Charges for medical recordsThe Law Society receives a large number of complaints from solicitors about charges being raised by hospitals, health trusts and GPs for providing copies of medical records and X-rays.

The most common complaints are:-- Standard administration charges of £50 -- £150 sometimes in addition to charges for photocopies.-- Photocopy charges in excess of those which solicitors are allowed to recover on taxation.-- Payment being demanded in advance of supply or supplementary unexplained charges being levied at a later date without notice.-- Differential systems of charging when the client applies under the Access to Health Records Act 1990, and when the solicitor does.Some disputes have resulted in litigation between plaintiff solicitors and health trusts.

As a result of pressure by the Law Society, the Association of Personal Injury Lawyers (APIL), the Association of Victims of Medical Accidents (AVMA) and the Legal Aid Board, the NHS Management Executive has issued guidance to hospitals which should resolve any problems.

Copies are available from G Whiting, Health Promotion Division, Department of Health, Wellington House, 133-155 Waterloo Road, London SE1 AUG.

The position is as follows:Access to clients' records-- The Access to Health Records Act 1990 gives patients a right to see their health records made after 1 November 1991 (limited exceptions).-- Reasons do not have to be given for access.-- A patient can authorise another to apply for access on his or her behalf, including a solicitor.-- It is Department of Health policy that patients be permitted to see what has been written about them and that healthcare providers should make arrangements to allow patients, if they wish, to see records other than are covered by the 1990 Act.-- Ss 33 and 34 in a Supreme Court Act 1981 provide for pre-action disclosure of medical records in personal injury cases.

An application for pre-action disclosure can be made if the records are not provided voluntarily or in reasonable time.Charges for records-- The Access to Records 1990 Act prescribes a maximum fee of £10.

Photocopying and postage costs can be charged.

No other charges may be levied.-- The NHS executive guidance makes it clear to healthcare providers that 'it is a perfectly proper use' of the 1990 Act to request records in that framework for the purposes of potential or actual litigation, whether against a third party or against the hospital or trust.-- The 1990 Act does not permit differential rates of charges to be levied if the application is made by the patient, or by a solicitor on his or her behalf, or whether the response to the application is made by the healthcare provider directly (the Medical Records Manager or a Claims Manager) or by a solicitor on their behalf.-- The NHS executive guidance recommends that the same practice should be followed with regard to charges when the records are provided under a voluntary arrangement as under the 1990 Act, except that in those circumstances the £10 access fee will not be appropriate.-- The NHS executive also advises:-- That the cost of photocopying only includes 'the cost of staff time in making copies'.-- That the common practice of setting a standard rate for an application or charging an administration fee is not acceptable because there will be cases when this fails to comply with the 1990 Act.What practitioners should do in future:-- Ensure that they enclose with any requests for medical records signed authority from the client.-- Explain the period for which the records are required, and preferably the purpose (this is not strictly necessary for a request under the 1990 Act but it will assist the heathcare provider to take appropriate steps particularly if the records have been requested for a potential medical negligence claim against that provider.)-- Ask for confirmation in advance of the fees payable, which should not exceed the £10 access fee (under the 1990 Act), plus the cost of photocopying and postage.

Excessive charges for the latter should be queried and reference made to the NHS executive guidance.Practitioners might find the Law Society's medical records protocol useful, published by the Law Society's civil litigation committee, August 1995 it is endorsed by the Department of Health.

Copies available from Susan Bolsover, Law Society Publications Unit, 50/52 Chancery Lane, WC2A 1SX on receipt of an SAE (A4).VAT on medico-legal servicesIn December 1996 HM Customs and Excise decided that in certain circumstances, there is a VAT liability on services provided by doctors to a third party.

However, as neither the initial business brief issued by Customs and Excise, nor the subsequent guidance note for the medical profession make the position completely clear; both doctors and legal practitioners seem to be uncertain about when VAT is chargeable.

VAT is chargeable when doctors are acting in a quasi-legal capacity, for instance when acting as an advocate, mediator or arbitrator or w hen providing advice on an issue of principle eg the interpretation of medical regulations.

When doctors are applying medical knowledge to advise on medical issues, they are not providing a quasi-legal service and VAT is not chargeable.

This will apply to examinations and the provision of medical reports for insurance purposes, and to all expert witness work for litigation.Queries concerning the change in liability should be addressed to HM Customs and Excise VAT Policy Directorate, Social Division, Charities and Healthcare Branch, New Kings Beam House, 22 Upper Ground, London SE1 9PJ.Charges for road accident reportsFrom time to time the Law Society receives complaints about charges raised by police forces for copies of road accident reports.

In the past the Home Office recommended standard charges which police forces should levy for supplying copies of reports to solicitors, insurance companies and members of the public.

But some forces were levying charges considerably in excess of the recommendations.Following concerns expressed, the Association of Chief Police Officers (ACPO) Traffic Committee has issued guidelines on charges to all police forces with the intention of ensuring a more uniform approach.

This guidance states that:-- Forces should charge on the basis of recovering the cost to the force of reproducing documents, including specialist accident investigation reports.

They should not be seeking to make a profit.-- The basic charge recommended for a copy of an accident report book is £50, with additional charges for additional books in relation to accidents or statement copies of £2 per page.-- The recommended charge for copies and plans is £21, photos £15, and video tapes £50.-- The recommended charge for interviews is £84.The Home Office takes the view that it has no power to direct the level of charges applied or to investigate complaints about non-compliance with the ACPO guidance.

If practitioners are charged in excess of the guidance they should contact Paul Manning honorary secretary, ACPO Traffic Committee c/o Metropolitan Police, 3-5 Penrhyn Road, Kingston-Upon-Thames, KT1 2BT.

If practitioners are still not satisfied they should write to Suzanne Burn at the Law Society, 114 Chancery Lane, WC2A 1SX.ne, WC2A 1SXtWordStar 4.0B Messages 14 Feb 87Copyright (C) 1983,1987 MicroPro International Corp.All