Towards a Patient Advisory and Liaison Service

Overview

The Patient Advisory and Liaison Service (PALS) is a patient-focused initiative designed to assist individuals and their families navigate healthcare systems efficiently. It acts as a bridge between patients and healthcare providers, ensuring that patients receive appropriate, fair, and ethical medical care.

Objectives

Providing Guidance on Medical and Legal Rights: Many patients are unaware of their legal rights and entitlements concerning medical treatment. PALS educates patients about their rights under healthcare laws, medical ethics, and consumer protection regulations, enabling them to make informed decisions.

Addressing Complaints and Grievances: PALS is a dedicated platform where patients can voice concerns about medical negligence, overcharging, misdiagnosis, poor treatment, and ethical violations. It ensures that complaints are processed efficiently and resolved fairly.

Facilitating Communication Between Patients and Healthcare Providers: Miscommunication often leads to misunderstandings and dissatisfaction. PALS ensures that patients clearly understand their treatment plans, diagnoses, and medical bills, fostering transparency between healthcare professionals and patients.

Ensuring Transparency in Medical Treatment and Billing: Hospitals and medical practitioners are required to maintain ethical billing practices. PALS monitors and prevents unethical financial exploitation, such as unnecessary medical procedures, inflated charges, and hidden costs.

Providing Support to Patients and Their Families: Serious medical conditions can be distressing for patients and their families. PALS provides emotional and legal support, helping them navigate complex healthcare procedures, medical insurance claims, and second opinions.

Promoting Patient-Centric Healthcare Policies: PALS collects data on patient grievances and collaborates with policymakers, hospitals, and legal experts to propose policy improvements, making healthcare more accessible and patient-friendly.

Legal Framework

The following legal provisions form the backbone of PALS to protect patients’ rights and ensure healthcare providers operate ethically:

The Clinical Establishments (Registration and Regulation) Act, 2010

This Act mandates the registration of all medical establishments, including hospitals, clinics, and diagnostic centres, ensuring they adhere to standardised healthcare practices. It regulates:

1. Infrastructure and Facilities: Hospitals must meet prescribed hygiene, medical equipment, and emergency care standards.

2. Transparency in Treatment: Ensures that healthcare facilities provide clear information about treatment protocols and charges.

3. Ethical Practices: Prevents medical institutions from engaging in malpractices such as overcharging or providing unnecessary treatments.

Consumer Protection Act, 2019

This law recognises patients as consumers and healthcare services as a service, enabling patients to seek redress for grievances. Key provisions include:

1. Medical Negligence: Patients can claim compensation if a doctor or hospital provides substandard care resulting in harm.

2. Deficiency in Service: Patients can take legal action against hospitals for issues like incorrect billing, denial of treatment, and unhygienic conditions.

3. Jurisdiction for Complaints: Patients can file complaints with Consumer Disputes Redressal Commissions at district, state, or national levels, depending on the claim’s value.

National Medical Commission (NMC) Guidelines (Formerly MCI Guidelines)

The NMC guidelines establish ethical and professional responsibilities for medical practitioners, ensuring patient protection and accountability. The key aspects include:

Patient Rights & Dignity:

Patients must be treated with respect and dignity, regardless of socio-economic status.

No discrimination based on caste, religion, gender, or financial background.

Informed Consent:

Doctors must explain all risks, benefits, and alternatives before performing any medical procedure.

Written consent is mandatory for surgeries and invasive treatments.

Confidentiality of Patient Information:

Hospitals and doctors must ensure that patient medical records remain private.

Patient data can only be disclosed with the patient’s consent or under legal obligations.

Prohibition of Commission-Based Referrals:

Medical professionals cannot accept commissions for patient referrals.

Ensures referrals are based purely on medical necessity rather than financial gain.

Fair Billing Practices:

Patients must receive clear and itemised bills for all treatments.

Unnecessary tests and inflated charges are strictly prohibited.

Medical Negligence & Accountability:

Adherence to standardised treatment protocols is mandatory.

Patients can file complaints against doctors for misconduct with the State Medical Council.

Right to Information (RTI) Act, 2005

This Act allows patients to seek transparency in hospital policies and billing. It ensures:

1. Access to Medical Records: Patients can request copies of their reports and hospital bills.

2. Transparency in Treatment Costs: Hospitals must disclose treatment costs to prevent hidden charges.

3. Public Accountability: Patients can file RTI applications to obtain information regarding hospital policies, government health schemes, and patient welfare programs.

Disaster Management Act, 2005

This Act regulates emergency healthcare responses in cases of pandemics or disasters. It ensures:

1. Healthcare Preparedness: Hospitals must be equipped to handle public health emergencies.

2. Legal Protections for Patients: Prevents denial of treatment during crises.

3. Government Intervention: Allows authorities to regulate hospitals and private healthcare facilities to ensure public safety during emergencies.

Criminal Laws

Bharatiya Nyaya Sanhita – BNS & Bharatiya Nagarik Suraksha Sanhita – BNSS cover medical negligence, fraud, and malpractice, including:

Section 123 (BNS) – Medical Negligence: Doctors can be liable for reckless treatment that harms patients, including failure to diagnose, incorrect prescriptions, and surgical errors.

Section 270 (BNS) – Fraudulent Practices: Legal action can be taken against hospitals engaging in unethical billing, unnecessary treatments, or false advertising of medical services.

Section 304A (BNS)—Death Due to Negligence: If a patient dies due to medical negligence, the doctor or hospital responsible may face criminal charges.

Section 341 (BNS) – Wrongful Restraint: Hospitals cannot detain patients for non-payment of bills, and any forceful detention can lead to criminal prosecution.

Section 420 (BNS)—Cheating: Fraudulent hospital practices, such as misrepresenting medical services, can lead to legal consequences.

Role of the Law of Torts

The Law of Torts is crucial in ensuring that patient’s rights are protected and healthcare providers are held accountable for wrongful actions. Since tort law primarily deals with civil wrongs and compensation, it provides legal remedies for patients who suffer harm due to medical negligence, unethical practices, or service deficiencies.

Medical Negligence

Definition:

Medical negligence occurs when a healthcare provider fails to meet the expected standard of care, harming a patient.

Key Elements of Medical Negligence:

To prove medical negligence, the following four elements must be established:

Duty of Care – The doctor or hospital was legally obligated to provide proper medical treatment.

Breach of Duty – The healthcare provider failed to meet the standard of care.

Causation – The patient suffered direct harm due to this breach.

Damages – The patient incurred physical injury, emotional distress, or financial loss.

Example

A surgeon leaves a foreign object inside a patient’s body during surgery, leading to infection and complications. The patient can sue for negligence, seeking compensation for pain, suffering, additional medical costs, and lost wages.

Legal Remedies

Compensation under tort law through civil courts.

Legal action under the Consumer Protection Act 2019 classifies medical negligence as a deficiency in service.

Deficiency in Service (Under the Consumer Protection Act, 2019)

Definition

The Consumer Protection Act of 2019 recognises patients as consumers and healthcare services as a service. If a medical service is inadequate, improper, or unfair, patients can file complaints against hospitals and doctors.

Examples of Deficiency in Service

Overcharging a patient beyond the agreed-upon rates.

Denying emergency medical care without a valid reason.

Providing incorrect or delayed treatment leads to worsening of the patient’s condition.

Legal Recourse

Patients can file complaints before the Consumer Disputes Redressal Commissions (District, State, or National) to seek:

Compensation for financial losses.

Reimbursement of medical expenses.

Punitive damages against the hospital or doctor for unethical practices.

Assault and Battery in Medical Treatment

Definition:

In tort law, assault and battery occur when a medical procedure is performed without the patient’s consent.

Battery: Unauthorized physical contact with the patient, such as performing surgery without consent.

Assault: Threatening a patient or forcing them into a medical procedure against their will.

Examples

A doctor conducts surgery without obtaining proper informed consent from the patient.

A hospital administers treatment, except in emergencies, despite the patient’s refusal.

Legal Implications

Patients can sue for assault and battery under tort law.

The hospital/doctor may face disciplinary action from medical regulatory bodies.

Criminal charges can be filed under Section 351 (Assault) and Section 352 (Battery) of the IPC.

False Imprisonment in Hospitals

Definition:

Hospitals illegally detaining patients due to unpaid bills or other non-medical reasons amounts to false imprisonment under tort law.

Examples

A patient fully recovers, but the hospital refuses to discharge them until pending bills are cleared.

A mental health patient is wrongfully confined without legal authorisation.

Legal Remedies

The patient can file a lawsuit for wrongful confinement and claim damages.

The hospital may be penalised for violating patient rights.

Criminal action can be initiated under Section 340 (Wrongful Confinement) and Section 342 (Punishment for Wrongful Confinement) of the IPC.

Defamation in Medical Cases

Definition:

Defamation occurs when a healthcare provider makes false and damaging statements about a patient, harming their reputation.

Types of Defamation

Libel – Written defamatory statements (e.g., a false medical report stating that a patient is HIV positive).

Slander – Spoken defamatory statements (e.g., a doctor falsely telling others that a patient has a contagious disease).

Examples

A hospital falsely accuses patients of not paying bills and publicises the claim, damaging their reputation.

A doctor wrongly discloses a patient’s confidential medical condition to the public.

Legal Remedies

The patient can file a defamation suit under Tort Law and IPC Sections 499 & 500.

If proven, the hospital or doctor may be required to compensate the patient for the harm caused.

Other Beneficial Laws

Various Indian laws provide a legal framework to protect patients, regulate healthcare professionals, and ensure accountability.

1. Indian Medical Council Act, 1956 & MCI Guidelines

Establishes the Medical Council of India (MCI) (now replaced by the National Medical Commission).

Regulates medical education and the ethical conduct of doctors.

Ensures accountability for medical negligence and unethical practices.

Patients can file complaints against erring doctors for negligence, malpractice, or professional misconduct.

Example: A doctor prescribes unnecessary surgeries to patients for financial gain. PALS can assist the patient in filing a complaint with the Medical Council for disciplinary action.

2. Drugs and Cosmetics Act, 1940

Regulates manufacture, sale, and distribution of drugs and cosmetics.

Ensures only approved and safe medicines are available in the market.

Prevents sale of expired, substandard, or counterfeit drugs.

Example: A hospital provides expired medicines to patients, leading to complications. PALS can file a complaint with drug regulatory authorities.

3. Rights of Persons with Disabilities Act, 2016

Ensures accessibility in healthcare for persons with disabilities (PWDs).

Provides equal rights to treatment, emergency care, and insurance benefits.

Prevents discrimination against disabled patients.

Hospitals must have disabled-friendly infrastructure (ramps, wheelchairs, sign language interpreters, etc.).

Example: A hospital denies admission to a visually impaired patient, citing a lack of facilities. PALS can help the patient file a legal complaint for discrimination.

4. Transplantation of Human Organs and Tissues Act, 1994

It prevents illegal organ trading and trafficking.

Ensures ethical organ donation with proper consent.

Protects both organ donors and recipients from exploitation.

Establishes guidelines for organ transplant procedures.

Example: A patient is pressured into donating a kidney for money. PALS can report the illegal act to medical authorities.

5. Mental Healthcare Act, 2017

Ensures mental health patients receive dignified treatment.

Prohibits forced hospitalization (except in emergencies).

Provides legal protections for individuals suffering from mental illnesses.

Establishes rights such as privacy, informed consent, and non-discrimination.

Example: A hospital detains a psychiatric patient against their will, even after recovery. PALS can initiate legal proceedings against wrongful detention.

6. Biomedical Waste (Management & Handling) Rules, 2016

Holds hospitals accountable for proper medical waste disposal.

It prevents the spread of infections and environmental hazards.

Ensures segregation, treatment, and disposal of infectious medical waste.

Example: A hospital disposes of used syringes and medical waste in open areas, leading to infections. PALS can report the violation to environmental and health authorities.

7. Consumer Protection Act, 2019

Recognizes patients as consumers and healthcare services as a service.

Patients can file complaints against medical negligence, overcharging, and unfair practices.

Provides for compensation in case of medical malpractice.

Example: A hospital charges a patient double the actual bill amount. PALS can assist in filing a complaint before the Consumer Disputes Redressal Commission.

8. Right to Information Act, 2005

Patients can access their medical records, hospital policies, and treatment details.

Ensures transparency in government healthcare institutions.

Helps patients hold hospitals accountable for discrepancies.

Example: A government hospital refuses to provide a patient with medical test results. PALS can help the patient file an RTI request.

9. The Epidemic Diseases Act, 1897

Empower the government to take preventive measures during epidemics.

Regulates quarantine, hospital admissions, and public health safety.

Prevents discrimination against patients suffering from infectious diseases.

Example: During COVID-19, a hospital refuses treatment to a patient based on fear of infection. PALS can report the violation to health authorities.

10. The Clinical Establishments (Registration and Regulation) Act, 2010

Ensures all hospitals meet minimum quality standards.

It prevents overcharging and mismanagement in private hospitals.

Provides guidelines on emergency treatment, patient rights, and hospital transparency.

Example: A hospital denies treatment to an accident victim, citing lack of payment. PALS can file a complaint with regulatory authorities.

11. The Medical Termination of Pregnancy (MTP) Act, 1971

Regulates safe and legal abortion services.

Ensures privacy and informed consent for women seeking abortions.

Protects women from forced pregnancies and unsafe medical procedures.

Example: A hospital refuses to provide an abortion to a woman despite legal eligibility. PALS can assist in legal action against the hospital.

Indian Medical Council Act, 1956 → Ensures ethical medical practices.
Drugs and Cosmetics Act, 1940 → Regulates medicines and prevents the sale of substandard drugs.
Rights of Persons with Disabilities Act, 2016 → Protects disabled patients’ rights.
Transplantation of Human Organs Act, 1994 → Prevents illegal organ trading.
Mental Healthcare Act, 2017 → Prevents wrongful detention of mental health patients.
Biomedical Waste Rules, 2016 → Ensures proper disposal of hazardous hospital waste.
Consumer Protection Act, 2019 → Allows patients to seek compensation for medical negligence.
RTI Act, 2005 → Ensures transparency in medical services.
Epidemic Diseases Act, 1897 → Regulates public health during epidemics.
Clinical Establishments Act, 2010 → Regulates private and public hospitals.
MTP Act, 1971 → Protects women’s reproductive rights.

These laws provide a legal framework for patient advisory and liaison services (pals), protect patient rights, regulate healthcare institutions, and ensure ethical treatment. By leveraging these laws, PALS can effectively protect patients from medical negligence, ensure hospitals follow ethical standards, and advocate for patient rights.

A vital initiative

PALS is a vital initiative that empowers patients by ensuring their rights are protected, and grievances are addressed. By providing legal assistance, mediation, and transparency in medical services, PALS can create a more accountable healthcare system. With the proper legal framework, operational strategies, and patient awareness programs, PALS can significantly improve healthcare accessibility and justice for patients and their families.

Patient Guidance and Support

1. Providing Information on Healthcare Services: Educating patients about available medical facilities, treatment options, and financial aid programs.

2. Explaining Patient Rights: Ensuring patients understand their rights under healthcare laws, consumer protection acts, and medical ethics guidelines.

3. Assisting with Consent and Medical Procedures: Guiding patients through complex medical procedures and ensuring they provide informed consent before treatment.

Handling Patient Grievances and Complaints

1. Receiving and Documenting Complaints: Establishing an accessible system (helplines, online portals, in-person offices) where patients can register grievances.

2. Investigating Complaints: Investigate allegations of medical negligence, overcharging, misdiagnosis, or unethical behaviour.

3. Mediation Between Patients and Healthcare Providers: Facilitating discussions between patients and hospitals to resolve disputes amicably.

4. Escalation to Legal Authorities: If serious misconduct is detected, cases are forwarded to consumer courts, medical councils, or law enforcement.

Ensuring Transparency in Medical Billing and Financial Practices

1. Monitoring Billing Practices: Ensuring that hospitals provide clear, itemized bills and do not impose hidden charges.

2. Preventing Unnecessary Medical Procedures: Evaluating whether patients are advised unnecessary tests, surgeries, or treatments for profit motives.

3. Assisting in Medical Insurance Claims: I help patients navigate complex insurance claims and ensure they receive entitled reimbursements.

Facilitating Communication Between Patients and Healthcare Providers

1. Clarify Medical Procedures and Diagnoses: Ensuring patients fully understand their medical conditions and treatment plans.

2. Address Language and Cultural Barriers: Providing translation services or cultural mediation where necessary.

3. Ensure Respectful Treatment: Addressing complaints about rude or dismissive behaviour by medical staff.

Providing Emotional and Psychological Support

1. Offering Counseling Services: Assisting patients and families in coping with serious diagnoses, treatment-related anxiety, or grief.

2. Connecting Patients with Support Groups: Facilitating peer support networks for individuals with similar health challenges.

Advocacy for Patient-Centric Policies

1. Identifying Systemic Issues: Collecting and analysing data from complaints to recognise patterns of malpractice or inefficiencies.

2. Engaging with Healthcare Authorities: Collaborating with medical boards, consumer protection forums, and government agencies to enhance healthcare regulations.

3. Promoting Ethical Healthcare Practices: Encouraging hospitals and clinics to adopt patient-friendly policies and adhere to high ethical standards.

Organising Legal Assistance and Representation

1. Legal Consultation for Patients: Offering preliminary legal advice to help patients understand their rights and possible legal actions.

2. Assisting in Filing Consumer Complaints: Helping patients file grievances with consumer courts or other legal bodies.

3. Providing Legal Representation: Collaborating with legal professionals ensures patients receive fair trials and just compensation.

Establishing Training and Awareness Programs

1. Workshops on Patient Rights: Conducting seminars to educate patients about their healthcare and legal rights.

2. Training Healthcare Staff on Ethical Practices: Ensuring medical professionals adhere to ethical and transparent patient care standards.

3. Community Awareness Programs: Conduct outreach initiatives in rural and urban areas to inform communities about PALS services and healthcare rights.

Developing Digital Platforms and Helplines

1. Setting Up Toll-Free Helplines: Providing a direct communication channel for patients to seek assistance.

2. Developing Online Complaint Portals: Enabling patients to report grievances through digital platforms.

3. Using Mobile Applications for Healthcare Advisory: Mobile apps offer real-time healthcare information, legal guidance, and case tracking.

Monitoring and Evaluating Healthcare Standards

1. Conducting Patient Satisfaction Surveys: Collecting patient feedback to assess hospital performance and service quality.

2. Monitoring Healthcare Facilities: Ensuring hospitals and clinics comply with regulatory standards.

3. Suggesting Policy Enhancements: Recommending amendments to laws and healthcare regulations to ensure better patient protection.

Challenge

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Hospitals and medical professionals may perceive PALS as a threat to their authority, leading to non-cooperation.

Solution:

Build strategic partnerships with hospitals and medical associations to gain their trust.

Highlight the benefits of PALS in improving hospital reputation and patient satisfaction.

Engage in dialogues with healthcare institutions to align interests and reduce resistance.

Delay in Resolving Patient Grievances

Solution:

Establish Standard Operating Procedures (SOPs) with defined timelines for resolving complaints.

Implement a real-time complaint tracking system to update patients on case progress.

Recruit dedicated grievance officers to ensure timely resolution of cases.

Legal and Bureaucratic Hurdles

Solution:

Work closely with legal experts specialising in medical law and consumer protection.

Simplify documentation requirements for filing complaints.

Advocate for policy reforms to streamline healthcare grievance redressal mechanisms.

Limited Financial Resources

Solution:

Seek government grants and funding from healthcare organisations.

Partner with corporate sponsors under Corporate Social Responsibility (CSR) initiatives.

Implement a nominal membership or service fee for sustainability while keeping services accessible to the needy.

Ensuring Confidentiality and Data Protection

Solution:

Use secure digital platforms with encryption to store patient records.

Train staff on privacy laws and maintain strict confidentiality policies.

Implement regular audits to ensure compliance with data protection regulations.

Addressing Complex Medical Disputes

Solution:

Establish a medical advisory board with doctors and healthcare specialists.

Collaborate with independent medical experts for unbiased case evaluations.

Provide mediation services to resolve disputes amicably without lengthy litigation.

Handling a High Volume of Cases

Solution:

Develop an automated complaint management system for efficient tracking.

Hire and train more staff members to manage the workload.

Prioritize cases based on urgency and severity, ensuring critical cases are addressed first.

Building Trust and Credibility

Solution:

Maintain transparency in operations by regularly publishing reports on case resolutions.

Engage in third-party audits to ensure accountability.

Promote success stories and testimonials to build credibility within the community.

Goals

Short, Medium and Long-Term

Short-Term Goals (0-6 Months)

Establish Core Team: Recruit legal, medical, and administrative professionals.

Legal Registration: Register PALS under the Cooperative Societies Act and comply with healthcare regulations.

Develop SOPs: Create clear guidelines for grievance redressal and patient assistance.

Set Up Helplines & Digital Platforms: Launch a toll-free helpline, website, and mobile app for accessibility.

Public Awareness Campaigns: Conduct educational programs on patient rights and legal protections.

 Mid-Term Goals (6 Months – 2 Years)

Strengthen Partnerships: Formalize agreements with hospitals, diagnostic centres, and legal aid organizations.

Expand Legal Assistance Services: Provide free or subsidized legal aid for consumer disputes and medical malpractice cases.

Train Healthcare Providers: Organize workshops to promote ethical medical practices.

Financial Sustainability: Secure funding through CSR initiatives, government grants, and cooperative membership fees.

Improve Efficiency: Enhance digital complaint tracking and case management systems.

 Long-Term Goals (2+ Years)

Policy Advocacy & Legal Reforms: Work with policymakers to enhance patient rights laws.

Expand to Other Regions: Establish PALS chapters in multiple districts and states.

Develop an Independent Dispute Resolution Body: Create a mediation panel to resolve healthcare disputes without litigation.

Continuous Evaluation & Improvement: Implement annual audits, data-driven policy changes, and service expansion.

Influence National Healthcare Standards: Advocate for ethical billing, transparency, and standard treatment protocols in hospitals.

Short-Term Goals (0-6 Months)

Establish Core Team: Recruit legal, medical, and administrative professionals.

Legal Registration: Register PALS under the Cooperative Societies Act and comply with healthcare regulations.

Develop SOPs: Create clear guidelines for grievance redressal and patient assistance.

Set Up Helplines & Digital Platforms: Launch a toll-free helpline, website, and mobile app for accessibility.

Public Awareness Campaigns: Conduct educational programs on patient rights and legal protections.

 Mid-Term Goals (6 Months – 2 Years)

Strengthen Partnerships: Formalize agreements with hospitals, diagnostic centres, and legal aid organizations.

Expand Legal Assistance Services: Provide free or subsidized legal aid for consumer disputes and medical malpractice cases.

Train Healthcare Providers: Organize workshops to promote ethical medical practices.

Financial Sustainability: Secure funding through CSR initiatives, government grants, and cooperative membership fees.

Improve Efficiency: Enhance digital complaint tracking and case management systems.

 Long-Term Goals (2+ Years)

Policy Advocacy & Legal Reforms: Work with policymakers to enhance patient rights laws.

Expand to Other Regions: Establish PALS chapters in multiple districts and states.

Develop an Independent Dispute Resolution Body: Create a mediation panel to resolve healthcare disputes without litigation.

Continuous Evaluation & Improvement: Implement annual audits, data-driven policy changes, and service expansion.

Influence National Healthcare Standards: Advocate for ethical billing, transparency, and standard treatment protocols in hospitals.

Steps

Steps to Establish PALS

Formation of the Core Team

1. Appoint legal experts, healthcare professionals, and patient representatives.

2. Define roles such as grievance handling, legal advisory, patient counselling, and coordination with medical institutions.

Drafting the Constitution & Bylaws

1. Clearly define the purpose, responsibilities, and operational scope of PALS.

2. Establish a framework for handling disputes and resolving patient grievances.

Developing Standard Operating Procedures (SOPs)

1. Define how patient complaints will be received, processed, and resolved.

2. Establish timelines for addressing grievances and ensure accountability.

Collaboration with Healthcare Institutions

1. Form partnerships with hospitals, clinics, and diagnostic centres.

2. Establish a communication channel for resolving patient issues directly with healthcare providers.

Setting Up Helplines & Digital Platforms:

1. Create a toll-free helpline for patient grievances.

2. Develop an online portal for complaints, legal guidance, and patient education.

Training and Awareness Programs

1. Conduct training sessions for PALS staff on medical ethics, legal rights, and communication skills.

2. Organize awareness campaigns to educate cooperative society members about PALS.

Grievance Redressal & Legal Assistance

1. Provide legal aid for medical negligence or malpractice cases.

2. Mediate disputes between patients and healthcare providers to facilitate fair resolution.

3. Offer representation in consumer forums and legal bodies for patients facing serious grievances.

4. Collaborate with legal experts and medical professionals to establish clear dispute resolution mechanisms.

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