Medical dispute committees in the Netherlands:A qualitative study of patient expectations and experiences

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

The role of victims’ lawyers in criminal proceedings in the Netherlands

The role of the victim in the criminal trial process has evolved considerably in recent decades. On a European level, an important driver has been the EU Directive 2012/29/EU, according to which European countries are legally bound to afford certain rights to crime victims. In the Netherlands the EU Directive has instigated several extensions of existing victims’ rights, and in the Code of Criminal Procedure a separate section has been devoted to the victim. The current study specifically addresses one of the victims’ rights, i.e. the right to be legally represented. The Dutch government has financially invested in access to and specialization of victim lawyers in order to stimulate the realization of victims’ rights, specifically for victims of severe crimes and sex offences. The goal of the current study was to investigate the added value of victim lawyers and the extent to which they contribute to fulfilment of victims’ rights in the criminal law process. A literature study was conducted to examine legislation pertaining to victims’ rights; a questionnaire study was conducted to investigate the perspective of victim lawyers (n=148); and interviews were conducted to examine the perspective of the police, Victim Support, Public Prosecuting Service, and criminal courts (n=17). The results show that victim lawyers were important to the realization of victims’ rights. They were considered most necessary with respect to the right to claim compensation and with respect to the right to get access to the case file. They were also required because victims’ rights have not yet been smoothly implemented into legal practice. In addition, victim lawyers’ presence in the courtroom was considered important as it contributed to victims experiencing that they were taken seriously. It has been concluded that the support of victim lawyers is an important contribution to victim participation in criminal procedures

Empowerment of personal injury victims through the internet: design of a randomized controlled trial

Abstract Background Research has shown that current claims settlement process can have a negative impact on psychological and physical recovery of personal injury (PI) victims. One of the explanations for the negative impact on health is that the claims settlement process is a stressful experience and victims suffer from renewed victimization caused by the claims settlement process. PI victims can experience a lack of information, lack of involvement, lack of 'voice', and poor communication. We present the first study that aims to empower PI victims with respect to the negative impact of the claims settlement process by means of an internet intervention. Methods/design The study is a two armed, randomized controlled trial (RCT), in which 170 PI victims are randomized to either the intervention or control group. The intervention group will get access to a website providing 1) an information module, so participants learn what is happening and what to expect during the claims settlement process, and 2) an e-coach module, so participants learn to cope with problems they experience during the claims settlement process. The control group will get access to a website with hyperlinks to commonly available information only. Participants will be recruited via a PI claims settlement office. Participants are included if they have been involved in a traffic accident which happened less than two years ago, and are at least 18 years old. The main study parameter is the increase of empowerment within the intervention group compared to the control group. Empowerment will be measured by the mastery scale and a self-efficacy scale. The secondary outcomes are perceived justice, burden, well being, work ability, knowledge, amount of damages, and lawyer-client communication. Data are collected at baseline (T0 measurement before randomization), at three months, six months, and twelve months after baseline. Analyses will be conducted according to the intention-to-treat principle. Discussion This study evaluates the effectiveness of an internet intervention aimed at empowerment of PI victims. The results will give more insight into the impact of compensation proceedings on health over time, and they can have important consequences for legal claims settlement. Strengths and limitations of this study are discussed. Trial registration Netherlands Trial Register NTR236