Legal concepts for health professionals

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Chapter 1 Legal concepts for health professionals

INTRODUCTION

The delivery of pharmacy services, as with any health care service, takes place within a legally regulated environment. The law therefore plays a significant role in the day-to-day activities of a pharmacist, whether the practice is conducted in the private or public sectors of health care delivery, whether it is a sole practice, part of a pharmacy group or whether it is within the institutional setting. The very nature of pharmacy practice places the pharmacist in situations where legal issues need to be considered when making decisions about a patient’s or client’s clinical management and care. The provision of services by a pharmacist are therefore based on a framework of common law principles, legislative provisions and professional guidelines and policies which regulate and determine not only the standard of the care but also the rights and obligations of both the pharmacist and their patients or clients. This area of law, referred to as ‘health law’, operates as one of the mechanisms by which pharmacy practice and the provision of individual services by pharmacists is controlled and regulated.

It is fundamental to the provision of a safe and competent service that the pharmacist has an understanding of the relevance of the law to the provision of that service. Within Australia, health law is made up of a range of legal concepts that derive from the common law, civil and criminal law, contract law, the regulation of industrial relations and agreements as well as the statutory arrangements between state, territory and federal governments. The obligations and responsibilities imposed through the federal government’s commitment to international treaties and declarations also impact significantly on the provision of pharmacy services within the Australian context.

As stated, health law is only one area of the law that governs the conduct of pharmacy practice. It is therefore important for the reader to have an understanding of the Australian legal system as a whole. This chapter will provide an outline of the structures of the Australian legal system, including sources of the law and an overview of the hierarchy of the courts and their processes.

SOURCES OF THE LAW

The law is reflective of the values and attitudes of the particular society in which it exists and, as such, evolves over time. This evolution can be seen if one considers the laws which applied to the provision of pharmacy services in Australia a decade ago and compares them with the current laws under which pharmacists in Australia now practise. The law may be prescriptive, in setting out what is required from a pharmacist in relation to registering to practise, providing a service, managing a business or working as part of a health care team within a health care facility. Simultaneously, the law defines what the pharmacist is prohibited from doing in exactly the same situations and circumstances.

The law also determines the consequences that will follow when a pharmacist fails to comply with the requisite legal obligations and requirements. It can confer powers on individuals and groups, such as the power of the pharmacist to legally dispense or supply medications and poisons. The law can also remove or place limits on the powers of individuals or groups. It is evident that the law provides a framework that imposes obligations and bestows rights on individuals, institutions and entities such as corporations. In Australia, the sources of these obligations, responsibilities and rights are to be found in the decisions of the courts, the legislation passed by state, territory or federal parliaments and the provisions of applicable international laws. From these sources the behaviour and standards of practice for health professionals, including pharmacists, are determined and maintained.

There are several different legal systems which operate throughout various countries around the world. As an example, there are countries which function under Islamic law, socialist law or Asian legal systems. Many European countries have a civil system, which was inherited from French or Roman cultures and is based on codes. One of the characteristics of a civil legal system is the inquisitorial nature of the trial process. This means the judge, rather than remaining impartial and making a decision based on the merits of a case argued before the court, will take an active role in investigating the facts and evidence. Unlike many European and Middle Eastern countries, Australia is described as a common law country (See Figure 1.1). This resulted from the colonisation of New South Wales by the British, who also operated under a common law system. The Australian legal system, and system of government, were thereby inherited as a function of British colonisation and have continued to develop post-federation into the systems as they exist today. As a common law country there are two sources of law under the Australian system. The first is legislation passed by the parliaments at both the state and federal levels. The second source is the common law that has developed from judicial decisions handed down by the courts.

Legislation — parliamentary law

Prior to the formation of the Commonwealth of Australia on 1 January 1901 the self-governing colonies operated independently and passed legislation through their own individual parliaments and, for some, under their own Constitution. The passage of the Commonwealth of Australia Constitution Act 1900 (the Constitution) by the British government established the Commonwealth of Australia. The Constitution gave the Commonwealth Parliament the power to make laws either exclusively or concurrently with the states. Under the Constitution, the state parliaments retained their power to make laws as they had done prior to federation, unless the power to make laws about a specific matter had been given exclusively to the Commonwealth. Section 107 of the Constitution states:

The Commonwealth Constitution thereby limits and controls the power of the states to pass legislation. Section 52 of the Constitution identifies the matters over which the Commonwealth Parliament has exclusive power to pass legislation whereas section 51 grants powers over matters which are not exclusive to the Commonwealth and are thereby shared with the states. These are referred to as ‘concurrent powers’. Under section 51 of the Constitution both the state and Commonwealth parliaments are empowered to pass laws on matters such as trade and commerce with other countries, tax, postal and telegraphic services and under placita 51 xxiiiA ‘… the provision of … pharmaceutical, sickness and hospital benefits, medical and dental services …’.

Each of the federal, state and territory parliaments, through their individual constitutions, may pass laws for the ‘peace, and good government’[1] of the jurisdiction.

The federal, state and territory parliaments are therefore empowered to enact legislation, also known as Acts or statutes, for the purpose of regulating certain aspects of society. An Act, passed by the parliament elected by the people, is a primary source of the law and has priority over the common law, which is derived from court decisions. That is, legislation takes precedence over judge-made law (case law) and while it is not the role of the court to make laws where the same subject matter is covered by an Act, it is the role of the court to interpret legislation that is relevant to the determination of the case that is before it. Some states and territories will also have codes which are a complete statement of the law in a particular area. Legislation can be accessed online through the state, territory or Commonwealth government websites.

Prior to a draft Act (statute) being approved by the parliament it is called a Bill. A Bill must be passed by parliament before it is sent to the Governor-General, or Governor, for signature, also known as assent, which generally results in it becoming an Act and having legal force. This will be the case unless the Bill identifies its own procedure of enactment. That is, it may stipulate that it will not become effective until there is a notice placed by the government in the Government Gazette. The process for enacting legislation is the same in each jurisdiction where a Bill must pass through both the Lower and Upper Houses of parliament. However, in Queensland, there is only one house of parliament through which a Bill must pass.

At Commonwealth, state and territory levels legislation prescribes many of the activities of individual health professionals, professional regulatory authorities, health care facilities and institutions. The legislative provisions that apply to all aspects of the health care industry are therefore regularly amended and updated to keep pace with the current demands and constraints. There are many Acts of parliament at both the state and federal levels which regulate and control the practices of pharmacists and the services provided by them. To give some examples, at the state level, there are statutes that control the registration and regulation of pharmacists, legislation controlling workplace health and safety within a pharmacy practice, and legislation providing avenues for complaints by consumers of pharmacy services. At the federal level the legislation is primarily directed to issues of funding and regulating Commonwealth health care agencies and services.

STATUTORY INTERPRETATION

When reading legislation the focus must be on the actual language used. Examples of words that mandate a particular activity or status include will, shall or must. However, the use of a word such as may indicates a discretionary power. It is important when attempting to interpret an Act that the legislation is read as a whole so as to obtain the context of the words used. Explanatory notes, that sometimes accompany the Act and associated regulations, may also assist in resolving any ambiguity or clarifying the intention of the law. Statutory interpretation is now governed by various state, territory and Commonwealth Interpretation Acts.[2] Section 15AA (1) of the Acts Interpretation Act 1901 (Cth) states:

Reading an Act

While statutory interpretation is a major function of the courts and lawyers it may be of assistance to pharmacists to understand how an Act or regulation is to be read and understood. An Act is referred to by its name, the year it was passed by the parliament and the jurisdiction in which it was passed; for example, Pharmacy Practice Act 2006 (NSW). The Act will also be given a number; for example, the Pharmacy Practice Act 2006 (NSW) no 59 identifies the order in which the Act is assented to by the Governor or, in the case of Commonwealth legislation, the Governor-General. The date of assent is the date on which the Bill formally completed its passage through the parliament and met the constitutional requirement for becoming an Act. If the date of assent is included it is usually bracketed under the long title. The assent date may be different for the commencement date, which is when the Act becomes law. The long title for the Pharmacy Practice Act 2006 (NSW) states:

The layout of an Act depends on its subject matter. Many Acts are divided into Parts, which are like chapters in a book. For example, the Pharmacy Practice Act 2006 (NSW) has 158 sections in 12 Parts. The Parts are as follows:

Certain items and prescribed forms may be set out in a list appended to an Act in the form of Schedules. Sections in the Act will therefore refer to a Schedule effectively incorporating the content of the Schedule into the law. For example, the Pharmacy Practice Act 2006 (NSW), contains seven Schedules.

Common law

The law as it was imposed by England and Wales at the time of colonisation is referred to as common law. In addition to the use of the term to describe a legal system (comprising case law and statute law) it also describes a system of law that developed in the King’s courts from the 10th century through the accumulation of decisions made by judges in cases that came before them. Through the recording of principles and judgments in law reports there developed a body of case law and principles that could be referred to and followed. This practice, of following earlier decisions, is known as the doctrine of precedent and served to provide a level of certainty and predictability in the law.

In addition to the law, which developed in the common law courts, there is a distinct and separate system of case law referred to as equity. The laws of equity developed at the end of the 13th century when dissatisfaction with the common law courts led to the establishment of the Court of Chancery where legal disputes were resolved on the basis of conscience and equity rather than the rigid rules of the common law courts. While common law and equity remain distinct areas of law, the Australian courts consider both.

Generally, statute law overrides common law and common law prevails when no specific statute exists. Both common law and statute law are applied in the courts. In Australia there is a hierarchy of courts within the state and territory jurisdictions and the federal jurisdiction.

TYPES OF LAW

There are various methods of classifying the different types of law, one method being to describe law as either substantive or procedural.

Substantive law is the law that regulates citizens in specific areas of their lives. This includes industrial law, contract law, criminal law, family law, tort law and even constitutional law. As an example, when a pharmacist enters into a contract with Medicare Australia to provide pharmaceutical benefits he or she is entering into a legally binding agreement to which contract law applies. Procedural law governs the way in which laws are implemented and enforced. This would include rules of the courts, rules applied to civil and criminal procedures, and rules of evidence. Were a pharmacist to sue a supplier of products for breach of a contract, it is the procedural law which dictates the evidence required to substantiate that claim and the appropriate legal process and remedies to address the breach.

Another significant distinction of the law is that between civil and criminal law. The common distinguishing features that differentiate civil and criminal jurisdictions include the following:

THE AUSTRALIAN LEGAL SYSTEM

Adversarial and inquisitorial system

One of the functions of the law is to resolve disputes when conflicts arise between individuals, companies and institutions. The resolution of a conflict can take place through alternate dispute resolution mechanisms or through the court process. If resolution is sought through the courts the case will be brought before a magistrate, judge, or judge and jury with the expectation that the issues in dispute will be resolved and that there will be a declared ‘winner’. This competition between the parties that takes place within the courts is referred to as the adversarial process. There are very strict rules as to how this process is conducted and what are the roles, functions and obligations of all those who participate in this process. The role of the judge during court proceedings is to remain impartial and to ensure that the procedural rules are adhered to. The judge or jury will determine the outcome, where only one of the parties to the proceedings will be successful. This is different from the inquisitorial approach where the court may become a participant in the actual process.

The inquisitorial approach of resolving legal disputes is a characteristic of the civil law system practiced in many European countries. Under a civil law system the law is contained in a code (similar to an Act), and a judge may participate in the process of inquiry (which under a common law system is the role of the police and lawyers). The judges in civil law courts are therefore not confined to the evidence as put before them by the police and lawyers but may seek out information in their own right to assist them reaching their decision. Within the health care context the operation of the Coroner’s Court would be classified as inquisitorial while cases involving negligent actions will progress in an adversarial manner.

The doctrine of precedent (stare decisis)

In the discussion of common law, mention was made of the role of judges in making law. The word ‘common’ is used to denote the fact that judges have developed a process whereby courts are, to a certain extent, bound to follow decisions they have made previously as well as being bound by decisions made by other judges at the same level of the hierarchy or in senior courts. Judge-made law, or common law, began as a custom that valued the accumulation of judicial wisdom passed on through the ages. In this way a common thread of judicial certainty was maintained despite different judges presiding. Early in the 19th century this custom became enshrined as a doctrine known as stare decisis or the ‘doctrine of precedent’. It allows for some predictability when dealing with legal matters involving courts because one is able to determine the outcomes of similar cases that have occurred before, and estimate the probability of similar judgments being passed.

The doctrine of precedent originated in England and over time developed into a sophisticated and historically consistent system of justice. The underlying principle is that if a case is decided in a certain way today then a similar case should be decided in the same way tomorrow. The reason or ground of a judicial decision is called the ratio decidendi. It is the ratio decidendi of a case which makes the decision a precedent in future cases. When the courts hand down their decisions they are to be found in the many law reports that emanate from the state, territory, federal and international jurisdictions. It is important to remember that many cases are not included in the published law reports; however, unreported decisions should be equally regarded as establishing precedent.

All judgments do not bind all courts. Nor are all judges compelled to follow all that has been set down in previous decisions. Precedent can only bind if it comes from a higher court within the same hierarchy. For example, a decision in the Supreme Court of New South Wales is binding upon the District Court in New South Wales and local courts in New South Wales, but it is not binding on the equivalent courts in other states and territories of Australia because they are not in the same court hierarchy. Even so, a lower court in one state or territory would be unlikely to depart from a decision taken in a higher court of another Australian state or territory where the issues are similar.

Australian laws apply only to Australian courts. Australian courts are not bound to follow decisions made in foreign courts; however, they can influence decisions taken in Australia. This is sometimes referred to as persuasive precedent. For example, decisions made in other common law countries such as Canada or the United Kingdom may be considered by the Australian courts. Judgments made in English courts are no longer binding on any Australian court.

The court hierarchy

The Australian court system is structured hierarchically so as to delineate the extent of authority and the jurisdictional limits of each court. The jurisdiction of any court or tribunal gives the lawful authority to adjudicate or decide on an action, suit, petition or application brought before it. Jurisdictional power varies according to the seriousness of the offence, the amount of compensation that can be awarded, the nationality or place of residence of the parties, whether the matters are criminal or civil in nature, or even when and where the offence or event occurred.

Original and appellate jurisdiction

When a matter first arises, the court in which it is heard has what is known as original jurisdiction. Before a decision may be appealed in another court the dissatisfied party must be able to establish appropriate grounds. If this is established the subsequent court will be exercising its appellate jurisdiction. A decision may be the subject of an appeal in certain circumstances including: when a judge has misdirected a jury, made an error in relation to admitting or refusing to admit evidence, or there is an issue as to the severity or leniency of the sentence. For example, the District or County Court may hear a matter and, if a party appeals that decision, the Supreme Court will hear the matter using its appellate jurisdiction. Appellate jurisdiction is restricted to the superior courts including the District/County Court, Supreme Court, Federal Court, Family Court and High Court. In relation to the High Court, special leave (permission) must be sought before it will exercise its appellate jurisdiction. Figure 1.2 provides an overview of the court hierarchy, to illustrate the differences in both structure and jurisdiction of the courts in the hierarchy.

CASE REFERENCES

It is important for pharmacists to understand how to read judicial decisions as contained in the various law reports. Previously, cases were written up and reported in books that were most frequently held in law libraries. However, many of the sources of law, such as case reports and statutes, are now stored electronically and are more easily accessible. There are a wide range of databases which facilitate access to legal materials. In Australia, the Australian Legal Information Institute, also referred to as AusLII, makes all Australian case law and legislation freely available. The following information provides an overview of the elements of a case reference to assist in the reading and understanding of cases. For example:

This citation provides information on the name of the case and the location of the full court report. This refers only to published law reports of which there is a wide range available in higher court jurisdictions.

As stated above, cases may also be found online via the world wide web (www) or on CD-ROM or disc. The expansion of cases capable of being stored on electronic databases has resulted in unreported cases (those decisions that were not included in the printed volumes of the law reports) now being available. As an example, the unreported case of Adamson v Pharmacy Board of Tasmania [2004] TASSC 32 is able to be located on AustLII and a number of other legal databases. It is to be noted that the format of web-based and online databases differs from that of the traditional paper-based law reports.

Law reports

For a health professional to understand the common law principles that apply to their practice it is necessary to have the skills to read a case as reported. Figure 1.3 provides an overview of the features of the case of Qidwai v Brown [1984] 1 NSWLR 100.

As this is an appeal from the findings of the Medical Disciplinary Tribunal to the Court of Appeal of the New South Wales Supreme Court, Qidwai is the appellant and Brown is the respondent. The letter ‘v’ between the names of the parties is the abbreviation of the Latin word versus and signifies that the parties are against one another in the process of litigation. Directly beneath the names of the parties is the court in which the case was decided. That being the Court of Appeal. Below the court title are the names of the Justices before whom the case was heard, being Hutley, Samuels and Priestley JJA.

Next appear directly below words or phrases that are written in italics. These are the catchwords considered to be the important aspects of the case. In this case:

The following section is referred to as the ‘headnote’ which is a summary of the case. Though there is no case summary provided in the report in Qidwai, the headnote would generally contain the facts of the case which the reporter, responsible for providing the headnote to the publisher, regarded as important to that decision. It is essential for a comprehensive understanding of a case, that the entire judgment (and not just the headnote) is read. A list of cases that the court considered in reaching its decision are provided below the headnote. As Qidwai is an appeal, the last court or tribunal that decided the case is referred to next. In this case it was the Medical Disciplinary Tribunal where the appellant was found guilty of misconduct in a professional respect and reprimanded. The decision of the court, indicated by the word ‘Held’, contains the ratio decidendi. A summary of the findings of each of the judges who heard and determined the case is also provided. This may appear as separate reasons as delivered by each of the Justices or, where there is agreement (where they concur), two or more Justices may hand down a joint decision. At the end of the written determination the ‘orders’ (the judge’s final decision) handed down by the court will be reported.

As can be seen from Figure 1.4, while the formatting of web-based case reports may differ from the previous paper-based law reports, the information provided is essentially the same. The wide range of electronically based legal resources now available facilitates greater access to, and understanding of, the law. Knowledge of the Australian legal system and the legislation and case law that regulates the provision of pharmacy practise is essential to the provision of safe and competent pharmacy services.

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