Professional Accountability Judicial system –Criminal justice system Criminal liability –Civil justice system Civil liability Professional self regulation Disciplinary procedures by employer

Professional Accountability Legal liability –Civil liability civil action is started by the victim (the plaintiff) who sues the defendant (the wrongdoer). such an action is entirely at the option of the plaintiff-victim the burden of proof in civil law is generally on the plaintiff to prove the case on a balance of probabilities.

Professional Accountability Tort Law Tort: some act by the defendant which, without just cause or excuse, causes some form of ‘harm’ to the plaintiff Inter-personal wrongdoings short of criminality –Negligence –Nuisance –Defamation –Trespass to person

Professional Accountability Types of Liability Independent liability Several liability Joint liability –shared intent –vicarious liability

Professional Accountability Negligence First recognised in case of Donoghue v Stevenson (1932) Comprises three elements: –a duty of care –breach of that duty, and –foreseeable injury resulting from that breach

Professional Accountability Negligence: Duty of care Neighbour principle in Donoghue v Stevenson (1932) “ You must take reasonable care to avoid acts or omissions which you can reasonably forsee would be likely to injure your neighbour. Who, then, in law is my neighbour? The answer seems to be – persons who are so closely and directly affected by my act that I ought reasonably to have them in contemplation as being so affected when I am directing my mind to the acts or omissions which are called in question”.

Professional Accountability Pharmacists’ duty of care Traditionally: To accurately dispense prescribed products How is it evolving?

Professional Accountability Standard of Care A person who claims to posses a special skill is judged by the standard of a reasonable person having that skill Bolam v Friern Hospital Management Committee (1957) –A doctor is not deemed to be negligent if acting in accordance with the opinion of a responsible body of medical practitioners Bolitho v City & Hackney Health Authority (1997) –Such opinion must be reasonable and capable of logical analysis

Professional Accountability Breach causing damage The plaintiff must prove that the defendant’s breach caused the damage in fact and law –Causation – as a matter of fact, the defendant’s breach caused the plaintiff’s loss - the ‘but for’ test –Remoteness – the damage was not too remote – damage which was reasonably foreseeable as a result of the defendant’s breach

Professional Accountability Legal liability –Criminal liability criminal actions are brought by the State (the Crown) which prosecutes the defendant (the wrongdoer). This is not at the option of the victim, whose role in the case is only that of a witness. Thus criminal actions may proceed (or not) against the victim’s wishes. the burden of proof in criminal law is generally on the prosecution to prove the case beyond a reasonable doubt.

Professional Accountability Criminal liability Conviction for a criminal offence requires proof beyond reasonable doubt that –the person charged has carried out an unlawful act (actus reus) and –in doing so had the necessary guilty state of mind (mens rea) There are crimes –requiring proof of mens rea (a guilty mind) which may be intention or recklessness or a special mental state –crimes satisfied by proof of negligence (lack of care) and –strict liability crimes which do not require proof of full fault.

Professional Accountability Criteria for involuntary manslaughter by breach of duty R v Adomako (1994) –The existence of a duty of care –Breach of the duty causing death –Gross negligence which the jury considered justified a criminal conviction

Professional Accountability Professional regulation Statutory Self-Regulatory Bodies –Regulate the qualification and registration of professionals –Royal Pharmaceutical Society – pharmacy profession –General medical Council – medical profession –Nursing and Midwifery council – nursing profession Council for the Regulation of Healthcare Professionals (CRHP)

Professional Accountability Professional regulation Employers/Employing authorities –Contracts of employment Suspension or dismissal on –Gross misconduct; incompetence; incapacity etc. Practitioner NHS Contract