Spanish doctors' strike

cedes the need for confirmation by field trials and the innovativeness of the tobacco

Meanwhile tobacco manufacturers have Ottawa that any attempt to generic impose packaging will carry a hefty price tag since they will seek redress for trademark infringements in violation of international trade agreements. But antismoking groups counter that international trade agreements allow countries to impose labelling and packaging standards in the interests of health. :

warned

:

industry.

Ottawa is already facing a constitutional challenge to the legality of its existing ban on tobacco advertising. And the Supreme Court is expected to rule later this year on a tobacco manufacturers’ : challenge to that federal ban. Marleau : said that the government will have to : await the ruling before proceeding with any form of plain-packaging legislation.

Four weeks into the strike by Spanish doctors, their negotiators came to a preliminary agreement with the Ministry of Health at 6 am on Wedesday, after an all-

night meeting.

In a year of many political conflicts for the Spanish government, the troubles for the Health Minister, Angeles Amador, and her department were no exceptions. Wayne Kondro First, medical students won a long battle over the organisation of postgraduate draw up this "negative" list by Oct 1. : training necessary for work in public hosA drug will be put on the negative list if pitals. Then came the strike. it is not necessary; it is not effective; or The unrest began on May 8, when one there are equally good alternatives for the of the main doctors’ organisations, the drug. Some drugs will be removed National Confederation of Medical Trade because they are easily affordable by the ’., Unions (CESM), called a strike of physi: cians working in hospitals of INSALUD, public, or because they are obsolete. In a letter to the Health Insurance the national health service. CESM’s main Board, Borst says that many demands were greater participation of should no longer be available because theydoctors in hospital management, are unnecessary ("a sleep disturbance is a improved job security for the 40% of slight inconvenience") and because they INSALUD doctors on temporary do not really help ("habituation reduces contracts, government-financed insurance their efficacy"). Lifestyle advice is better coverage for medical liability, and pay that giving hypnotics, she said. If a sleeprises. The last claim was the main reason ing pill is necessary, it should be prethat the strike continued for nearly a scribed for not more than 2 weeks, she month. Doctors wanted an extra 100 000 wrote, adding that there are hypnotics pesetas (about jC500) per month, which affordable to all. Among the drugs she would bring their salaries up to those of described as obsolete were some antitheir colleagues in other parts of the counparkinsonian agents, antacids, antitustry such as the Canary Islands, Navarra, sives, and topical eye preparations. For Basque country, and Catalonia. These some of these there are better alternatives, regions regulate independently on health but most of the symptoms for which they issues. are used are merely an inconvenience, she The health turned down the

About-turn on availability of : "pill" in Netherlands

,

Spanish doctors’ strike

Oral contraceptives are to remain available under the Dutch social insurance system after all. Although a proposal to make them ineligible for refund under the social: insurance system was due to have been debated this week (see Lancet May 27, p 1357), Health Minister Els Borst-Eilers has been persuaded by the pharmaceutical industry that some oral contraceptives should not be available without prescription. This reason and the inability to extract from all the manufacturers a guarantee to reduce the price of all oral contraceptives made Borst-Eilers decide not to proceed with her proposal, which was to make the pill available over-the-counter from 1996, except for girls under 18. She announced her change of mind at a meeting of the Royal Association of Dutch Pharmacists last week, when she also explained that the savings of Dfl 90 million a year expected with the proposed explained. move on the pill will be achieved by taking 80 other drugs off the social insurance list in 1996. The Health Insurance Board will Marjanke Spanjer

hypnotics

: :

Mierlo,

ministry

pay

claim, arguing that the proposal

would cause an unacceptable 16 000 million pesetas rise in public spending. While recognising that Spanish doctors were poorly paid, Amador offered only an extra 30 000 pesetas a month-on condition that such a rise be linked to increased productivity. One of the Ministry’s proposals to shorten lengthy surgical waiting lists involved extending the working day from 8am-3pm to 8am-5pm. All of the Ministry’s proposals were rejected by the doctors. The situation worsened when the doctors of several autonomous regionsGalicia, Andalucia, Valencia-also went on strike. In Valencia, however, doctors in different departments went on strike in rotation to protect against loss of earnings during the strike. Public support for the doctors ranged from 90% to 25%, depending on whether the CESM or the Ministry provided the data. According to CESM, almost 2000 surgical procedures and 70 000 outpatient appointments were cancelled each day. However, emergency services and activities such as work in intensive-care units

for Foreign Affairs, Hans Van and the Minister for Economic Affairs, The Ministers for Public Health (Els Hans Wijers, have tried to influence the and Borst-Eilers) Justice (Winnie tone of the note. Officially, the postponeSorgdrager) have been prevented by the ment is due to "technical" reasons. : Ministers of Foreign and Economic In parliament, sections of the Labour Affairs from presenting their Note (proparty and the Democrats 66 (the four posal to change policy) on drugs, : ministers concerned in the controversy are scheduled for last month. : D66 members) have strongly advocated Borst-Eilers has declared her wish for liberalising drug policy, to get away from an experimental programme to allow the current "double" but illegal situation heavy users to take hard drugs under of tolerating sale but not supply. Legalismedical supervision, as had been advised ing soft drugs has been strongly supported by the Health Council, of which she was by the country’s legal advisers, the prosedeputy chairman before becoming miniscutors, the police, and health officials. : ter. Sorgdrager has advocated The supply of hard drugs to heavy users is: coffee-shops to sell soft drugs because, she controversial but might be a successful thinks it is "hypocritical" to tolerate sales policy if strictly supervised. The Health at the "front door" while forbidding Council is an influential body, so a tightsupply at the "back door"-sales at these ened version of the proposal might get shops of soft drugs are tolerated but supthrough, although the views within the plies of drugs to the shop are not. Cabinet are not clear: the Liberal party is These views caused anxiety at home divided; the Minister for Inner Affairs and abroad, mainly because of the bad does not want to change the status qua, were fully preserved. Meanwhile, nurses image that that Netherlands has with and the Prime Minister (Labour) is not and doctors on temporary contracts were regard to drugs. Because of severe critilikely to embrace plans that might damage considering striking and laboratory techcism by the USA, France, and Germany, : international relations. : nicians and midwives were watching the situation carefully. and to prevent any threat to the climate of . The strike was hotly debated in the investment in the Netherlands, the Minis- Marjanke Spanjer

Dutch cabinet’s

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drug war

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media. While some medical organisations, such as Organizacion Medica Colegial (a federation of medical associations), and clerical groups supported the doctors’ actions, consumers’ associations and some trade unions argued that the two sides had to come to an agreement. Other commentators suggested that the strike was politically motivated, since it coincided with the town and autonomous-region council elections on May 28-a claim strenuously denied by CESM and OMC. Some consumers’ associations made preparations to stop the strike. One organisation was going to present a petition to the general public prosecutor asking for the possible illegality of the strike to be considered.

Ownership of medical records in Australia has been granted special leave appeal to the High Court of Australia against a ruling that her medical records

A

be adversely affected if there was not a full explanation of the content, meaning, and implications of the records, when and if access were

patient’s well-being could

woman

to

the property of her doctor. : The woman had sought full access to granted. the records of a breast implant procedure The President of the Australian Associwith which she had experienced compliation of Surgeons, Mr John Buntine, cations. In December, 1994, the New wrote in the April, 1995, issue of The Australian Surgeon, that the Association South Wales Court of Appeal upheld a would oppose any transfer of ownership previous ruling by the Supreme Court, that the surgeon was "the legal owner" of of medical records from doctor to patient, the records, and need not give the patient and commented that he "need not elaboaccess to them. The patient had rejected rate on the host of problems which would a previous offer by the surgeon to provide follow such a radical change". Buntine recommended that written notes and her with an abridged version of the records, provided that she would indem"musings" should not be given to nify him from any legal action arising out patients, but "it may be reasonable for Josep E Baños of the procedure in question. patients to be given copies of histopatho: The patient-a participant in a classlogical reports ... and copies of other action in the United States-based her typewritten documents". The appeal to the High Court, which is appeal against the Supreme Court deciYemenite babies sion on her belief that she had a propriregarded as a test case, is expected to be heard late in 1995, but will rule only on etary right and interest in the records, Hearings before a commission appointed and that she had a access to medical records held by doctors relationship fiduciary by the Israeli Supreme Court began this with the in private practice. Patients are already surgeon. : week and are expected to investigate the able to access their records compiled in : The surgeon defended his right not to purportedly 4500 mostly Yemenite babies the patient access to the records, if public institutions, by way of freedom of give and children who disappeared from hospiinformation legislation. for no other reason than that some of the tals, clinics, and refugee camps in the earinformation in them could cause the ly 1950s. These children went missing and that the Peter Harrigan from among some 50 000 impoverished, patient "unnecessary worry" religious Jews who had been flown from in NSW in Yemen to Israel. : The official Israeli government line has account of the events leading up to his been to downplay the disappearances. In The Woods case, which resulted in a award of has Aus$3-2 million, damages alleged refusal to attend the boy. The the 1980s, the government mounted a re-defined a doctor’s responsibility to was sued for allegedly failing neurologist limited investigation headed by Dr Moshe a patient in an emergency, even attend to instruct Woods’ family to administer Shalgi upon the urging of Rabbi Uzi there is no existing doctor-patient diazepam per rectum, in an emergency. Meshulam, a former military intelligence though The of the case relationship. implications Ottley wrote that the case "is of officer. His concern is that, unknowingly, have been summarised Richard immense by Ottley, significance to the medical proincest might be committed. The current a leading medicolegal expert and partner fession" because it seems to be the first to commission, unlike its predecessor, can in the firm Tress Cocks and Maddox in address a doctor’s common-law duty to compel witnesses to testify; one of these answer an emergency where there is no will surely be a former head of the police the April, 1995, issue of The Australian : pre-existing doctor-patient relationship Surgeon. national missing person’s bureau, Arnon : In February, 1995, in the New South between the doctor and the person in Navot. His discoveries at the time of Wales Mr Badneed of treatment. Ottley added that the Justice Supreme Court, "hundreds of basically illegal adoptions", handed down a decision common law does not impose a duty to that, gery-Parker and of death records at the Health Minwhen a doctor is asked to attend an emerassist a person in peril, even where it is istry that he was unable to verify, were not a that doctor owes of care to that a failure to assist could foreseeable duty followed up, and he quit the police when gency, in the injury or death of that perthe patient even if he or she is not already result his superiors suppressed his investigations. the practitioner’s patient. : son. This current panel of inquiry is also the : Patrick Woods, who was aged 11 in Justice Badgery-Parker’s conclusion result of a concerted effort by the rabbi had a history of epilepsy, for which was that "... circumstances may exist in 1987, for a full and open review of the evidence he was receiving treatment, including that which a general practitioner comes under that had come to his attention, mostly in from a paediatric neurologist. On holiday, a duty of care ... a duty of action for the form of personal testimonies. These for negligence in the event of a Woods had a seizure and his sister ran to damages stories by hundreds of mothers have a pata local general practitioner, and allegedly breach of that duty ...". Ottley said that tern : children who were not apparently asked him to attend her brother. After the judge seemed to have been influenced sick were told to report to the local hospisome discussion of options, the doctor by the Medical Practitioners Act 1938 tal or clinic, and they never returned; or to attend. Woods was refused (NSW), which then provided that a allegedly mothers who gave birth in hospital were taken to another general practitionrefusal or failure, without reasonable then handed a death certificate instead of a cause, to attend a person who urgently er, who treated him, but the fits persisted. baby. He was taken to a local regional hospital needed attention from a doctor, was proIt is hoped that the inquiry will resolve fessional misconduct, unless the doctor by ambulance. Heroic medical efforts definitively all doubts and answer all quesnot before Woods the but fits, stopped arranged for another doctor to attend tions about the fate of these children, said had anoxic brain which caused within a reasonable time. damage, commission head Yehuda Cohen. total and permanent disablement. : According to Ottley, the judge relied on : The general practitioner first consulted reference in the Act to a "person" rather Rachelle H B Fishman was sued but contested Woods’ sister’s than a "patient" as being particularly were

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