Alan Merry practises in anaesthesia and chronic pain management at Auckland City Hospital. He is Head of the School of Medicine at the University of Auckland. He is Chair of the Board of the NZ Health Quality and Safety Commission and on the Boards of the World Federation of Societies of Anaesthesiologists and Lifebox, both of which aims to improve standards of anaesthesia and surgical care in low-income areas of the world. His books, book chapters and papers in peer-reviewed journals reflect interests in human factors, patient safety and simulation.
Errors, Medicine and the Law: Towards Better Regulation of Healthcare
During the 1990s, errors of low intrinsic culpability but devastating consequences resulted in charges of manslaughter against nine health professionals in New Zealand. The low threshold for such prosecutions at that time was out of kilter with approaches in comparable countries, notably the UK. Advocacy from the New Zealand Law Reform Group led to the Crimes Amendment Act 1997, which elevated the threshold for the prosecution of negligence to that of a “major departure” from the expected standard of reasonable knowledge skill and care. This advocacy also argued for improved methods of accountability aligned with initiatives to improve patient safety. Today, with the Office of the Health and Disability Commissioner, the Health Quality and Safety Commission, the Accident Compensation Corporation and an excellent publicly funded health system, New Zealand has the essential elements for establishing a just culture in a high-quality patient-centred health system committed to continuous quality improvement. By contrast, recent UK cases have once again raised questions about the role of the criminal law in regulating health care. An understanding of these issues lies in an appreciation of the different ways in which harm can occur in healthcare. It is necessary to distinguish errors from violations, and then to appreciate the wide range of culpability that may be associated with the latter. On this basis, a five-level framework of blameworthiness has been described that provides a framework for evaluating failures in healthcare, and for informing initiatives to improve patient safety.
 Merry AF, Brookbanks W: Merry and McCall Smith's Errors, Medicine and the Law: 2nd Edition. Cambridge: Cambridge University Press, 2017.
 Merry AF: How does the law recognize and deal with medical errors? Journal of the Royal Society of Medicine 2009, 102:265-71.
 Braithwaite J, et al: Complexity Science in Healthcare - a white paper. Australian Institute of Health Innovation, 2017.
 Dekker S: Just culture: Balancing safety and accountability. 2nd ed. Aldershot, Hampshire: Ashgate Publishing Limited, 2012.
 Reason J: Human Error. New York: Cambridge University Press, 1990.
 Reason J: Managing the Risks of Organizational Accidents. Aldershot: Ashgate, 1997.