This article was authored by Jyotsana Vilva from NLSIU, Bangalore.
Introduction
In today’s world, doctors and medical professionals are not only searching aggressively for cures to the numerous diseases that plague mankind, but are also on the hunt to find a cure to the increasingly pervasive crisis of medical malpractice. Historically, medical professionals and patients have typically adopted the route of litigation to tackle their medical malpractice claims. A recent Supreme Court judgement awarded one of the highest compensations for a victim of wrongful death due to medical negligence – a pay out of INR 11 Crores to be paid by the private hospital and doctors responsible for the same.[1]
With the phenomena of medical malpractice becoming increasingly commonplace, it is imperative to examine whether the process of resolution of disputes regarding the same, i.e, through litigation, is actually resulting in a resolution and closure for the parties involved and a reduction of such cases, or whether it is simply leading to a practice of defensive medicine and increased litigation. Consequentially, we need to examine whether there is a need to modify the method in which medical malpractice has been tackled in India.
While the Balram Prasad case is one story of success with medical litigation, the process of medical litigation is saddled with a host of problems, including, but not limited to the unpredictable method of calculation of compensation, time delays, costs involved with the process, and most importantly – the stress and re-traumatisation of the victims, their families, and the doctors involved. Further, the awarding of high compensation for medical malpractice claims, and these various factors involved in medical litigation have received great debate and attention due to their impact on the practice of medicine in the country, and the consequential potential transfer of rising costs to patients.[2]
In light of the same, it is argued that the adversarial system is ill suited for addressing legal issues in the healthcare and medical malpractice sector, and that the very nature of medical malpractice cases necessitates a switch to a less confrontational mode of dispute resolution, such as mediation. Part I of this paper discusses the current framework of medical malpractice in India. Part II examines the usage of litigation as the current method of dispute resolution, and argues that it does not suit the needs of legal issues in the healthcare sector. Part III argues that mediation might be a more effective method of dispute resolution in the healthcare sector. Finally, Part IV concludes by analysing the current legal and developments favouring mediation in the country, and any potential obstacles in the entrenching of medical mediation in the country.
I. Medical Malpractice in India
The healthcare sector in India, while having been affordable and within reaches of the common man previously, and heavily government subsidised, is no longer so. The sector has witnessed skyrocketing costs in recent years, not just in terms of treatment, but in insurance and litigation processes as well.[3]
Insurance companies and healthcare administrations allege that the central factor behind said increase has been the medical malpractice tort system, one which has been transferring income from doctors to lawyers.[4] The tort litigation system in the sector in essence amounts to a lottery, with some patients and their lawyers being awarded high payouts,[5] while society at large pays the price. The potentiality of high payouts for cases of medical negligence has only resulted in a trickle down of costs to the patients, in the form of increased premiums.[6] The costs of fighting a negligence or a malpractice claim is high, and 70% of claims to do not result in compensation to the plaintiff,[7] showing the extent to which our economic resources are being spent on prolonged legal methods, which could instead be put to use reducing healthcare costs.
While the Balram Prasad case did conclude with the patients receiving a high award, this was a result of a long drawn-out, weary process of 15 years of litigation, across various forums, and with various lines of reasoning being provided at every stage. One respondent had even died before the Supreme Court had pronounced its judgement, and another respondent had become ill and unemployed in the intervening years, and was thus unable to pay.[8] Even the possibility of obtaining compensation at the end of the litigation process is unpredictable. Compensation in medical negligence cases is calculated on the basis of the common law principle of restitution in integrum, i.e., restoring the injured party to the position they could have been in, had the injury not occurred.[9] While compensation typically is intended to cover a victim’s financial losses due to the negligence, pain and suffering undergone, and any future medical expenses, there exists a high level of inconsistencies with regards to the awarding of compensation as each case has to be considered individualistically on its facts.[10] This increases the power of discretion in the hands of the judges, and the level of unpredictability for a litigant.
Thus, innumerable delays in the process of litigation, the wide scope for appeals, and the high costs that are concurrent with the same, the mental trauma during the process, reputational damages, and more, all amount to a denial of justice to both parties in the dispute, with no party being the winner.
II. Healthcare Litigation: A Lost Cause
A previously discussed, litigation is the traditional method adopted to resolve disputed of medical malpractice. Thus, it must form the standard against which other methods of dispute resolution are compared to.
Litigation is often the most sought after method of dispute resolution owing to its perceived role in emotional fulfilment, and the plaintiff’s search for vindication, as they feel they have been wronged. Phrases that are often heard when a person feels that they have been legally wronged or violated include “I’m going to drag them to court for everything they’re worth” or “I’m going to hit him with a suit.”[11] It is hardly ever that you hear someone exclaim “I’m going to mediate or arbitrate this case” on being wronged. Litigation, in essence, fills the need of the aggrieved party to be heard.[12]
Faults with the Litigation process
However, it is being increasingly realised in academic circles, and in practice, that litigation may not be the most effective method of dispute resolution for medical malpractice cases.[13] In a survey of plaintiffs in medical malpractice suits, 6 faults were identified by them with regards to the process of litigation: i) a hostile atmosphere; ii) problems with regards to enforcement; iii) heavy costs involved; iv) lack of flexibility in outcomes/solutions; v) uncertainty with regards to compensation and outcome; vi) procedural delays.[14] The problem of high costs was particularly highlighted. The accumulation of costs of expert witnesses, court fees, lawyer fees, and other overhead costs could take up as much as 50% of the final compensation that the party could be awarded.[15] Thus even in the rare circumstance that there is a payout for the victim, a large proportion of the same never accrues to them.
Adversarial Faults
While numerous faults exist with the litigation process, these factors mentioned above hold true for litigation in any sector. An often neglected factor with regards to medical litigation is that the adversarial nature of the process in itself makes it unsuitable for medical dispute resolution. The demarcation of blame, the right/wrong dichotomy that litigation results in, and the psychological effects of prolonged litigation, all adversely affect the patient-doctor relationship. The rise of health maintenance organisations (organisations which enter into contracts with specific healthcare providers to offer healthcare services to its members through a prepaid plan system) and employer health insurance plans which designate the same hospital for all its employee plans necessitates the patient-doctor relationship being preserved.[16] For employees who are stuck with their providers due to inbuilt plans in their employment contract, the litigation process may not provide the closure that the patient needs to emotionally. Litigation may appease the victim’s need for vindication and closure, but it cannot by itself eliminate it.[17] Patients who have been adversely affected by medical professionals often need a process which is less formal and less highly charged than litigation, a process by which they can ask questions, vent their frustrations, and express their feelings and views.[18] The failure of the litigation process and the resultant large fallouts, i.e., costs, could also prompt extra-legal methods of handling disputes. Recently in Guangzhou in China, the dissatisfaction of the doctors’ handling of a family member’s illness and the failure of litigation prompted the patient’s family members to act out and attack the doctors responsible.[19] 4 doctors of the responsible hospital were attacked with a hammer and knife, out of which one suffered a ruptured spleen and several injuries to his eyes, and resulting in the death of another doctor.[20] This same trend of extra-legal solutions as an alternative to litigious failure is prevalent in India as well.[21]
Further, the Indian legal system is defined by its adversarial nature, which places winning at a pedestal, with less importance provided to the fact finding process and the uncovering of the best solution to the problem, or the truth.[22] In the course of the same, the failure of relationships, and aggravation of conflict is bound to take place. While the adversarial system may be appropriate for cases which require the declaration of rights, or where authoritative interpretation is required, or where negotiating would create a clear power imbalance, its uniform application to all types of disputes pertaining to various levels of conflict is problematic, and could exacerbate the medical malpractice crisis.[23] Just as the source and symptoms of a disease differ from person to person, the same goes for the roots and effects of a conflict. Resultantly, the treatment for each scenario must be tailored appropriately, instead of subjecting each case to the labours of the civil procedural code.[24] Reforming the system effectively involves both a substantive re-haul both in terms of ethics and efficiency.
Lack of Deterrence Value
Finally, deterring medical malpractice thought the method of punitive compensation, or simply even compensating the losses of the aggrieved parties, does not solve the dilapidated condition of India’s healthcare sector, and the problem of increasing medical malpractice incidences, and the need to control private healthcare providers.[25] It has been empirically shown that the compensation-deterrence principle of torts, i.e., the imposition of liability leading to future deterrence of negligence, has not held true.[26] One reason for the same could be that the medical professional who undergo a trial for their apparent malpractice charge undergoes a large amount of psychological strain and self-doubt during the process, which negatively affects their performance.[27] These doctors are disengaged and distracted by the ongoing proceedings, feel vilified due to the adversarial nature of the proceedings, are ostracised by their patients and peers, all to the detriment of their professional self-confidence and medical decision making ability.[28] Essentially, the litigation process could itself lead to future mistakes.
Thus, as the overly adversarial litigation process in India is not suited to the healthcare sector for the reasons detailed above, and in fact, could exacerbate the problems in this sector, litigation clearly is not an effective means of resolving the disputes arising from the healthcare industry.
III. Mediation: A More Suitable Alternative
Alternative dispute resolution mechanisms like Mediation have immense potential to reform the tort based medical malpractice dispute resolution system, and has been gaining traction in several countries, due to its excellent track record of increasing party satisfaction, and decreasing costs.[29] Mediation is a voluntary process by which both parties to a dispute agree to participate in an interactive, structured discussion of the matter at hand, with the help of a trained neutral third party, who assists in arriving at a settlement.[30] The focus of mediation is the retention of the relationship between the parties, and this it emphasises on communication and cooperation between them.[31] The goal of the mediation process is to arrive at dynamic, mutually-acceptable solutions for both the parties involved, keeping in mind both their interests, and not simply the allocation of liability.[32]
While the process of preparation for a medical mediation may involve some of the steps of the litigation process, such as discovery, the conducting of depositions, presentation and discussion of evidence, opening and closing arguments,[33] the goals of the mediation process differ. Amongst the goals of mediation are enhancing opportunity for closure, opening avenues of communication and restoration of relationships, flexible and viable solutions to the problem, all in a time and cost effective manner.[34] Thus, the goals of mediation are themselves in harmony with the ultimate goal of medicine – healing. On the other hand, the overly adversarial litigation process does not promote healing at all, and in fact, could even open the aggrieved patients and family members up to re-traumatisation.
Mediation would provide the most effective method of ultimately resolving disputes arising from the healthcare sector, and provides several benefits for the parties involved in the process.
Confidentiality
Lawyers litigating issues of medical malpractice more often insist that their doctor clients refrain from interacting with or making any communications with the aggrieved patient, so as to avoid their clients making any incriminating statements.[35] This stifles the patient’s avenues to ask questions, seek answers, or hear a simple apology, which are all pathways to their closure. However, this is not a problem with Mediation as the outcome of the mediation process and the discussions and documents produced during the course of the process are all kept confidential by the parties involved during the course of settlement, and an additional confidentiality clause can be imposed by the parties (at their behest and volition) at the time of writing up settlement terms.[36] The parties are encourages to speak freely, and the questions posed by the aggrieved party, and explanations provided by the doctor in a confidential setting enable the aggrieved party to obtain closure with regards to information, abate their anger, and move towards a mutually amenable solution.[37]
Time and Cost Savings
Empirical evidence from ADR organisations resolving medical malpractice disputes in the USA have shown that the time taken to mediate disputes usually amount to around 85-165 days, with an average attorney preparation time of 10 hours. This is as opposed to the average litigation taking 5 at minimum to arrive at a conclusion, with preparation time being 36 hours.[38]
Mediation shows an average of 90% party satisfaction, saving of $50,000 per case, and a success rate of 75-90% in avoiding litigation.[39] The skyrocketing costs associated with litigation are avoided, and the aggrieved party retains a larger portion of the compensation, as well as other benefits.[40]
Maintenance of Relationship
As the adversarial nature and hostile atmosphere of the dispute settlement process has been removed, and due to the element of confidentiality, the erring party is more willing to provide information about the issue at hand, without the looming fear of criminal prosecution. The forum of mediation provides an opportunity for the doctor to apologise and respond to the questions and needs of the patient.[41] As the tensions have been vastly allayed by the process, the doctor-patient relationship has a higher chance of surviving.[42] This, as previously mentioned, is beneficial in the face of rising instances of employee insurance plans and HMOs.
Deterrence Value
Mediation allows for creative solution outside the binary of penalty-compensation which is associated with litigation. Several mediation programmes in the USA, such as the Massachusetts Board of Medical Registration programme, show a 90% settlement rate, with many cases using corrective action as an alternative to money.[43] A clinical trial system was agreed to change their information system which had endangered a patient; a paediatrician modified his office procedures so as to account for children playing with unsupervised devices; a urologist agreed to take an updated training course so as to better detect early stage cancer; d more, have all been the outcomes of mediation processes.[44] These solutions could drastically improve healthcare quality and service, and patient safety, and could concretely reduce the occurrence of physician mistakes. Further, the tendency of defensiveness and oppositional feelings of doctor respondents in a malpractice trial can be avoided.
Other Creative Remedies
As previously discussed, the informal atmosphere of mediation facilitates creative remedies such as expressions of sympathy, admissions of negligence, operation of new safety protocols, physician training programmes in new areas, corrective treatment for the patient, improved training programmes for hospital staff, etc, which could prove to be more satisfying for the patient,[45] and more beneficial in the long run.[46] Monetary compensation has found to be less important to the patients than information regarding the event, an apology, and an assurance of no future mistakes.[47] In fact, the component of aggrieved parties needing to be heard which litigation provides is better provided through mediation. The use of apologies programmes as a component in several mediation programmes such as Philadelphia’s Drexel University Medical Centre, and Chicago’s Rush-Presbyterian-St. Luke’s Medical Centre have made their dispute settlement programmes immensely successful.[48] As the settlements have been negotiated by and agreed upon by both parties, they have the greatest possibility of success and satisfaction. The adversarial system prevents the same as their parties often mask their interests and needs in face of the hostile environment.[49]
Finally, even in the event of failure of the process of mediation, or if the parties decide to opt out of mediation mid-way, the mediation process would have led to the clarification of several issues, thus expediting the fact finding and arguments process during trial.[50]
Thus we can see that the cooperative and communicative settlement of medical malpractice disputes through the process of mediation proves to be a much for effective means than the adversarial method of litigation, both in terms of a final settlement of the issue, and for the satisfaction of the aggrieved party, which is paramount.
IV. Legal Developments Favouring Mediation In India, and Obstacles to the Same
The current legal and political framework in the country has been moving towards a more ADR friendly approach for the settlement of disputes. This is especially necessary considering the fact that there are over 30 million cases pending before the various courts, with an average life span of trial being 13 years. Litigants in total shell out nearly INR 30,000 Crores just to attend proceedings before the courts.[51]
In light of the same, the government has taken several steps to incorporate mediation into the dispute resolution framework. The Code of Civil Procedure, 1908, already mandates that the court shall direct parties (after the recording admissions and denials in plaint and written statements) to opt for any one mode of alternative dispute resolution amongst arbitration, mediation, conciliation, judicial settlement through Lok Adalats.[52] In the case of Afcons Infrastructure and Ors. v Cherian Varkey Construction and Ors., it was held that all cases necessarily have to be considered for ADR (but not necessary to refer all cases for them).[53] Further, as per the amendment to Sec 16 of the Court Fees and Valuations Act, if a matter is settled by ADR, the court fee will be refunded.[54] This was upheld by a recent Delhi HC judgement which held that “in cases which have been referred to mediation by the court at pre-evidence stage and where a compromise decree has been incorporated, an interpretation of the statute inuring to the litigant’s benefit should be preferred, and if a plaintiff is able to demonstrate that the case falls within the requirements of Section 16 and a settlement has been arrived at, refund of the full amount of the court-fee ought to be granted.”[55]
Other steps taken by the government have been the various court annexed mediation programmes in various states, such as the Bangalore Mediation Centre. The Centre boasts of an 80% success rate of settling cases on the first day itself, a 60% settlement success rate overall, and an average time span of 90 days for completion of the process.[56] As recently as August, 2018, the central government passed the Commercial Courts, Commercial Division and Commercial Appellate Division of High Courts (Amendment) Bill, 2018, which creates a provision for mandatory mediation prior to the institution of a commercial suit, in matter which do not require interim relief immediately.[57]
Finally, other bodies such as the Mediation and Conciliation Network, a consortium of non-profit and commercial initiative to provide ADR services, have started offering mediation services with regards to medical malpractice issues.[58]
Obstacles
However, the road to medical mediation is not without its share of problems. Healthcare, by its very nature, carries inequalities with regards to the level of information, control, and power of the parties.[59] Information asymmetries are especially common, both with regards to information provided by the patient, and that information and medical knowledge which lies with the doctor. This makes the reconciliatory process harder, but is a problem which can be surmounted through making information about medical procedures more widespread. The open and conciliatory process of mediation further facilitates information sharing.
There also exists a level of scepticism with regards to medication of medical disputes due to the lack of information about the benefits of mediation.[60] Parties often do not suggest mediation despite wanting to exercise that option, fearing that the other party could consider it a sign of weakness in their case.[61] Further, the lack of enforcement power in mediation weakens its image. Again, the disbursal of information and the education of both litigators and the general populace about the process and cases of mediation, and its benefits for both parties, can help allay the same.
Conclusion
There exists a need to overhaul the manner in which India addresses its problems of medical malpractice. The problems of transfer of rising costs to patients, the increase in insurance premiums, and the potential practice of defensive medicine, all result in negative impacts on the patients – the party who is supposed to benefit from such litigation. The doctor involved, whether actually at fault or not, does not benefit either, with the psychological stress often leading to increased risk of further mistakes and perpetuation of a vicious cycle. The systemic fault with the litigation process, such as judicial discretion, uncertain payouts, time delays, huge costs of litigating, only burden the healthcare sector more. For a country such as India in which their exists low drive to improve the healthcare sector, the wide chasm between rural and urban healthcare, a paucity of human resources, and a lack of investment in healthcare, the traditional model of adversarial litigation is woefully inadequate, damaging, and lacks deterrent value. In light of the same, a system such as mediation would prove all the more efficient, satisfactory, less emotionally exhausting, and cheaper. India can especially benefit by learning from the mediation and apology models adopted by countries such as USA, Singapore, and South Africa, who have had an excellent track record with medical mediation in the recent past.
However, one of the real barriers to mediation is its potential impact on litigator’s revenues. Attorneys typically view mediation as an economic threat, as it reduces their contingency fees, the time billable on extensive preparation and research for trial, and lesser appearances for them.[62] By focussing on the interests and needs of the parties, and involving them personally in the process, monetary considerations such as payouts are excluded in favour of non-material settlements such as changes in practice or apologies. Thus, it is not hard to potentially see lawyers’ opposition to medical mediation as an alternative mode of dispute resolution. In light of the same, a legislation by the central government mandating medical mediation may be the best means to tackle this problem, and to give the parties involved more agency in the process. Education about legal processes, as well, would prove to be one of the best methods of tackling the current pro-litigation atmosphere, and ushering in an age of ADR and Mediation.
[1] Balram Prasad v. Kunal Saha, (2014) 1 SCC 384.
[2] Meghana S. Chandra and Suresh Bada Math, Progress in Medicine: Compensation and Medical Negligence in India: Does the System Need a Quick Fix or an Overhaul?, 19(1) Annals of Indian Academy of Neurology, 21 (2016).
[3] Edward Premdas Pinto, The jurisprudence of emergency medical care in India: an ethics perspective, 2(4) Indian Journal of Medical Ethics 125 (2017).
[4] Florence Yee, Mandatory Mediation: the Extra Dose Needed to Cure the Medical Malpractice Crisis, 7 Cardozo Journal of Conflict Resolution 393 (2009).
[5] Balram Prasad v. Kunal Saha, (2014) 1 SCC 384; V. Krishnakumar v. State of Tamil Nadu, AIR (2015) SC 4283; Nizam’s Institute of Medical Sciences v. Prashant S. Dhanaka, (2009) 6 SCC 1.
[6] Florence Yee, Mandatory Mediation: the Extra Dose Needed to Cure the Medical Malpractice Crisis, 7 Cardozo Journal of Conflict Resolution 393, 403 (2009).
[7] S.V. Joga Rao, Medical negligence liability under the consumer protection act: A review of judicial perspective, 25(3) Indian Journal of Urology 361 (2009).
[8] Balram Prasad v. Kunal Saha, (2014) 1 SCC 384.
[9] Malay Kumar Ganguly v. Sukumar Mukherjee and Ors., (2009) 9 SCC 221.
[10] Meghana S. Chandra and Suresh Bada Math, Progress in Medicine: Compensation and Medical Negligence in India: Does the System Need a Quick Fix or an Overhaul?, 19(1) Annals of Indian Academy of Neurology, 21 (2016).
[11] David T. Caldon, Medical Malpractice Disputes in the Age of Managed Care, Mediate, (Apr. 18, 2018), www.mediate.com/articles/caldon.cfm.
[12] David T. Caldon, Medical Malpractice Disputes in the Age of Managed Care, Mediate, (Apr. 18, 2018), www.mediate.com/articles/caldon.cfm.
[13] Rita Lowery Gitchell, and Andrew Plattner, Mediation: A Viable Alternative to Litigation, 2 Depaul Journal of Health Care Law 421, 423 (1999); Malpractice Disputes in the Age of Managed Care, Mediate, (Apr. 18, 2018), www.mediate.com/articles/caldon.cfm.
[14] Justice R.V. Raveendran, Mediation: Its Importance and Relevance, 10 The Practical Lawyer (2010).
[15] Justice R.V. Raveendran, Mediation: Its Importance and Relevance, 10 The Practical Lawyer (2010).
[16] Kelly K. Meadows, Resolving Medical Malpractice Disputes in Massachusetts: Statutory and Judicial Initiatives in Alternative Dispute Resolution, 4 Suffolk Journal of Trail and Appellate Advocacy 165, 167 (1999).
[17] Scott Forehand, Helping the Medicine Go Down: How a Spoonful of Mediation Can Alleviate the Problems of Medical Malpractice Litigation, 14 Ohio State Journal on Dispute Resolution 907, 909 (1999); Kelly K. Meadows, Resolving Medical Malpractice Disputes in Massachusetts: Statutory and Judicial Initiatives in Alternative Dispute Resolution, 4 Suffolk Journal of Trail and Appellate Advocacy 165, 167 (1999).
[18] K. Ganesh, Patient-doctor relationship: Changing perspectives and medical litigation, 25(3) Indian Journal of Urology, 356 (2009).
[19] Mandy Zuo, Mediation, not more security, the cure for hospital violence in China, South China Morning Post, Nov. 03, 2013.
[20] Mandy Zuo, Mediation, not more security, the cure for hospital violence in China, South China Morning Post, Nov. 03, 2013.
[21] Ashish Pandey, Doctor attacked by patient’s relatives in NIMS Hyderabad, India Today, May 30, 2018.
[22] Conference Report, Conference sponsored by the Law Commission of India on ADR/ Mediation (May 3-4, 2003), http://lawcommissionofindia.nic.in/adr_conf/sriram17.pdf.
[23] Conference Report, Conference sponsored by the Law Commission of India on ADR/ Mediation (May 3-4, 2003), http://lawcommissionofindia.nic.in/adr_conf/sriram17.pdf.
[24] Conference Report, Conference sponsored by the Law Commission of India on ADR/ Mediation (May 3-4, 2003), http://lawcommissionofindia.nic.in/adr_conf/sriram17.pdf.
[25] Scott Forehand, Helping the Medicine Go Down: How a Spoonful of Mediation Can Alleviate the Problems of Medical Malpractice Litigation, 14 Ohio State Journal on Dispute Resolution 907, 909 (1999).
[26] Results of the Harvard Medical Practice Study III, 325 New England Journal of Medicine 245, 245-51 (1991).
[27] Passineau, Why Burned-out Doctors Get Sued More Often, Med-econ (May 04, 1998); Thommasson, et al., Patient Safety and Implications of Medical Malpractice Claimed Resolution Procedures, In Proceedings of Enhancing Patient Safety and Reducing Errors in Healthcare (1998).
[28] Passineau, Why Burned-out Doctors Get Sued More Often, Med-econ (May 04, 1998)
[29] Scott Forehand, Helping the Medicine Go Down: How a Spoonful of Mediation Can Alleviate the Problems of Medical Malpractice Litigation, 14 Ohio State Journal on Dispute Resolution 907 (1999).
[30] Conference Report, Conference sponsored by the Law Commission of India on ADR/ Mediation (May 3-4, 2003), http://lawcommissionofindia.nic.in/adr_conf/sriram17.pdf.
[31] Florence Yee, Mandatory Mediation: the Extra Dose Needed to Cure the Medical Malpractice Crisis, 7 Cardozo Journal of Conflict Resolution 393 (2009).
[32] Florence Yee, Mandatory Mediation: the Extra Dose Needed to Cure the Medical Malpractice Crisis, 7 Cardozo Journal of Conflict Resolution 393 (2009).
[33] Rita Lowery Gitchell, and Andrew Plattner, Mediation: A Viable Alternative to Litigation, 2 Depaul Journal of Health Care Law 421, 423 (1999).
[34] Eric Galton, Mediation of Medical Negligence Claims, 28 Capital University Law Review 321, 321 (2000).
[35] Sheila M. Johnson, A Medical Malpractice Litigator Proposes Mediation, 52 Dispute Resolution Journal 42, 51 (1997).
[36] Sheila M. Johnson, A Medical Malpractice Litigator Proposes Mediation, 52 Dispute Resolution Journal 42, 51 (1997).
[37] Sheila M. Johnson, A Medical Malpractice Litigator Proposes Mediation, 52 Dispute Resolution Journal 42, 51 (1997).
[38] Eric Galton, Mediation of Medical Negligence Claims, 28 Capital University Law Review 321, 321 (2000).
[39] Scott Forehand, Helping the Medicine Go Down: How a Spoonful of Mediation Can Alleviate the Problems of Medical Malpractice Litigation, 14 Ohio State Journal on Dispute Resolution 907, 919 (1999).
[40] Scott Forehand, Helping the Medicine Go Down: How a Spoonful of Mediation Can Alleviate the Problems of Medical Malpractice Litigation, 14 Ohio State Journal on Dispute Resolution 907, 919 (1999).
[41] Rita Lowery Gitchell, and Andrew Plattner, Mediation: A Viable Alternative to Litigation, 2 Depaul Journal of Health Care Law 421, 423 (1999).
[42] Rita Lowery Gitchell, and Andrew Plattner, Mediation: A Viable Alternative to Litigation, 2 Depaul Journal of Health Care Law 421, 423 (1999).
[43] Edward A. Dauer et al., Prometheus and the Litigators A Mediation Odyssey, 21 Journal of Legal Medicine 159, 161 (2000).
[44] Edward A. Dauer et al., Prometheus and the Litigators A Mediation Odyssey, 21 Journal of Legal Medicine 159, 161 (2000).
[45] Edward A. Dauer et al., Prometheus and the Litigators A Mediation Odyssey, 21 Journal of Legal Medicine 159, 161 (2000).
[46] Edward A. Dauer et al., Prometheus and the Litigators A Mediation Odyssey, 21 Journal of Legal Medicine 159, 161 (2000).
[47] Amy B. Jenkins, Preparing for Effective Participation in Mediation, 27 Wyoming Law Review 21, 22 (2004).
[48] Edward A. Dauer, Apology in the Aftermath of Injury: Colorado’s “I’m Sorry” Law, 34 Colorado Law Review 47, 48 (2006).
[49] Amy B. Jenkins, Preparing for Effective Participation in Mediation, 27 Wyoming Law Review 21, 22 (2004).
[50] Florence Yee, Mandatory Mediation: the Extra Dose Needed to Cure the Medical Malpractice Crisis, 7 Cardozo Journal of Conflict Resolution 393 (2009).
[51] K. Giriprakash, How private mediation helps corporates solve disputes faster, Business Line (KJune 11, 2018).
[52] Order 10, Rule 1A, The Code of Civil Procedure, 1908.
[53] Afcons Infrastructure and Ors. v. Cherian Varkey Construction and Ors., 2010 (8) SCC 24.
[54] Sec. 16, Court Fees Act, 1985.
[55] Nutan Batra v. M/s Buniyaad Associates, CS(COMM) 1464/2016 I.A. 13454/2016.
[56] K. Giriprakash, How private mediation helps corporates solve disputes faster, Business Line (KJune 11, 2018).
[57] Juhi Gupta, Mandatory Pre-Institution Commercial Mediation In India: Premature Step In The Right Direction, Kluwer mediation Blog (Sept. 01, 2018), http://mediationblog.kluwerarbitration.com/2018/09/01/mandatory-pre-institution-commercial-mediation-india-premature-step-right-direction/.
[58] Juhi Gupta, Mandatory Pre-Institution Commercial Mediation In India: Premature Step In The Right Direction, Kluwer mediation Blog (Sept. 01, 2018), http://mediationblog.kluwerarbitration.com/2018/09/01/mandatory-pre-institution-commercial-mediation-india-premature-step-right-direction/.
[59] Meghana S. Chandra and Suresh Bada Math, Progress in Medicine: Compensation and Medical Negligence in India: Does the System Need a Quick Fix or an Overhaul?, 19(1) Annals of Indian Academy of Neurology, 21 (2016).
[60] Meghana S. Chandra and Suresh Bada Math, Progress in Medicine: Compensation and Medical Negligence in India: Does the System Need a Quick Fix or an Overhaul?, 19(1) Annals of Indian Academy of Neurology, 21 (2016).
[61] Meghana S. Chandra and Suresh Bada Math, Progress in Medicine: Compensation and Medical Negligence in India: Does the System Need a Quick Fix or an Overhaul?, 19(1) Annals of Indian Academy of Neurology, 21 (2016).
[62] Andreas Nelle, Making Mediation Mandatory: A Proposed Framework, 7 Ohio State Journal on Dispute Resolution, 287, 293 (1992).
