Increase In Natural Disasters Health And Social Care Essay

Increase In Natural Disasters Health And Social Care Essay Extreme weather temperatures and increase in natural disasters in recent years have finally made the policy makers think earnestly about Climate change and Natural disasters. The stern review and the Intergovernmental Panel on Climate Changes fourth (revised) assessment report in 2008  [A]  had clearly stated that increase in natural disasters due to climate change will have adverse affects on social and economic sectors. The report which had declared that climate change will cause increase in natural disasters in coming years, has lived up to its prediction. According to UNISDR from year 2008-2011 natural disasters have been responsible for economic damages worth 730 Billion USD, have adversely affected 843 million people and killed about 598,000 people around the world. There has been an increase of more than 50% in the number of floods in the last decade in comparison to the 1990s and similarly the occurrence of total natural disasters has also increased over the last decade. [Error: Reference source not found] The increase in both the intensity and frequency of floods over the last decade has raised concerns within development agencies, governments and regional co-operations; natural disaster management has gained priority among all stakeholders. In 2005 U.N created The Hyogo Framework for Action  [B]  ; a global blueprint for disaster risk reduction efforts with a ten-year plan, the framework was adopted in January 2005 by 168 governments at the U.N World Conference on Disaster Reduction. [2]Although all 168 countries did accept the framework in principle, however there has been little done to reduce greenhouse emissions or adapt disaster risk reduction strategies across the board. Similarly in response to the December 2004 tsunami and the earthquake of December 2005 in South Asia, a Special Session of the SAARC Environment Ministers (Malà ©, 25 June 2005) adopted the Malà © Declaration on a collective response to large scale natural disasters. A SAARC Disaster Management Centre (SD MC) was established in New Delhi in October 2006, the SDMC was created to provide policy advice and facilitate capacity building including strategic learning, research, training, system development, expertise promotion and exchange of information for effective disaster risk reduction and management. [3] Policy making has also been activated at the state level, for example the government of Queensland in Australia has taken initiative on a state level of creating a policy framework to reduce and tackle natural disasters. The framework called the Disaster Management Strategy Policy framework includes Research, Policy and Governance, Risk Assessment, Mitigation, Preparedness, Response, Relief and Recovery, Post-Disaster Assessment. [4] One might be of the opinion that disaster events are probabilistic events and their occurrence can only be calculated on a probability basis and there is no escape from their destruction. However it is important to understand the consequences of the occurrence and what can be done to help the affected populace overcome the calamity natural disasters cause. Research has shown despite the scale of the disaster, a combination of national and international policy can help ward off disease and death in countries with functioning governments. This literature review investigates previous studies conducted on the socio economic impact of floods in context to Gender. The 2010 floods in Pakistan The geological department of the Australian government defines floods as the covering of normally dry land by water that has escaped or been released from the normal confines of: any lake, or any river, creek or other natural watercourse, whether or not altered or modified; or any reservoir, canal, or dam. [4]Floods primarily impact the human community either directly through contact with the water or indirectly through the damage the water does to the natural and human built environment. [5] Localized floods can have a significant impact on peoples physical and mental health. [6] The 2010 monsoon floods were one of the largest floods in the history of Pakistan causing unprecedented damage and killing more than 1,700 people. The floods affected over, 20 million people, inundated almost one fifth of the countrys land and caused loss of billions of dollars through damages to infrastructure, housing, agriculture and livestock, and other family assets. [8]The World Bank and Asian Development Bank estimated that the flooding had caused the economy $9.7 billion in losses. [9] Cases of malnutrition, gastroenteritis, diarrhea, skin infections, cholera, typhoid, malaria, and hepatitis were reported. Food prices dramatically increased after the flooding, putting an economic strain on the entire population. The southern province of Sindh was hit quite heavily by the floods, it was reported that nearly Seven million people were affected by floods in the province; thousands were trapped by flood waters and had been in need of assistance. Our study region the southern district of Thatta was affected in a catastrophic manner by the floods, as the flow of the flood waters touched 9,50,000 cusecs the feeble dykes built to protect the districts populace overflowed causing both banks of the Indus River to flood causing enormous amount of destruction. At the time of flooding the state machinery which included both the provincial and federal government along with many international and national NGOs led the relief efforts and was able to avoid the occurrence of any larger catastrophe such as far spread hunger or famine. However in recent years continuous acts of terrorism have kept the government preoccupied with matters of public safety and security, this has diverted the governments attention from institutional reform to matters of ad-hoc nature. The presence of situational challenges has reduced state capacity to productively provide basic services for which resources had already been deficient. This has limited governments response to natural disasters mostly to needs assessment and immediate relief operations. The assessments have typically focused on direct damages of capital assets which includes number of deaths and injuries, damages to buildings and public infrastructure, loss of crop and livestock. Assessments of disaster impacts on social sectors such as health and education are also limited to the measurement of damages to school and hospital buildings, the assessments tend to ignore the long term affects on the health and education levels of the affected populace. Long term assessments of social sectors is critical even more so for a country like Pakistan as it already struggles with low social development indicators, ranking 145 out of 187  [C]  countries in the Human Development Index and a Gender Development Index (GDI) ranking of 120 out of 146  [D]  countries. Approaches to measure impact of natural disasters Researchers across the world have used diverse approaches to determine the impact of floods. In Pakistan the EU has previously employed the EMMA (Emergency Market Mapping and Analysis), which is a rapid market analysis designed to be used in the short term aftermath of a sudden-onset crisis. A better understanding of the most critical markets in an emergency situation enables decision makers (donors, NGOs, government, other humanitarian actors) to consider a broader range of responses. The aim of the approach is to gauge and understand the structure and functioning of key markets in the short term so that immediate recovery programs are in consistent to the on the ground situation. Although the research is useful in providing immediate relief, however the approach does not take into consideration the long term effects of the disaster. [10] Likewise another approach which can help donors target their recuperation efforts is ECLAC, ECLACs methodology is related to post disaster evaluation; it focuses on rehabilitation and recuperation. It advocates using a dynamic and sectoral perspective that enables the researchers to calculate future losses derived by the destruction of productive structures and forfeitures of business opportunities and its middle/long term effects in different terms. The methodology aims to enable its users to try to define if and which type of international cooperation the community affected needs. Although precise knowledge of various sectoral damages and losses, present and future, suffered by the communities enables the disaster relief agencies to execute more specific rehabilitation projects, however usage of a macro-perspective to gauge the damages and provides losses in monetary terms leaves out the impact on social sectors and chiefly focuses on economic costs. [11] In a Flood-site project report on the Mulde River in Germany the researchers have taken the bottom up perspective to analyze social vulnerability posed by floods. The methodology seeks to categorize the circumstances that make an individual or a community vulnerable and investigate how some groups in these circumstances might be more vulnerable than others. The researchers who define social vulnerability as the characteristics of a person or group in terms of their capacity to anticipate, cope with, resist, and recover from the impact of a natural hazard primarily focus on how communities and social groups are able to deal with the impacts of a natural hazard. The approach provides valuable insight into the dynamics of social capital, but lacks detail of sectoral assessments. [12] Along with well targeted programs it is important that recovery programs are sustainable. In Sudan, AIACC has employed a research method based upon the sustainable livelihood conceptual framework; the research method aims to evaluate the performance of sustainable livelihood and environmental management measures. International Institute for Sustainable Development defines sustainable livelihoods as being concerned with peoples capacities to generate and maintain their means of living, enhance their well-being, and that of future generations. Sustainable livelihood assessment is intended to generate an understanding of the role and impact of a project on enhancing and securing local peoples livelihoods. It primarily relies on a range of data collection methods, a combination of qualitative and quantitative data indicators and, to varying degrees, application of a sustainable livelihoods framework. The model focuses on five types of capital namely; natural, physical human, social and f inancial. The framework employs the Livelihood Assessment Tracking (LAST) System to measure changes in coping and adaptive capacity. Quantitative and qualitative indicators are combined with the LAST system for its use; the LAST system is developed through creation of development indicators by the help of the local community. [13] All the above mentioned frameworks, even with their short-comings provide valuable inputs into the assessment methods of disaster impacts. However, the above discussed frameworks which focus on immediate needs assessment, macro-economic impacts, social capital, and sustainable livelihoods do not seem to be gender sensitive and lack concentration on social sectors in a gender sensitive manner. It has been time and again noted that women are most adversely affected by natural disasters. Sara-Bradshaw in her paper socio-economic impacts of natural disasters advocates the use of a gender approach; the paper states that the first step to ensuring that the specific basic needs of women are addressed over the short and long term is to collect data broken by sex and age segments immediately after the occurrence of a disaster. This is important because breaking up of data helps realize the affects of the flood on women in particular and assists in highlighting the specific requirements of the gender. For example in many cases in a Muslim country women might opt not to visit a male doctor, hence if the researchers have the number of women who need medical attention they can arrange female doctors accordingly. [14] Gender Aspects of Natural Disasters International Enarson et al 1998, Fordham 1998, Morrow 1999 and Tapsell et al 2000 are of the view that floods and other disasters can impact upon men and women in different and distinct ways. Similarly It is believed that men and women will be faced with different vulnerabilities to climate change impacts due to existing inequalities such as, their role and position in society, access to resources and power relations that may affect the ability to respond to the effects of climate change (WEDO 2007; Commission on the Status of Women 2008; Carvajal et al 2008; Bridge, 2008). [15][16] [17] [18] [19] It is a basic fact that majority of the women in developing countries and particularly in the South Asian region are at a disadvantage when compared to their male counterparts. International Literature such as Tapsell et al 2003 illustrates that women suffer markedly more than men at the worst time of flooding. Research has shown that due to socially constructed roles and responsibilities, women seem to bear the most burdens resulting from climate variability impacts. Due to the traditional gender roles in many developing countries, it is seen that women are in charge of the house and responsible for household needs such as cooking, washing, hygiene, children and raising small livestock. Children, in particular girls share these responsibilities. In Africa, women do 90% of the work of collecting water and wood, for the household and food preparation. It is noted that women have to work extra workloads when faced with natural catastrophes as they try to manage their everyday tasks during an emergency situation. [20] [21] Qualitative research suggests that this is because women have the main responsibility for, and probably, a greater emotional investment in the home than men. They also usually have the key responsibility for the care of children and the elderly in the home, for example even in a post flood situation it is the central responsibility of the woman for getting the home back to normal after the flood. [22] In many developing countries and especially in the south Asian region, food hierarchies favor male nutritional requirements and often women nutrition and health requirements are ignored. In Bangladesh it has been reported that Given the already precarious nutritional state of large numbers of girls and women in Bangladeshà ¢Ã¢â€š ¬Ã‚ ¦any further increase in discrimination would have serious consequences. In poor households, throughout the world, women go without food for the benefit of their children or male family members. [30][31] Moreover an ADB report in 2001 found that in Bangladesh of the 20-30% female headed households, 95% are living below poverty line. Even in developed countries such as the U.K, lone parent and single pensioner households-the majority of which are female headed are most likely to be living in poverty. It is noted that in some instances pressure on families has been so severe that there have been reports of children being offered for domestic employment, a nd of female children being sold. The evidence informs us that women headed households already tend to have limited economic resources and hence a natural disaster can have a greater impact on their livelihoods in comparison to others. Other than the over-all poverty rates, health and education are two sectors where women in the region still lag behind men. The poor nutritional status of women makes them more susceptible to disease infection, particularly in developing countries where there is little social provision and limited or no access to proper medical care. Poor nutrition also makes women more vulnerable to disasters, and makes the physically strenuous tasks of water and fuel collection more difficult. Research in India has found that girls nutrition suffers most during periods of low consumption and rising food prices , which is common during disaster situations [36][37]. Fewtrell and Kay (2006) provide evidence of floods causing Bacterial, fungal, respiratory disease, and gastrointestinal infection along with earache and skin rashes among others. It is widely acknowledged in health research that some groups, such as women (especially pregnant women), the young, the elderly and immune compromised people are more vulnerable to health impacts (especially infection) than other people (e.g. Flynn and Nelson, 1998; White et al., 2002; WHO 2004). [28] Moreover floods can also have an impact on the mental health of the affectees. It has been suggested that women may suffer more mental strain in certain situations, due to cultural norms. Women in poor health prior to the flood are more likely to experience the flooding as traumatic. When whole families move to urban slums or relief camps the women face challenges adapting to the new environment. Problems include harassment, lack of security, unreliable water supplies which increases their workload, and gender insensitive conditions such as lack of privacy also have a tolling effect. Long journeys to the relief camps can cause both physical and mental stresses when coupled with experiences of sexual harassment on these journeys. Womens dramatically expanded care giving roles following a disaster, and putting family needs before their own, may explain overall decline in emotional well being. [29] Gender Aspects of Natural Disasters Pakistan The international literature on women in relation to climate change clearly highlights the severe vulnerability and adverse exposure natural disasters pose to women in particular. Similarly research studies have been conducted by different development organizations to gauge the impact of the severe floods that hit Pakistan recently. The research results are in line with international research literature. As Pakistani women particularly tend to mainly have reproductive and domestic roles in the households and are barely visible in the public spheres, particularly in rural areas, these characteristics make way for a greater impact on their socio-economic conditions from natural disasters. The existing situation of women in Pakistan cannot be fully valued without an understanding of the ways in which religion, culture and traditions have organized social relations and fractured society along class, racial, ethnic and gender lines. Pakistan therefore, presents a distinctive situation fro m a socio-economic perspective. In Pakistan Men and boys are given more weightage over the family resources in comparison to women and girls. A survey conducted by OCHA as a Needs Assessment study on the 2011 floods in Sindh found that 37% of households had reduced or skipped food intake; practice adopted by women and girls in the household to meet the ration requirements, which is similar to findings mentioned earlier from Bangladesh. [32] Nazish brohi et al have analyzed emerging trends and data, relying primarily on the Gender Needs Assessment (GNA), the Multià ¢Ã¢â€š ¬Ã‚ cluster Rapid Assessment Mechanism (McRAM), case studies and emerging secondary information. Their study includes case studies based on the various experiences of women to floods. The women respondents in the study have insisted that they had no prior information about the floods and many were taken back by surprise. The unexpectedness of the floods magnified its impact and also increased the exposure of the flood victims. The study present insights into the experiences of women through case studies, for example in Mianwali, a thirty year old woman, Jawwahi, rushed out with her family in waist high water and saw her house crumble before her; in Charsadda, women awoke to cries and found water rushing into their houses. Similarly the study also illustrates how women hygiene had been affected due to floods. For example in Kalabagh district, Baghat Bi bi, a sixty year old woman with her three daughters and three daughters in law visited the river every few days and submerged themselves in the water to clean themselves and their clothes, and then dry themselves while wearing the same clothes it is reported that the they had been doing it for over three weeks. As women in rural areas are not used to moving about in public spaces other than their villages; girls and women are often embarrassed to be seen accessing lavatories and hence do so during nightfall or early morning. Such overwhelming circumstances coupled with cases of harassment can have profound impacts on mental health. [35] The Preliminary Gender Needs Assessment report by UNIFEM  [E]  reports that the women were under severe stress as the devastation caused by the floods destroyed their limited assets, worsened their personal security situation, and changed their responsibilities as they were forced to respond to emergency conditions. The report stresses upon the fact that even though womens health is vital to the well-being of their families, after disasters, traditionally as caregivers, they tend to place their needs last. It also affirms that in certain provinces, cultural norms such as purdah limit women from being able to express their needs, additionally women also tend to have a chance of going unnoticed in the compensation process as their economic contributions are usually unseen. Similarly the women interviewed by IDMC in Sindh alleged that access to income-earning opportunities has been their biggest challenge and a major concern for women heads of household. The slow pace of recovery from the extensive damage the floods caused to the agricultural sector was expected to have a major impact on womens employment. Women also lacked the documentation to prove their property rights. As a result, widows and women heads of household interviewed by IDMC reported great difficulty in claiming inheritances, land and possessions left at home when they fled. [23] A March 2011 report by the UN Office for the Coordination of Humanitarian Affairs (OCHA) found that internally displaced women and girls across the country could not venture out to receive emergency food aid without being threatened for violating purdah. [24] Women complained that most health services available in the aftermath of the floods concentrated on primary health care with little specialized focus on reproductive health for women. [25] A 2010 assessment by the UN Development Fund for Women (UNIFEM) quoted women as reporting sexual harassment in flood displacement camps where different tribes, families and villages were placed together. [26] Hence it is essential that researchers while assessing the effects of flood take both long term and short term health impacts into account. It is important for the research study to describe the characteristic impacts of floods on health outcomes, describe the factors that influence human health as a result of floods, describe the direct health impacts of floods and develop a conceptual framework to aid in the management and evaluation of flood related health management. The literacy rates of women in developing countries are much lower than their male counterparts. A study by UNICEF in the aftermath of the 2010 floods showed that there are gender disparities in supply side factors in Sindh including availability of schools for girls and boys. Pre flood institution break up by gender, level and sector shows that at the primary level there are 60% mixed schools in the public sector and 42% mixed schools at the middle level. At the primary level parents are more comfortable with sending their girl child to mix school; however there is reluctance when it comes to middle school when the girl attains puberty, the dropout rates are also highest at that point and majority of the dropouts occur when girls move from primary to middle level. Similarly the study provides evidence of gender disparities existing in Thatta; the study demonstrates the trends in pre and post flood situations in primary enrollment. [38] Lack of access to education isnt always related to scarcity of schools however the unavailability of this supply side factor can play a major role in decreasing access to education along with the unavailability of female teachers as well. Economic costs, social traditions, and religious and cultural beliefs also limit girls educational opportunities particularly when it comes to middle and high level schooling. As these social development indicators become worse due to the affects of climate change it is important for the authorities to not only measure them but also address them with sustainable development programs. Given that men and women in the study area are poverty-stricken with dependency on agriculture and natural resources for their livelihoods, natural disasters pose a high risk for them. As evident by the literature reviewed vulnerability seems to be higher for women as they do not have alternative means of employment and most of all employed women in the study area are employed by the agriculture sector. More and more researchers have concluded that it is important to opt for a gendered analysis when researching on flood impacts, Sarah Bradshaw in her study Socio-economic impacts of natural disasters: a gender analysis states The first step towards ensuring that the specific basic needs of women are addressed over the short and long term is to collect data broken down by sex and age segment immediately after a disaster. The breaking up of data helps researchers understand women specific needs better, which in turn can help policy makers design and implement women specific strategies a nd programs. [27] Even though the evidence provided above from both international and local research literature clearly advocates the case for greater vulnerability of women from natural disasters; not much has been done to assess the post disaster impact of floods on women. Research studies have remained limited to rapid assessments or need assessments, post disaster impact have not been concentrated upon. In order to design long term sustainable gender sensitive recovery programs it is crucial to understand the post disaster impact of floods on women, keeping this in mind the present study Social-Economic Impact of Flood in District Thatta: A Gendered Analysis is a pioneering work in Pakistan in which SPDCs researchers have gone a step ahead from other studies and have tried to assess the post disaster impact of one of the worst floods of the century. Furthermore, research has shown that despite obstacles faced by women, they are already developing effective coping strategies which include adapting their farming practices. Literature such as (WEDO, 2003; Gurung et al., 2006; Mitchell et al., 2007) pointed out that women are very knowledgeable and experienced with regards to coping with climate related impacts. They are aware of their needs and are very innovative in the face of change. Communities on the frontline in adapting to the effects of natural disasters need but so far often lack, adequate information about climate change and adaptation strategies. Due to the womens lower literacy levels in many regions, and other barriers to accessing information, such as culture, it is vital that womens needs are addressed in efforts to provide necessary information. [43] Ariyabandu and Wickramasighe (2005:26) suggest that although women are often more vulnerable to disasters than men (owing to conventional gender responsibilities and relations) however they are not just helpless victims as often represented. Women have valuable knowledge and experience in coping with disasters. Yet these strengths and capabilities of women are often ignored in policy decisions and in mitigation, thereby, allowing these valuable resources to go to waste and sometimes creating dependency situations. Ignorance of gender differences in the past has led to insensitive and ineffective relief operations that have not been able to target womens needs and their potential to assist in mitigation and relief work. [44] Hence this research is also important because not all is gloomy, as international research has suggested that in developing countries already experiencing negative effects of climate change, women have been identified as particularly adaptive and innovative, there fore the current research study shall play a valuable role in making policy makers better understand the long term issues of Pakistani women in particular and identify their strengths and weaknesses. Taking the above into consideration, SPDC has designed a gender sensitive research study to determine the impact of the 2010 flood of Thatta. A gender sensitive primary survey is vital in helping identify Gender gaps, hence SPDC researchers created separate questionnaires for men and women. The study helps understand the differences in the socio-economic impact of the flood on women, men, girls and boys. This includes gathering gender sensitive data on the sectors of education, health, economic, flood coping capability and the overall impact of the flood. In order to assess and evaluate the effect of flood on the household welfare and behavior, the study collects individual and household information from both male and female respondents separately, making use of gender sensitive approaches which in the past have been limited to needs assessments or rapid assessment studies.

Shottky diode

The Schottky diode is an important device which is widely used in radio-frequency (RF) applications. It possesses many similarities to the point-contact diode. In fact many of the early devices were made in the same way as a point-contact diode, although today's devices are made with totally different manufacturing techniques. Unlike conventional semiconductor diodes, which consist of a PN Junction, the Schottky diode is made from a metal semiconductor Junction.This offers a number of dvantages in some circumstances as the diode has a very low forward-voltage drop, and secondly it has a very fast switching speed. Both of these properties make it ideal for many RF applications as well as giving it uses in many other areas, as we shall see. Characteristics. The Schottky diode is what is called a majority carrier device. This gives it tremendous advantages in terms of speed. By making the devices small, the normal RC (resistancecapacitance) type time constants can be reduced, making the Schottky diode an order of magnitude faster than the conventional PN diodes.This factor is he prime reason why they are so popular in RF applications. The Schottky diode also has a much higher current density than an ordinary PN junction. This means that forward-voltage drops are lower, making these diodes ideal for use in powerrectification applications. The main drawback of the diode is found in the level of its reverse current, which is relatively high. For many uses this may not be a problem, but it is a factor which is worth watching when using Schottky diodes in more exacting applications. Variety of Applications.The Schottky diode is used in a wide variety of applications. It can naturally be used as a general-purpose rectifier. However, in terms of RF applications, it is particularly useful because of its high switching speed and high-frequency capability. Schottky diodes are similarly very good as RF detectors as their low capacitance and forward- voltage drop enable them to detect signals which an ordinary PN Junction would not It has already been mentioned that the Schottky diode has a high-current density and low forward-voltage drop. As a result, Schottky diodes are widely used in power supplies.By using these diodes, less power is wasted, making the supply more nd smaller heatsinks may be able to be incorporated in the design. The Schottky diode is used in logic circuits. Although not as common these days, the 74LS (low-power Schottky) and 74S (Schottky) families of logic circuits use Schottky diodes as a core component. The Schottky is inserted between the collector and base of the driver transistor to act as a clamp (see Fig. 2). To. produce a low or logic ‘O' output the transistor is driven hard on, and in this situation the base-collector junction of the diode is forward biased.When the Schottky diode is present, this akes most of the current and allows the turn-off time of the transistor to be greatly reduced, thereby improving the sp eed of the circuit.

A Letter of Advice to Nhs Litigation Authority on Clinical Neglgence Case of Missed Fractured Scaphoid Bone

To: NHS Litigation Authority, Re: Chandler Bing v Friends Health NHS Foundation Trust Dear Sir/ Madam, Thank you for your referral of the case concerning Mr. Chandler Bing’s missed fracture scaphoid bone received on 31 August 2010. The following is the Letter of Advice to the NHSLA concerning the above-mentioned case. The Claimant: 1. The Claimant was born on 8 April 1969. As a result of the events referred to in their particulars of claim the claimant is now represented by Bloomingdale Solicitors to launch to launch a civil action against Friends Health NHS Foundation Trust on 31 August 2010. The Defendant: 2. The Defendant was at all relevant times responsible for the management control, and administration of Friends Health NHS Foundation Trust, and for the employment of doctors, nurses, and other medical specialist s including emergency medicine, radiology and orthopaedic surgeons at and for the purpose of the said hospital. Duty of care: 3. Each of the doctors, nurses, and other staff employed at the hospital who treated the Claimant at the hospital owed the Claimant a duty of care. This duty included a duty in respect of: a. The advice given to the Claimant; . The diagnosis made in respect of the condition of the Claimant; c. The treatment prescribed for the Claimant and advice as to the effect of the treatment; d. The monitoring of the Claimant whilst treatment was given to the Claimant. 4. The Defendant is vicariously liable for any such breach of duty on behalf of any of its employees. Procedural Steps: 1. Protocol Steps: a. Obtaining health records: to provide suf ficient information to alert the Healthcare provider where an adverse outcome has been serious; to request for specific medical records involving the case. . Request for copies of patient’s clinical records with approved standard forms. c. Make sure the copy records to be provided within 40 days of the request and for a cost not exceeding changes permissible under the Access to Health Records Act 1990. d. If the Healthcare provider fails to provide health records within 40 days, their advisers can then apply to Court for an order for pre-action disclosure. e. If Healthcare provider considers additional health records are required from a third party, these should be requested through the patient. Third party Healthcare providers are expected to co-operate. 2. The response: Letter of response: a. Provide requested records and invoice for copying. b. Comments on events and/or chronology. c. If breach of duty and causation are accepted, suggestions for resolving the claims and request for further information offer to settle. d. If breach of duty and/or causation are denied, outline explanations for what happened by Healthcare provider suggests further steps like further investigations, obtaining expert evidence, meetings, negotiations or mediation, or an invitation to issue proceedings. e. Healthcare provider should acknowledge receipt of letter of claim within 14 days of receipt. f. Healthcare provider should, within 3 months of letter of claim, provide a reasoned answer. g. If claim is admitted, then the Healthcare provider says so. h. If any part of claim is admitted, then Healthcare provider makes clear which issues of breach of duty and/or causation are admitted and which are denied and why. i. If claim is denied, include specific comments on allegation of negligence, and if synopsis or chronology of relevant events provided and is disputed, Healthcare provider’s version of events provided. . Additional documents, for instance, internal protocol, copies provided. k. If patient made an offer to settle at this stage as a counter-offer by supporting medical evidence, and/or other evidence in addition to claim in healthcare provider’s possession. l. If parties reach agreement on liability, but time is needed to resolve claim, then aim to agree a reasonab le period. Witness Evidence: The witnesses concerned in this case include: 1. Claimant’s family members and colleagues concerning the accused loss of function in daily activities of living. . Healthcare providers beside the medical doctor in Accident and Emergency Department, including accident and emergency doctors and consultants, radiologists, orthopaedic specialists, nurses, family doctors, etc, who have treated the Claimant. 3. The Claimant himself. Where a witness statement or a witness summary is not served, the party will not be able to call that witness to give oral evidence unless the Court allows it. Matters to be covered in the witness’s statement will include: 1. Occupation and working ability of the Claimant, if this has changed, since the injury, previous occupation of the Claimant. 2. Brief description of marital and family circumstances including dates of birth of all the family members of the Claimant. 3. The Claimant’s amount of the sequence of events relating to the treatment in question. Care should be taken to avoid importing text and phraseology from medical records or reports that the Claimant would not use in the normal course of discussing the case. 4. If the witness’s factual recollection of events differs in any important respect from the medical records, or from the version of facts set out in the Defendant, the statement should acknowledge this and comment upon these differences. 5. The witness should describe the effects of the injury; this will include the effects on his physical condition, emotional condition, the practicalities of everyday life, the Claimant’s financial affairs, family life, and future plans and projects. Additional witnesses should state their relationship to the Claimant. If a amily member is providing a statement which is collaborative of the Claimant’s amount of events, the witness should confirm that he or she has read the Claimant’s statement and state that he or she agrees with its contents, insofar as those within his or her knowledge. The statement should then deal with issues of which the witness can give primary evidence. Where a party is required to serve a witness st atement and he is unable to obtain such a statement, for example because the witness refuses to communicate with the Defendant’s solicitor, he may apply to the Court for the permission to serve only a witness summary instead. This application should be made without notice. The witness summary is a summary of the evidence which would otherwise go into a witness statement, or if the evidence is not known, matters about which the party serving the witness summary will question the witness. Expert Evidence: 1. In clinical negligence disputes, expert opinions may be needed: a. On breach of duty and causation. b. On the patient’s condition and prognosis. c. To assist in valuing aspects of the Claims. The main expert witnesses to be considered include: a. Orthopaedic specialists. b. Accident and Emergency specialists. c. Radiology specialists. 2. The new Civil Procedure Rules will encourage economy in the use of experts and a less adversarial expert culture. It is recognized that in clinical negligence disputes, the parties and their advisers will require flexibility in their approach to expert evidence. Decisions on whether experts should be instructed jointly; and on whether reports might be disclosed sequentially or by exchange, should rest with the parties and their advisers. Sharing expert evidence may be appropriate on issues relating to the value of the Claim. However, this protocol does not attempt to be prescriptive on issues in relation to expert evidence. 3. Obtaining expert evidence will often be an expensive step and may take time, especially in specialized areas of medicine, where there are limited numbers of suitable experts. Patients and Healthcare providers, and their advisers, will therefore need to consider carefully how best to obtain any necessary expert help quickly and cost effectively. . Assistance in locating a suitable expert is available from a number of sources. Here the NHSLA has already supplied a number of experts for this case. 5. This is a case of missed fracture of the waist of the scaphoid, for a patient initially seen in the Accident and Emergency Department, is often a clinical diagnosis rather than a radiological diagnosis, because this fracture may not become apparent on an X-Ray until often a period of 10 days, and some times konger, has elapsed. . Tenderness in the anatomical snuffbox at the base of the dorsal aspect of the thumb, or pain produced by proximal pressuring on the wrist joint in radial deviation by comparison to the unaffected side, together with diminished power of grip, is an indication for the forearm to be put into a scaphoid plaster of Paris. 7. The patient must have the plaster checked the following day and will need to be X-Rayed again in 10 to 14 days if a fracture line was not initially visible. 8. When a fracture of the scaphoid is suspected, â€Å"scaphoid views† should be asked for. 9. The doctor at Accident and Emergency Department must ensure that 4 views have been carried out: Anterior-Posterior, Lateral, Supination oblique, and Pronation oblique. 10. If there is doubt about the diagnosis or the fracture is displaced, then a more senior or orthopaedic opinion must be sought forthwith, otherwise a scaphoid plaster must be applied, and the patient referred to the next Accident and Emergency review clinic or fracture clinic. 11. There is a component of contributory negligence by the Claimant who insists to remove the plaster in the follow up clinic despite he was strongly advised not to do so. The effect of this contributory negligence on the Claims should be further explored and evaluated. Quantum of damages: The means to calculate the quantum of damages made in this case of clinical negligence include various heads of the following damage: 1. Pain, suffering and loss of amenity; 2. Loss of earnings; 3. Care and assistance; 4. Travel and parking; 5. Miscellaneous expenses. The Claims on items (1), (3), (4) and (5) are measured quite subjectively by the patient affected. The calculation of loss of earning could be done by using the Ogden tables, which are involving a set of statistical tables for use in Court case in the United Kingdom. Beside the age of this patient (Date of Birth=08/04/1969) being 41 years old on the date of claim (that is 12-11-2010) is known, we still need to know about the patient’s earning per annum, what is his occupation, whether he had any disability resulted, his qualifications, and his planned age for retirement. In case where the period of loss of earnings will continue for many years into the future, it is particular important to ensure that amount is taken of likely periodic changes to the Claimant’s income. The Claimant will want to point to anticipated career progression. In such cases, the Court will either: 1. Determine the average multiplicand, based upon the likely earnings throughout the period of loss, which will be applied to the full period of the loss, or; 2. Use stepped multiplicands for each stage of the Claimants career. Generally, this will result in a lower multiplicand at the beginning and possibly at the very end of the period of loss, with one or more higher multiplicands to represent the likely career progression that would have been followed. There is a need to interview the Claimant in more details to decide these uncertainties for a more comprehensive evaluation. Last but not least, the importance of expert evidence in such a case is vital. Medical evidence can provide an indication as to what work the Claimant will be capable of undertaking, both at present and in the future. This, together with evidence of the Claimant’s employment prospective, will assist the Court in determining what will happen to the Claimant in the future. Another means to calculate for the approximate quantum of the damage in this patient is to look into common laws and journals for similar cases for comparison and a rough estimation of quantification of similar claims. In Johns v Greater Glasgow Health Board1, a 44 years old lady broke her scaphoid bones in both wrists in a fall. The fractures were only diagnosed three months later. As a result the fractures would not unit, causing continuous incapacity and pain. Bone grafting was contemplated, despite an earlier unsuccessful attempt. Held, that solatium was properly valued at 11,000 pounds with wage loss to date and for a further 4 years. In W v Ministry of Defence2, which is a case of failure to diagnose fractured scaphoid from Clinical Risk 2010; Volume 16: p. 198 (by Collier et al). The case was settled concerning damages awarded to the Claimant pursuant to the delay in the diagnosis of the fracture of his hand, without which the Claimant could have avoided undergoing surgery and regained his complete and normal wrist function. W made an offer to settle in the sum of 15,000 pounds. The amount awarded to the Claimant was reduced to 9,000 pounds after further negotiation. 1. Johns v Greater Glasgow Health Board (1990) SLT 459. 2. W v Ministry of Defence (2009) MLC 1652 In B v Norfolk & Norwich University Hospital3, the Claimant, a male nurse aged 29 years, had attended the Norfolk & Norwich University Hospital NHS Trust after falling off his bike in July 2004. His left fractured scaphoid bone wad missed and a non-united scaphoid fracture with humpback deformity and associated ligament damage had occurred. The Claimant thus made a Part 36 Offer for the sum of 14,000 pounds that was agreed with the Defendants in March 2006. In N v Pontypridd & Rhona NHS Trust4, the Claimant injured his right wrist in a fall whilst ice-skating on March 14, 1998. He attended the Hospital’s Accident and Emergency Department and was noted as having a tender scaphoid. An X-Ray of the wrist was taken which was interpreted as disclosing no fracture. Nonetheless the wrist was set in plaster of Paris and the Claimant released. On March 19, 1998, the Claimant re-attended the Hospital’s Accident and Emergency Department still in pain. The cast was removed; no X-Ray was repeated. The Claimant was given tubi-grip dressing and told to exercise the wrist. On April 29, 1998, the Claimant attended a different Hospital complaining pain and swelling over scaphoid region. X-Ray showed a fracture of scaphoid bone in his right dominant hand. On May 29, 1998, the fracture showed sign of delayed union. As a result, a settlement of total damage of 12,500 pounds; general damage of 8,000 pounds, and special damage for income loss and care of 4,500 pounds were awarded. In P v United Bristol Healthcare NHS Trust5, the Claimant was involved in a fracas at nightclub in Bristol and arrested for punching security camera. The Claimant attended Accident and Emergency Department at the Bristol Royal Infirmary on 27 May 2000 and he experienced problems relating to his right wrist. The SHO treated the injury as being a sprain and no X-Ray was taken. The Claimant’s GP then identified tenderness in anatomical snuffbox. An X-Ray confirmed fracture through scaphoid being missed by Accident and Emergency Department. The Claim was finally settled for 40,000 pounds with causation proved. 3. B v Norfolk & Norwich University Hospital (2006) MLC 1350 4. N v Pontypridd & Rhona NHS Trust (2003) MLC 1031 5. P v United Bristol Healthcare NHS Trust (2004) MLC 1159 QBD Settlement Where a Claimant has received State Benefits as a result of a disease and is subsequently awarded compensation, the Department for Work and Pension (DWP) will seek to recover these benefits from the Defendant via a system operated by the Compensation Recover Unit (CRU). The CRU is also responsible for collecting from a Defendant the cost of any NHS treatment that a Claimant has received following a clinical negligence. Notifying the DWP: Section 4 of the 1997 Act requires the compensator to inform the DWP not later than 14 days after receiving the Claim. The Notification should be made on Form CR1 which is sent to the DWP. On receipt of Form CRU1, the CRU will send Form CRU4 to the Defendant. The Claim then progresses to the settlement stage. When ready to make an offer of compensator, the compensator submits form CRU4 to obtain a Certificate. The CRU acknowledges receipt of form CRU4 within 14 days. The CRU sends the Certificate to the compensator- a copy will also be sent to the Claimant’s solicitor. The compensator will then settle the compensation claim and pay the relevant amount to the DWP within 14 days of the settlement. The compensator will also complete and send to the DWP Form CRU102 detailing the outcome of the Claim. The rules relating to recovery of benefit apply to clinical negligence claims. Due to their complexity, especially relating to causation, the CRU has set up a specialist group to deal with the claims, and makes a special request their compensators inform the CRU about clinical negligence claims as soon as the pre-action correspondence is received. Part 36 Offer: A party who wishes to make a Part 36 Offer must first apply for a Certificate of Recoverable Benefit from the CRU. Although Part 36 does not spell it out , guidance from case law suggests that the offer should therefore particularize the various heads of damage, and indicate the amount of benefits to be deducted against each head. Mediation: The parties should consider whether some form of Alternative Dispute Resolution Procedure would be more suitable than litigation, and if so, endeavour to agree which form to adopt. Both the Claimant and Defendant may be required by the Court to provide evidence that alternative means of resolving their dispute were considered. The Courts take the view that litigation should be a last resort, and that claims should not be issued prematurely when a settlement is still actively being explored. Parties are warned that if the protocol is not followed, then the Court must have regard to such conduct when determining costs. Mediation is one option for resolving disputes without litigation: it is a form of facilitated negotiation assisted by an independent neutral party. The Clinical Disputes Forum has published a guide to mediation which will assist, available at www. clinicaldisputesforum. org. uk The Legal Services Commission has published a booklet on â€Å"Alternatives to Courts†, CLS Direct Information Leaflets 23, which lists a number of organizations that provide ADR services. It is expressly recognized that no party can or should be forced to mediate or enter into any form of ADR. (Total: 3000 words) Bibliography: 1. Lewis: Clinical Negligence: A Practical Guide, 6th edition, Tottel Publishing. . Khan M, Robson M, Clinical Negligence, 2nd edition, Cavendish Publishing. 3. Powers and Harris: Clinical Negligence, 3rd edition, Butterworths. 4. Woolf S (1995) Access to Justice – Interim Report HMSO. 5. Woolf S (1996) Access to Justice – Final Report HMSO. 6. (1999) The Civil Procedure Rules HMSO. 7. â€Å"Making Amends†, at www. dh. gov. uk 8. †NHS Redress Bill† at www. publications. parliment. uk 9. Civil Litigation Handbook by Woolf, Lord Justice; Burn, Suzanne; Peysner John (2001), The Law Society. 10. A. A. S. Zuckerman, Ross Cranston (1995), Reform of Civil Procedure- Essays on â€Å"Access to justice†, Oxford University Press. 11. The Judicial Studies Board, Guidelines for the Assessment of General Damages in Personal Injury Cases, 9th edition, Oxford University Press. 12. Personal Injury & Clinical Negligence: Tough Conditions – The Lawyer 10/10/05, www. lexisnexis. com 13. Opinion: Edwina Rawson: The Lawyer 26/09/05, www. lexisnexis. com 14. Butterworths: â€Å"Risk Assessment in Litigation: Conditional Fee Agreements, Insurance and Funding†, David Chalk 15. The Law Society: â€Å"Conditional Fees: A survival Guide†, Napier and Bawdon 16. The Law Society: â€Å"Civil Litigation Handbook†, Peysner. 17. â€Å"Mediating Clinical Negligence Claims†, Roger Wicks, www. medneg. com articles 18. â€Å"Guide to Mediation†, www. clinical-disputes-forum. org. uk 19. â€Å"Guide to Mediating Clinical Negligence Claims†, www. clinical-disputes-forum. org. uk 20. Kemp and Kemp The Quantum of Damages, Sweet and Maxwell. 21. Medical Litigation Online, www. medneg. com 22. AvMA Medical and Legal Journal 23. â€Å"General Damages – the NHS Case†, Philip Havers Q. C. and Mary O’Rourke, Quantum, Sweet & Maxwell (2000) 24. Practice Direction at www. justice. gov. uk 25. NHSLA website www. nhsla. com 26. Civil Procedure Rules at www. justice. gov. uk 27. Pre-action Protocol for the Resolution of Clinical Disputes and Practice Direction – Protocols, www. justice. gov. uk 28. â€Å"Guidelines on Experts’ Discussions in the Context of Clinical Disputes†, Clinical Risk (2000) 6, 149-152 29. The â€Å"Draft Guidelines On Experts’ Discussions in the Context of Clinical Disputes† (published by the Clinical Disputes Forum) 30. Part 36 and its Practice Direction, www. justice. gov. uk. 31. The NHS Redress Act 2006 can be found online at www. legislation. gov. uk/ukpga/2006/44 32. Johns vs Greater Glasgow Health Board, (1990) SLT 459, www. medneg. com 33. W v Ministry of Defence, (2009) MLC 1652, www. medneg. com 34. B v Norfolk & Norwich University Hospital (2006) MLC 1350, www. medneg. com 35. N v Pontypridd & Rhona NHS Trust (2003) MLC 1031, www. medneg. com 36. P v United Bristol Healthcare NHS Trust (2004) MLC 1159 QBD, www. medneg. com

The Agriculture Industry By How The Producer Orchestrates...

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