case introduction
patient Huang Moumou went to the defendant for treatment at around 10:00 on May 16, 2021 due to "middle-upper abdominal pain and 1 day of blackening stool". The defendant initially diagnosed Huang Moumou: 1. acute upper gastrointestinal bleeding ( peptic ulcer with bleeding?); 2. Moderate anemia; 3. gouty arthritis . The visitor is the intern physician Fu Moumou. The medical records are signed by Huang and Fu. After being admitted to the hospital, the defendant was given a diagnosis and treatment measure such as ban on drinking and fasting, inhibiting acid and protecting the stomach, phenolsulfoethylamine + azunolic acid + Yunnan Baiyao hemostasis and other diagnosis and treatment measures. After admission, the medical prescription recommended gastroscopy , but the patient said he refused and was unwilling to provide contact information from his family. At 4:25 on May 17, 2021, the patient suddenly vomited and had a fresh blood volume of about 100ml, and a fresh blood volume of about 500g of blood sample, accompanied by irritability and sweating. The defendant immediately organized medical staff to rescue the patient. At 4:45 on May 17, 2021, the patient had no spontaneous breathing and his blood pressure was not measured. The defendant immediately gave chest compressions, adrenaline static pushes and other rescued until 6:31 on May 17, 2021, and was declared clinical death. Causes of death: 1. Hemorrhagic shock; 2. Acute upper gastrointestinal bleeding; 3. Extremely severe anemia.
The plaintiff (Huang Moumou's family) believed that the defendant's hospital was at fault, resulting in Huang Moumou's death. After the negotiations between the two parties failed, the plaintiff went to the court and see the details.
Patient's opinion
Plaintiff believes that a certain health center had the following faults in the diagnosis and treatment process of patient Huang: 1. The doctor Fu Moumou's behavior of not obtaining the " doctor's professional qualification " and " doctor's professional certificate " for diagnosis and treatment violated the diagnosis and treatment standards; 2. After the patient was admitted to the hospital, hemoglobin concentration 61 was checked. .0g/L, the patient has reached the indication for blood transfusion. A certain health center has neither the transfusion conditions nor the patient transferred to the hospital for treatment in time, causing the patient to miss the best treatment opportunity; 3. The patient was seriously ill when he was admitted to the hospital, and the doctor who received the doctor insufficiently estimated the severity of the disease. During the hospitalization, the doctor on duty did not review the patient's hemoglobin concentration, which was seriously negligent; 4. The hospital did not fulfill the obligation to inform and explain, and when the patient's condition has not improved, it was not recommended that the patient go to a superior hospital with better treatment conditions for treatment. The plaintiff believes that the defendant's health center is seriously at fault for the death of the patient Huang Moumou, and should bear the liability for compensation to the plaintiff according to law.
Medical opinion
Defendant health center argued: 1. When the patient was admitted to the hospital, there was no causal relationship between the patient receiving the patient under the supervision and guidance of Huang's teaching teacher and the consequences of the sudden change in the patient's condition after the patient was hospitalized and eventually the rescue was ineffective. At the same time, while the medical staff fully fulfilled the obligation to inform the patient, they recommended that the patient undergo gastroscopy and transfer to the superior hospital for further treatment, but they were rejected by the patient. For this reason, the patient's subsequent condition mutation is the result of the natural development of the disease, and there is no causal relationship with the respondent's diagnosis and treatment behavior, and the respondent is not at fault. 2. After the patient is hospitalized, the respondent's condition has improved significantly after the existing medical conditions are given timely rescue, symptomatic diagnosis and treatment, and consultation. This shows that the respondent's diagnosis and treatment measures are correct and effective, and the respondent is not at fault. At the same time, when the patient's condition suddenly changed, the respondent was unable to obtain the opinions of the patient's close relatives, and after approval by the hospital leaders, he immediately organized relevant medical staff to provide full rescue to the patient. 3. Although the respondent had some defects in medical records, there was no causal relationship between the defect and the patient's death. To this end, the people's court is requested to reject the plaintiff's lawsuit in accordance with the law. During the trial, the defendant believed that the appraisal report determined that his fault participation was too high. Based on the diagnosis and treatment situation in this case and the defendant's responsibility, the defendant's fault was secondary responsibility, and the plaintiff asked him to bear all compensation liability without factual basis.
Judicial appraisal and administrative penalties
During the trial of this case, the plaintiff applied to this court for judicial appraisal for medical damage.Identification Opinions: The defendant subjectively did not understand the dangers and consequences of acute upper gastrointestinal bleeding, so that in the fault of objective diagnosis and treatment, there was no surgical consultation, preoperative blood type and blood preparation, and laparotomy and exploration surgery to stop bleeding as soon as possible; it was not clear and detailed information based on the specific situation of the hospital's objective reality, and transferred to the superior hospital or requested consultation or support; it was not possible to establish 1-2 sufficiently large venous channels in a timely manner; it was not possible to standardize the observation of nursing ; it was not possible to closely follow and review blood signs to understand the changes in the patient's condition; it was not possible to correctly select effective hemostasis drugs and methods; it was unable to estimate the patient's blood loss and perform effective blood replenishment volume and other behaviors that objectively did not meet the diagnosis and treatment standards. At the same time, according to the disease course records and rescue records, the patient refused to undergo gastroscopy. After admission, the defendant informed the patient of the patient's condition and treatment status, and he refused to provide family contact information. Therefore, it is believed that the patient's acute upper gastrointestinal bleeding disease, critical condition and poor medical care factors constitute an equal causal relationship with the death result. Based on the defendant's actual medical technology level and the limitations on conditions such as the lack of perfect medical equipment, the appraisal opinion suggests that the defendant's fault participation rate is 50%.
also found that witness Yin's testimony reported that when Xu Yin accompanied Huang to a health center for treatment at 10:00 on May 16, 2021, the reception staff were two women including medical student Fu and doctor Huang. The second brigade of Comprehensive Administrative Law Enforcement in Nanning City, on July 23, 2021, the Second Brigade of Comprehensive Administrative Law Enforcement of a District of Nanning City, on July 23, 2021, imposed an administrative penalty of 5,000 yuan on the act of a medical graduate who had not obtained a medical qualification on May 16, 2021, for violating the "Ministry of Health on Issues Related to Medical Students' No Medical Qualification Certificate to Engage in Diagnosis and Treatment Activities" and Article 28 of the " Medical Institutions Management Regulations ".
Court opinion
This court believes that a judicial appraisal center has made an appraisal opinion and determined that the defendant was at fault in his diagnosis and treatment behavior. The appraisal opinion suggested that the defendant's fault participation rate was 50%, and this court adopted it in accordance with the law. This court will not adopt the defendant's relevant defense regarding the degree of participation in the fault. Regarding the situation where the defendant's acceptance personnel claimed by the plaintiff are medical graduates who have not obtained medical qualifications and the diagnosis and treatment process violates laws and administrative regulations. The defendant's treatment behavior violates the mandatory provisions of administrative regulations. According to the law, it should be presumed that the medical institution is at fault. However, the time for the patient's admission to the invalid rescue of the patient was short and hasty. The rescue process was carried out under the guidance and participation of qualified medical staff. The existing evidence is not enough to prove that the irregular treatment behavior has a direct causal relationship with the patient's death consequences, but it can be used as a consideration for determining the proportion of responsibility. Based on the above situation, referring to the appraisal opinions, this court decides that the proportion of liability for the plaintiff and the defendants shall bear 50%.
Judgment result
July 9, 2022 Court judgment: A health center of the defendant compensates the plaintiff for the death compensation, funeral expenses, living expenses of the dependent, etc. 441,251.75 yuan
The author reminds
1. Is this case an illegal practice of medicine ?
This case is not an illegal practice throughout the whole process. When the patient visited the doctor, the reception process was an illegal practice because the reception staff were two women including medical student Fu Moumou, who did not have an practicing physician certificate . The instructor (practice physician) Huang Mou was not present, and the administrative agency also made a determination and imposed administrative penalties. It is certain that although illegal practice in this case is illegal, it should have no causal relationship with the patient's death, because except for the qualifications of the doctor, the treatment behavior is not at fault, the diagnosis is correct and hospitalization is admitted, which meets the diagnosis and treatment standards. Therefore, it is correct for the plaintiff in this case to voluntarily apply for judicial appraisal, otherwise the court will have reason to dismiss the plaintiff's claim for insufficient evidence.
2. If the plaintiff in this case does not apply for judicial appraisal, what should the defendant do?
Many people will say that the hospital in this case has illegal practice. If the principle of presumption of fault in Article 58 of the " Tort Liability Law" or Article 1222 of the " Civil Code ", should the court rule that the hospital bears full responsibility? The court may not necessarily support this point. If there is a fault, there must be evidence that the fault and the consequences of the damage constitute a causal relationship. Judging from the evolution of the patient's condition, most treatment behaviors are carried out by qualified doctors. It is impossible to directly determine from the medical record that there is a causal relationship between illegal practice and the death of the patient. Of course, if the defendant wants to avoid the court's direct judgment on the hospital to bear the compensation liability, he can actively apply for causal identification, and only determine whether the reception process is causal and effectual relationship with the death of the patient, and will definitely draw an identification conclusion that is beneficial to the hospital, and in the end the ball will be kicked to the patient's side.
3. How should hospitals avoid adverse consequences similar to this case?
In this case, the hospital did have many shortcomings in handling gastrointestinal bleeding. The key is that patients with gastrointestinal bleeding and hemoglobin 61g/L have insufficient assessment. Patients with a potential risk of death from major bleeding should not be admitted to the hospital by the health center, but should be transferred to the higher hospital as soon as possible (the defendant hospital claimed that the patient should be transferred to the hospital, but did not sign and left evidence, and the appraisal agency determined that it was not recommended to transfer to the hospital).
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