1. New Zealand A Study in a “no blame” culture of medicine
Viktoriya Tulchinskaya, MS4

2. View of the mountains in Glenorchy, South Island.

3. Background Information
1,500km east of Australia
2 major islands: North and South, separated by Cook Strait
Population 4.5 million
One of the most recent countries to be discovered and settled
Settled by Polynesians around 1300AD
Europeans landed in 1643AD
Primary languages: English and Maori
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4. Background Information
Rotation in Pediatric Neurology at Starship Children’s Hospital in Auckland
Auckland: largest city in the country, population of 1.5 million
Starship Children’s Hospital: first hospital in New Zealand built especially for children, in 1991
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5. Topic of Interest: Attitudes and Practices around Medical Malpractice
A common topic in the media.
An area of concern for practitioners, in general.
Something that is on my mind as a future provider.

6. Rationale: why this topic?
Medical malpractice is a topic of which medical students are made aware very early in education.
We are taught that much of the rationale behind medical decision-making centers on avoiding a lawsuit.
Is this a “unique” culture of medicine, or do other countries approach medical malpractice in the same way?
Obstetricians/Gynecologists encounter the most lawsuits of any medical specialty in the US.
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7. Structure of Malpractice in New Zealand
“No Fault” culture
Focus on a “systems” approach to determining the factors that contribute to medical mistakes
Patients get compensation from the government
In return, patients cannot sue
Provides more timely compensation to more patients
Accident Compensation Corporation (ACC)
ACC:
Claims are processed in weeks
Decisions within 9 months
Similar injuries receive comparable compensation
Funded through general taxation and employer payments
Compensation awards are lower than in malpractice suits

8. Interview with a Physician
Physician perspective:
Feels comfortable and safe practicing in this system
Supportive environment
Appreciate the fairness of examining all the systemic factors that led to the medical mistake
Consider the evaluation and compensation system to be good, too
More reasonable compensation for patients
Physicians don’t have outrageous malpractice insurance payments
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9. Conclusions/Suggestions
In 2003, per capita health spending was $1,886 vs. $5,635 in the US
New Zealand spends less on healthcare, less on malpractice, with comprarable patient outcomes
Is there room for the United States to reform it’s malpractice system?
Could it take an example from the system in New Zealand?

10. Most Profound Clinical Experience
Since the cost of healthcare is covered for most patients in New Zealand, it was profound to see families who didn’t have to worry about paying for a child’s health care.
Very sick children can stay in the hospital as long as they need, without caregivers worrying about money.
Families can focus on more important things, like setting up support and services, and taking care of each other.

11. Most Profound Cultural Experience
Tramping: a favorite Kiwi activity. Backpacking, hill walking, bushwalking, or hiking.
The Department of Conservation maintains an enormous network of tramping tracks.
Kiwis have a great pride for their country, and are known to enjoy spending time outside.

12. Tongrariro Alpine Crossing One of the “Great Walks”

15. References
zealand-holidays.aspx
obstetrician_1582.bc
literature/2006/feb/no-fault-compensation-in-new-zealand-- harmonizing-injury-compensation--provider-accountability--and
showcase/2014/11/20/starship-childrens-hospital-in-auckland- newzealand-by-stephenson-turner/