Medical Dispute Committees in the Netherlands: a qualitative study of patient expectations and experiences

Abstract

Background Health care incidents, such as medical errors, cause tragedies all over the world. Recent legislation in the Netherlands has established medical dispute committees to provide for an appeals procedure offering an alternative to civil litigation and to meet the needs of clients. Dispute committees incorporate a hybrid procedure where one can file a complaint and a claim for damages resulting in a verdict without going to court. The procedure is at the crossroads of complaints law and civil litigation. This study seeks to analyze to what extent patients and family members’ expectations and experiences with dispute committees match the goals of the new legislation. Methods This qualitative, retrospective research includes in-depth, semi-structured, face-to-face interviews with patients or family members who filed a complaint with a dispute committee in the Netherlands. The researchers conducted an inductive, thematic analysis of the qualitative data. Results A total of 26 interviews were held with 30 patients and family members. The results showed that participants particularly felt the need to be heard and to make a positive impact on health care. Some wished to be financially compensated, for others money was the last thing on their mind. The results demonstrated the existence of unequal power relationships between participants and both the defendant and dispute committee members. Participants reported the added value of (legal) support and expressed the need for dialogue at the hearing. Participants sometimes experienced closure after the proceedings, but often did not feel heard or felt a lack of a practical outcome and a tangible improvement. Conclusions This study shows that participants’ expectations and experiences were not always met by the current set up of the dispute committee proceedings. Participants did not feel heard, while they did value the potential for monetary compensation. In addition, some participants did not experience an empowered position but rather a feeling of a power misbalance. The feeling of a power misbalance and not being heard might be explained by existing epistemic injustice, which is a concept that should be carefully considered in processes after health care incidents.

Analysis of the characteristics and risk factors affecting the judgment results of medical damage liability disputes in 3172 second-instance and retrial cases in China

“…Because there is always an “expectations gap” between expectation and outcome from the patient side, the possibility of stopping judgment in the first instance is small [ 32 – 34 ]. The results of our study showed that 48.04% of second-instance and retrial cases were unilateral appeals by the patient.…”

“…Medical damage liability disputes involve the fields of law and medicine and are highly professional. In the context of epistemic injustice, the patient is frequently considered inferior and lacks support [ 34 ]. In our study, the proportion of patients entrusting lawyers was 9.24% lower than among medical appellants (21.75%); however, the total proportion of patients appealing was higher than the number of doctors, indicating a potential correlation between the high proportion of patients appealing and the low proportion of hiring lawyers.…”

South Tyrol Healthcare Company: A Look at a Peculiar Model of Claims Management in Italy and Analysis of Its Last 11 Years

“…Other examples are the Fonds des accidents médicaux (FAM), a service within the National Institute for Health Insurance and Invalidity (NIHDI), founded in 2010 in Belgium, which compensates the victims of healthcare injuries through public funding [ 12 ]; the dispute committees in the Netherlands, founded in 2016 and compulsory in cases of complaints to the healthcare provider/healthcare organization before any legal action is taken [ 13 , 14 , 15 ]; the Conciliation and Compensation Commission for Medical Accidents (CCI) in France, a part of the National Office for Compensation for Medical Accidents, Iatrogenic Diseases, and Nosocomial Infections (ONIAM), a public institution established by the Law in March 2002 to compensate damages attributable to medical research activities, iatrogenic injuries, nosocomial infections and, as of 2020, from vaccination against SARS-CoV-2 [ 16 , 17 ]; the Conciliation Commissions in Austria, which are committees set up in each Physician’s Order to assess medical liability cases in order to avoid in court legal action [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]; the evaluation and conciliation committees in Germany, which are very similar to those in Austria, and offer the possibility to request a free opinion from a committee of doctors and lawyers, to both a citizen who thinks they have suffered damage and to health professionals, for more than 40 years [ 26 , 27 ].…”