Medical records and pagination: the CJC report on fixed costs in lower value cases

We posted our general observations recently on the recommendations of the CJC report published in October. As a medical records pagination service, our specific area of interest is the preparation of medical records. The report makes several references to this stage of the case.

Fixed pagination costs

The report recommends that the claimant retain the responsibility for obtaining the medical records and sorting and paginating them. This was an early area of agreement within the working party (para 3.52). The working party also agreed (para 3.55) that the cost of this exercise should be included within the FRC limit, whether it was carried out by an external pagination service or inhouse. At Clinco we already operate capped or fixed fee schemes in anticipation of this provision and are expecting these to become the norm in lower value cases.

Limiting the range of the medical records

At Clinco we are increasingly asked to use our expertise and experience to prepare a core bundle of key documents at the outset, often alongside the full bundle with dual pagination.

The CJC recommended the scope of the records to be limited to:

the GP records
records from the healthcare provider(s) where the treatment giving rise to the allegations took place, and
records relating to follow-up care.

This proposal reflects current practice in the majority of cases, so there is nothing new here. The amount of records can still be very substantial. There was nothing in the report about making an analysis of relevance of medical records within a certain provider – we have seen many cases where there are years of complex history not relevant to the actual allegations. The creation of an early core bundle was also not mentioned.

There are costs savings to be made here, of particular benefit in lower value claims, and practitioners do not need recommendations from the CJC to implement them.

Clinical pagination

The report used the term ‘clinical pagination’ to describe the experts’ representatives’ preference for sorting medical records by specialty rather than pure chronological order. At Clinco, we always sort by category, specialty and (only then) date order as it makes analysis so much clearer. The exception is that a core bundle of, say, 100 pages of key medical records will often be more useful if it follows the order of events.

We’re surprised that experts have ever seen a whole bundle in chronological order (but not at all surprised they found this hard to navigate!)

Central electronic storage

The CJC report referred (para 3.54) to the ‘clear advantages’ of pagination services such as Clinco having a role in the central electronic storage of medical records and providing access to the parties. The advantages are particularly in the context of data protection for special category data. Clinco was the first independent pagination service in the UK to invest in ISO27001, the international standard in information security, precisely so that we could offer this facility to our clients. We have provided secure electronic storage of medical records for some time. This has evolved over the last year to create a secure central resource to assist our clients to enable both expert and defendant access to the collated records.

The role of the chronology – differing views

The experts’ representatives told the CJC that they did not need to receive a chronology with their instructions. At Clinco, we are asked to prepare a chronology of relevant events in most cases coming to us for pagination. The feedback we receive from both practitioners and experts is that it saves time and costs. We have even been instructed direct by the experts themselves to prepare a chronology from the records, which speaks for itself as to the usefulness. As the whole of the CJC report is restricted to lower value, less sensitive and more straightforward cases, that may be the relevant factor. We are always willing to accept cases on a ‘sort only’ basis and our indices are sufficiently detailed to provide a clear breakdown of the evidence including dates for admissions and surgery.