuits relating to patientcare damages have been judged in civil courts. But the new law will avoid the possibility of patients calling for any civil responsibility from health professionals. Instead, the health authority will absorb the doctor’s responsibility. Only doctors in the National Health Service will “benefit” from this legal change. A new legal term, “repercussion”, means that in a case in which the health authority is condemned as a result of a serious medical negligence, the health authority can ask the doctor to pay the indemnity to the patient. Such transfer of responsibility to the doctor will be initiated once there is a definitive sentence. This means that the doctor will face a claim not from the patient but from the public-health administration. When the health authority is condemned as a result of minor negligence, or because of external reasons (eg, a complication derived from the long waiting-lists), then the public institution cannot transfer a given compensation to the doctor. Given the extreme slowness of contentious justice, the “repercussion” effect would enter into effect 5–12 years after the first patient demand. According to experts from medical insurance companies, the new law will boost private civil-responsibility insurances among doctors because there may be an eventual confrontation between the public authority and the doctor. Some jurists say the reform will also lead to an increase in the number of penal lawsuits because the penal way is much cheaper and faster than the contentious one. Also, given the possibility of the “repercussion” effect, jurists recommend doctors appear in person during the proceedings against the health authority to defend his or her interests from the beginning.
A
Xavier Bosch
THE LANCET • Vol 353 • January 2, 1999
FDA urged to defer donations by UK residents ponents, or through plasma products. majority of a US FDA advisory The panel heard from UK and other committee recommended on experts that there has Dec 18 that the agency been no such disease should develop a new transmission to date in policy outlining deferral any country. of blood donations If any donor is found from people who might to develop variant have resided in or CJD, blood compovisited the UK during nents should be the peak years of recalled, said the advithe bovine spongiform sors. They said that encephalopathy (BSE) plasma derivatives do epidemic. not need to be withThe panel stopped drawn. short of saying how to The US blood-banklimit these donors, but BSE casts a long shadow ing industry said blockurged the US blooding donations from anyone who had banking industry to start surveying lived in or visited the UK during the donors to determine the potential past two decades could be disastrous. level of exposure to BSE. Donors According to preliminary surveys by should be asked whether they lived in the American Red Cross, 10·7%, or or visited the UK between 1980 and one million units, of the current the present, and how long they were blood supply would be lost, and one there, said the panel. million new donors would have to be The concern is that these donors found. could transmit variant CreuztfeldtJakob disease (variant CJD) through transfusions of whole blood or comAlicia Ault
A
US drug project abandons needle exchange longstanding drug project will abandon distribution of clean injecting equipment in New Brunswick (NJ, USA) after workers were convicted for this offence on Dec 17, and the project vehicle was confiscated. Diana McCague, who founded the Chai Project, a harmreduction initiative, was given a 90day suspended sentence, a US$750 fine, a 6 months’ driving-licence suspension, and 100 hours of community service. She and other workers at the project have been convicted before under New Jersey’s “zero tolerance” Comprehensive Drug Reform Act. McCague now almost certainly faces a jail term if she commits the offence again. She told the court that her “resolve has been broken” and that she, and the Chai Project while under her leadership, will abandon clean-syringe distribution. In her court statement, published on the Drug Reform Coordination Network website, she said “I am convinced that what we have been forced to discontinue is a public health service that has saved lives” (http://www. drcnet.org/). The most “shocking” part of the sentence, according to McCague, was the edict that she should spend
A
her community service working for the local DARE (Drug Abuse Resistance Education) programme. The countrywide DARE initiative involves uniformed police officers making regular visits to classrooms to educate students to “resist drug abuse”. At the start of the visits, students have to sign a pledge to “keep their body free from drugs”. But, many individuals and communities now question DARE’s content, cost, and effectiveness. “If they want me to go into schools and do drug education”, McCague told DRCNet, “I’m going to go in there and tell the truth. And truth has nothing to do with what the state means when it talks about drug education”. New Jersey has some of the toughest anti-paraphernalia laws in the USA. Yet McCague estimates that, of the 50 000 HIV-infected people in New Jersey, up to three-quarters of these infections could have been prevented by clean injecting equipment. According to statistics from a 1998 report, AIDS is the leading cause of death in US African-Americans aged between 25 and 44 years—more than half these deaths are thought to be associated with injecting drugs. Kelly Morris
49
Spanish law on lawsuits against doctors changed n important legal reform to health-professional responsibility was launched on Dec 14 in Spain. Its main consequence is that the most common process to bring a lawsuit against doctors, the civil process, has been tightened up. Possible damages to patients will be judged in contentious courts and against the health authority rather than doctors. 70% of lawsuits relating to patientcare damages have been judged in civil courts. But the new law will avoid the possibility of patients calling for any civil responsibility from health professionals. Instead, the health authority will absorb the doctor’s responsibility. Only doctors in the National Health Service will “benefit” from this legal change. A new legal term, “repercussion”, means that in a case in which the health authority is condemned as a result of a serious medical negligence, the health authority can ask the doctor to pay the indemnity to the patient. Such transfer of responsibility to the doctor will be initiated once there is a definitive sentence. This means that the doctor will face a claim not from the patient but from the public-health administration. When the health authority is condemned as a result of minor negligence, or because of external reasons (eg, a complication derived from the long waiting-lists), then the public institution cannot transfer a given compensation to the doctor. Given the extreme slowness of contentious justice, the “repercussion” effect would enter into effect 5–12 years after the first patient demand. According to experts from medical insurance companies, the new law will boost private civil-responsibility insurances among doctors because there may be an eventual confrontation between the public authority and the doctor. Some jurists say the reform will also lead to an increase in the number of penal lawsuits because the penal way is much cheaper and faster than the contentious one. Also, given the possibility of the “repercussion” effect, jurists recommend doctors appear in person during the proceedings against the health authority to defend his or her interests from the beginning.
A
Xavier Bosch
THE LANCET • Vol 353 • January 2, 1999
FDA urged to defer donations by UK residents ponents, or through plasma products. majority of a US FDA advisory The panel heard from UK and other committee recommended on experts that there has Dec 18 that the agency been no such disease should develop a new transmission to date in policy outlining deferral any country. of blood donations If any donor is found from people who might to develop variant have resided in or CJD, blood compovisited the UK during nents should be the peak years of recalled, said the advithe bovine spongiform sors. They said that encephalopathy (BSE) plasma derivatives do epidemic. not need to be withThe panel stopped drawn. short of saying how to The US blood-banklimit these donors, but BSE casts a long shadow ing industry said blockurged the US blooding donations from anyone who had banking industry to start surveying lived in or visited the UK during the donors to determine the potential past two decades could be disastrous. level of exposure to BSE. Donors According to preliminary surveys by should be asked whether they lived in the American Red Cross, 10·7%, or or visited the UK between 1980 and one million units, of the current the present, and how long they were blood supply would be lost, and one there, said the panel. million new donors would have to be The concern is that these donors found. could transmit variant CreuztfeldtJakob disease (variant CJD) through transfusions of whole blood or comAlicia Ault
A
US drug project abandons needle exchange longstanding drug project will abandon distribution of clean injecting equipment in New Brunswick (NJ, USA) after workers were convicted for this offence on Dec 17, and the project vehicle was confiscated. Diana McCague, who founded the Chai Project, a harmreduction initiative, was given a 90day suspended sentence, a US$750 fine, a 6 months’ driving-licence suspension, and 100 hours of community service. She and other workers at the project have been convicted before under New Jersey’s “zero tolerance” Comprehensive Drug Reform Act. McCague now almost certainly faces a jail term if she commits the offence again. She told the court that her “resolve has been broken” and that she, and the Chai Project while under her leadership, will abandon clean-syringe distribution. In her court statement, published on the Drug Reform Coordination Network website, she said “I am convinced that what we have been forced to discontinue is a public health service that has saved lives” (http://www. drcnet.org/). The most “shocking” part of the sentence, according to McCague, was the edict that she should spend
A
her community service working for the local DARE (Drug Abuse Resistance Education) programme. The countrywide DARE initiative involves uniformed police officers making regular visits to classrooms to educate students to “resist drug abuse”. At the start of the visits, students have to sign a pledge to “keep their body free from drugs”. But, many individuals and communities now question DARE’s content, cost, and effectiveness. “If they want me to go into schools and do drug education”, McCague told DRCNet, “I’m going to go in there and tell the truth. And truth has nothing to do with what the state means when it talks about drug education”. New Jersey has some of the toughest anti-paraphernalia laws in the USA. Yet McCague estimates that, of the 50 000 HIV-infected people in New Jersey, up to three-quarters of these infections could have been prevented by clean injecting equipment. According to statistics from a 1998 report, AIDS is the leading cause of death in US African-Americans aged between 25 and 44 years—more than half these deaths are thought to be associated with injecting drugs. Kelly Morris
49