“annex B paragraph 13. 1. 2: the DGP has agreed midwifery to be delivered by an integrated team of German and British midwives, sufficient numbers of British midwives to allow up to 2 British midwives to be on duty on each shift. These midwives will be under the direct control of the DGP.”
“if a dispute is based on a clinical matter, e.g. medical malpractice leads to a decision against DGP and/or to an insurance claim by DGP, the German court shall have jurisdiction unless DGP consents to arbitration proceedings under clause 19.3” “disputes that are not based on the grounds mentioned in clause 19.2 shall be referred to arbitration tribunal for decision after giving the other party written notice thereof.”
“We just crack on with whatever life deals with us, and just deal with it to the best of our abilities…”
“in retrospect, I now realise – I realised years later – that the reason that the paediatricians strolled into the room and then nearly, just shot into action, was because when Sheila rang them it was like a singsong voice. I saw, I was looking at Sheila ring and thinking “I wonder who she’s talking to” and it was la la la la la la, so the paediatricians strolled up the corridor, strolled into the room, and then just burst into action because they were not expecting what they found. Obviously, as I keep saying, I had not experienced this before, but years later, when I was putting my statement together, I thought you know, looking back, that was not right. That is why they burst in.”
“A. Well, Sheila knew at this point that the cerebral had been affected, because she stayed around, so she knew. I was not really taking much notice. I did not have time for anybody else’s upset, because I was dealing with what had happened with our child, so I did not really take much notice. I just sort of said, “it’s okay, Sheila”
“did not know what these complications were and whether the complications were caused by negligence or due to the inherent risks involved in childbirth. I also did not know if any such complications had caused any or any long-term injury to Harry at that point in time.”
“referring to our letter of 10 09 2002 we would like once again to ask for clarification as to whether the allegations of medical negligence are against the treating resident gynaecologist at Wegberg solely or are also against the doctors of the obstetric clinic.”
“In her opinion, it was the interaction of various doctors of the hospital in Viersen. Therefore the allegations of medical negligence are directed at the doctors of the hospital in Viersen.”
“Sheila, it has come back, there was negligence. There was.”
“In a letter of27 May 2003 the German panel of experts sent a copy of a letter from Dr Ring and Dr Baysal dated5 March 2003 . In that letter Dr Baysal explains that the midwife did not consult (Dr Baysal) between 02:30 hours and 0410 hours on14 June 2000 . It explains that without the doctor’s knowledge the CTG (Cardiotogram) lead was removed, thereby stopping the graphic registration and display of the fetal heart sounds. When Dr Baysal entered the labour room there had not been any CTG recording for nearly 30 minutes.” “Dr Baysal states that both the doctor and the midwife bear the responsibility for the birth and accordingly Mrs Sheila McClelland should also be a party to your claim.” “The panel of experts will obtain records of the medical treatment together with reports from Dr Ring (Chief Physician of the Paediatric Clinic of the AKH Viersen in order to clarify the facts. Finally, an experts opinion will be obtained so that in due course a decision can be made by the panel of experts.” “I will keep you informed as soon as I hear anything further.”
“After all these events I am very astonished and find it regrettable that Mrs Roberts now issues proceedings and only holds the doctors of the Allgemeines Krankenhaus Viersen and to be responsible. The responsibility of the birth is between doctor and midwife. In this case the midwife, Sheila Clelland, should be called, who is responsible too for the care of Mrs Roberts during the birth.”
“12(1) If it appears, in all the circumstances, from a comparison of— i. the significance of the factors which connect a tort or delict with the country whose law would be the applicable law under the general rule; and ii. the significance of any factors connecting the tort or delict with another country, that it is substantially more appropriate for the applicable law for determining the issues arising in the case, or any of those issues, to be the law of the other country, the general rule is displaced and the applicable law for determining those issues or that issue (as the case may be) is the law of that other country. (2) The factors that may be taken into account as connecting a tort or delict with a country for the purposes of this section include, in particular, factors relating to the parties, to any of the events which constitute the tort or delict in question or to any of the circumstances or consequences of those events.”
“(i) The rule applies irrespective of whether the applicable law has been determined by s.11(1) (clause (5) of this Rule) or by one of the limbs of s.11(2) (clause (6) of the Rule). (ii) It would seem that the case for displacement is likely to be the most difficult to establish in cases falling within s.11(2)(c), because the application of that provision of itself requires the court to identify the country in which the most significant element or elements of the tort are located. (iii) S.12 envisages displacement of the general rule not only in relation to the case as a whole, but also in relation to a particular issue or issues. (iv) The factors to be taken into account include, but are not limited to, factors relating to the parties, to any of the events which constitute the tort or delict in question or to any of the circumstances or consequences of those events. (v) It has been emphasised that “substantially” is the key word in determining whether displacement of the general rule should be permitted689 and that the general rule should not be dislodged easily, lest it be emasculated. (vi) The general rule in s.11 is not displaced simply because on balance, when all factors relating to a tort are considered, those that connect the tort with a different country prevail. (vii) Accordingly, the party seeking to displace the law which applies under s.11 must show a clear preponderance of factors declared relevant by s.12(2) which point towards the law of the other country. Whether that is the case will depend on the facts of the case and on the particular issue or issues which arise for decision. (viii) If, however, in addition to the factors to which the general rule in s.11 refers, there are other significant factors connecting the tort to the country whose law applies under that rule (such as the fact that it is the national law or country of residence of at least one party), this will make it much more difficult to invoke the rule of displacement in s.12.”
“101. The MoD did not in fact assume responsibility for treating service personnel dependents, including A and Be, in hospital itself after1 April 1996 . It did not accept them as patients for the purposes of hospital care. What it is assumed, and put into effect by various contractual arrangements with GST, was the obligation to provide access to an appropriate system or regime of secondary, hospital care provided by another. It had some teeth by its visits to the GPs which it monitored by “outcome”, although its contract with GST left management of the DGP contracts in the hands of GST which knew about such matters.” “107. In my judgement, the features of the special relationship between the MoD and service personnel and dependents in Germany, to which I have referred, imposed a duty on the MoD to provide access to an appropriate regime of secondary healthcare in Germany. The MoD’s assumption of this duty met the reasonable expectations of service personnel and their families. The MoD’s duty of care must be seen in the context of the obligation to provide access to an appropriate regime of secondary healthcare, and was, therefore, a duty to exercise reasonable care in selecting and putting into action appropriate providers. It discharged that duty by contracting with GST to procure the GPs and to manage their contracts.”
“55. The MoD is no longer in the business of treating patients in hospital in Germany. Its sole role is that of arranging for such treatment to be provided by others. If there is merit in [counsel for the claimant’s] argument of public policy, it can only lie in his basic proposition that it is plainly desirable that someone in the position of A and his parents should be able to bring proceedings against the MoD in England rather than against the hospital in Germany. Despite [counsel’s] submissions, I remain unpersuaded of this.” … “57. The injury suffered by A in this case was not one that raised an automatic inference that there had been negligent treatment. It is a tragic fact that babies are quite often born with brain damage although all reasonable skill and care has attended the delivery. In order to get a claim off the ground against the MoD, assuming the existence of a duty of care, it was necessary to investigate what had happened at the birth. This A’s parents were able to do by initiating the process that produced the investigation by the Gutachter Kommission… … “59. If one postulates that the MoD is not itself subject to liability in a case such as this, I expect that it would, through the army legal service, assist the service personnel to seek a remedy in Germany, albeit that German lawyers would almost certainly have to be involved. I’m inclined to think that such a situation would be more satisfactory than one in which the MoD, being itself a defendant, can less readily assist its personnel to obtain a remedy.”
“15. This court also set out the correct approach to section 12 in the case of VTB and this was again approved in the Supreme Court at paras 149 and 203 of the respective judgements: – “… A (7) The exercise to be conducted under section 12 is carried out after the court has determined the significance of the factors which connected tort or delict to the country whose law would therefore be the applicable law under the general rule. (8) At this stage there has to be a comparison between the significance of those factors with the other country. The question is whether, on that comparison, it is “substantially more appropriate” for the applicable law to be the law of the other countries so as to displace the applicable law as determined under the “general rule”. (9) The factors which may be taken into account as connecting a tort or delict with a country other than that determined as being the country of the applicable law under the general rule potentially much wider than the “elements of the events constituting the tort” in section 11. They can include factors relating to the parties’ connections with another country, the connections with another country of any of the events which constitute the tort or delict in question or the connection with another country of any of the circumstances or consequences of those events which constitute the total delict. (10) In particular the factors can include: (a) a pre-existing relationship of the parties, whether contractual or otherwise; (b) any applicable law expressly or impliedly chosen by the parties to apply to that relationship, and (C) whether the pre-existing relationship is connected with the events which constitute the relevant tort or delict.”
“it is obvious that a legal system can trade off within its limitation rules between the length of the period and the events which caused time to start running. What German law has in effect done is to be unsympathetic to claimants in relation to the commencement of the limitation period, yet generous to them in the length of the period.… There ought to be more respect for the policy choices made by other states… Limitation law is about balancing the interests of claimants and defendants and different states may legitimately take different views about where the proper balance lies. Judges should be very slow indeed to substitute their views for the views of a foreign legislature.”
“it would in our judgement be wrong to treat foreign limitation period as contrary to English public policy simply because it is less generous than the comparable English provision in force at the time.”
“According to the plaintiffs “undue hardship” would result to them if the defendants were allowed to rely on the time bar after agreeing to an extension of time. It is true that it was not to an extension of time for the purposes of Greek law that the defendants agreed, and it is the plaintiffs who have invoked Greek law. But by agreeing to extend time the defendants plainly intended to vouchsafe the plaintiffs more time in which to bring proceedings against them without being time-barred. Within the time allowed the plaintiff instituted proceedings in respect of cargo damage such as were contemplated by the parties. In these circumstances it would in my judgement constitute a real and undue hardship if the plaintiffs were to be denied the opportunity of pursuing their claim by an incident of foreign law by which the parties did not realise that their contract was governed. That hardship outweighs any that the defendants might be said to suffer by reason of the plaintiffs being able to take advantage of Greek law which excludes reliance on exemption clauses.”
“Even though a claimant has been at fault himself, it is an undue hardship on him if the consequences are out of proportion to his fault” [557].”
“… undue… simply means excessive. It means greater hardship than the circumstances warrant. Even though a claimant has been at fault himself, it is an undue hardship on him if the consequences are out of proportion to his fault”
“the claim… becomes time-barred three years from the point in time at which the injured person obtained knowledge of the damage and the person liable to reimburse him for the same, or regardless of this knowledge 30 years after the perpetration of this act.”
“the Federal Court of Justice held that for the purposes of section 852 of the BGP, the injured person… had to have a sufficient level of knowledge that he had been injured and therefore that he was potentially in possession of the right to bring a claim, which it would be reasonable for him to advance in order to avoid the claim becoming time-barred.… It confirmed that a negligent lack of knowledge would not be sufficient to meet this test, but that knowledge of the events giving rise to the claim would be sufficient. Knowledge of the underlying legal analysis of the claim was not necessary for these purposes.… Therefore the injured person must in principle simply be aware of the facts, which appear to him to make him an injured person and the owner of a right to claim damages”
“a sufficient level of knowledge that he had been injured and therefore that he was potentially in possession of the right to bring a claim, which it would be reasonable for him to advance in order to avoid the claim of becoming time-barred.”
“This alone however would not be sufficient to establish knowledge within the meaning of section 852… The Federal Court of Justice has made it clear that merely being told of the circumstances of the birth process and a medical diagnosis does not ordinarily establish sufficient knowledge that there has been a deviation from the ordinary medical procedure as opposed to an accidental or fateful mishap so as to provide the basis for a claim.”
“The court will therefore have to decide whether the evidence given by the claimant’s parents indicates that at this time they had sufficient knowledge of the potential deviation from the ordinary medical procedure during the birth process so as for it to have been reasonable for a claim to be commenced in order to protect the position on limitation. At the absolute latest by24 June 2003 when Mrs Roberts received the letter informing her that according to Dr Baysal “both the doctor and the midwife bear the responsibility for the birth and accordingly Mrs Sheila McClelland should also be a party to your claim”… there can be no doubt that the sufficient level of knowledge had been obtained.”
“22. “Knowledge of the damage” 852 BGB has been interpreted by the German courts so that the claimant’s “knowledge of the damage” requires, that he/she not only knew that there was damage but also needed to know that the other party acted negligently and the damage was caused by negligent acting. Therefore, the claimant needed to know not only the relevant facts about causation, but also such knowledge about the facts as allowed him, as a non-technical layman, an understanding that the author of the damage breached the negligence standard at the time the damage was caused.… In medical negligence cases this means that when the claimant knows that the doctor has broken the standard of care which is when he knows the result of an experts opinion informing him that this is the case (the decision of a panel of medical experts is also typically characterised as such an opinion).”
“23 “knowledge of the defaulter”
“this is the decision everybody relies on when knowledge is checked in medical malpractice cases. It is the one from 2009, it is not the old one.”
“… It is a question of whether the fact known to the claimant was sufficient to make obvious the conclusion of culpable misconduct by the second defendant as the damaging party and of this conduct causing the damage; then it would have been reasonable to expect the claimant, also taking into account a remaining procedural risk, to file a claim… When such knowledge is to be assumed to be present with the damaged party will depend to a large extent on the circumstances of the individual case. Of course it is to be conceded to the appeal court in the second appeal court that the peculiarities of medical liability proceedings require not concluding prematurely from the fact that an injurious act leading to the damage is obvious that there is a culpable treatment error (or error in medical advice). The causal processes in medical interventions are often not clearly ascertainable either with regard to the future or retroactively, because in each case a different organism is affected, the condition and reaction of which are not reliably predictable. Failures and complications in the process of medical treatment therefore do not always point to misconduct by the treating physician. Sufficient knowledge by the patient of facts which suggest such misconduct therefore requires, for example, the knowledge of the main circumstances of the treatment process, and in particular any anatomical peculiarities, a medical procedure deviating from the norm, the occurrence of complications and measures taken to control them.”
“it is not enough for the patient to know the details of the medical act or omission, as in this case the omission of an ultrasound examination of the claimant’s mother when she was admitted to the hospital. Rather, from a layman’s point of view, the patient must be aware of the importance of the medical actions for the success of the treatment. Therefore the limitation period does not begin to run until the patient, as a medical layman, has gained knowledge of facts from which it follows that the doctor has deviated from the usual medical procedure or has not taken measures which were necessary according to medical standards to avoid or control complications.”
“I think… It is very clear. In medical malpractice cases, the mere negative outcome of treatment without any additional obvious indications of an error in treatment does not mean that patient would have to take the initiative to clarify the treatment process in order to avoid the limitation of his claim, because the lack of success of medical negligence does not necessarily have to be due to the inadequacy of medical efforts, but can be fateful [i.e. just a matter of chance] and due to the characteristic nature of the illness”
“from my point of view, it is not enough when the claimant knows that the midwife should have called the doctor earlier. This is, what does it mean?”
“Q. it is pretty obvious, is it not, that what was happening was that Dr Baysal was angry with Sheila because Sheila had not done what she should have done and called her earlier? A. Yes”
“I always thought it was just one of those things, it was not – for example in the UK there are about 1700 kids born every year with cerebral palsy. It’s not all negligence.… Sometimes it’s just one of those things. I had a friend in Germany at the time his son had cerebral palsy. It was just one of those things, it was not negligence, so we just carried on. When these results [the December 2004 Commission Report] came back, I was just horrified. As I say, when we got the results, the first thing I did was ring Sheila, because I still did not realise the implications, because I was in effect telling Sheila that the arbitration had come back and she was found negligent…”
“Additionally, especially in the last 15 years it has turned out that an obstetric expert report alone is not sufficient to judge the cause of a child’s impairment. This is because only in a very small proportion of cases can a connection be found at all between the birth and a child’s condition. For this reason in addition to the obstetric evaluation in any case a paediatric neurological and neuro radiological evaluation of the brain is required, especially with an appropriate MRI examination and often also genetic checks and investigations into corresponding metabolic diseases.”