Introduction: Schistosomiasis is a chronic parasitic disease caused by Schistosoma genus Schistosoma. It is mainly prevalent in 73 countries in Asia, Africa and Latin America, with about 200 million people affected.

Introduction: Schistosomiasis is a chronic parasitic disease caused by Schistosoma . It is mainly prevalent in 73 countries in Asia, Africa and Latin America, with about 200 million people affected. Schistosomiasis is mainly divided into two types. One is intestinal schistosomiasis, mainly caused by Schistosoma mansoni and Schistosoma japonicum; the other is urinary schistosomiasis, caused by Schistosoma haematobium. The main epidemic in my country is schistosomiasis japonicum.

01 [Case Brief]

On March 24, 2020, Li was admitted to a hospital for treatment due to advanced schistosomiasis. Upon admission, he was diagnosed with: advanced schistosomiasis, refractory ascites (moderate) and 2 type diabetes . was hospitalized for 10 days and will go through the discharge procedures on April 3.

However, the patient did not actually leave the hospital, and went through the second hospitalization procedure on April 3 and continued treatment in the hospital. The diagnosis on that day was: Liver cirrhosis (decompensated stage) (hepatitis B + schistosomiasis), refractory Ascites (moderate), hypoalbuminemia ; chronic hepatitis B; liver cancer to be deleted? Type 2 diabetes. was hospitalized for 5 days and was discharged on April 8. The discharge diagnosis was: liver cirrhosis (decompensated stage) (hepatitis B + schistosomiasis), refractory ascites (moderate), hypoalbuminemia; chronic hepatitis B; small amount in the left chest Fluid; Liver cancer to be deleted? cholecystitis and gallstones ; type 2 diabetes; shock cause: septic shock ?

At 11:10 on April 8, the patient was transferred to the Central Hospital for continued treatment. The preliminary diagnosis of the Central Hospital was: Shock. Cause: Infectious? Hypovolemic? Acute gastroenteritis; Schistosomiasis cirrhosis , Liver ascites ; Chronic hepatitis B virus ; Type 2 diabetes. was hospitalized for nearly one day and was discharged at 10:40 on April 9. The final diagnosis was: sepsis, septic shock, hypovolemic shock; multiple organ function impairment (heart, lungs, liver , kidney); hypoalbuminemia; acute gastroenteritis; schistosomiasis cirrhosis, liver ascites; type 2 diabetes; chronic hepatitis B virus.

Patient Li died on April 9 after being discharged from hospital.

Although Li had been treated in two hospitals, the treatment at the first hospital was a crucial stage of diagnosis and treatment before being transferred to the central hospital. The patient chose a specialized hospital precisely because he knew he was in the late stage of schistosomiasis.

But there was no improvement after repeated treatment, and even resulted in death. The family decided to take the hospital to court.

02 [Rights Protection Process]

In the lawsuit, Li's family applied to challenge whether a certain hospital's medical behavior was at fault, whether there was a causal relationship between its behavior and Li's death, and whether the hospital was responsible for the patient and close relatives. Evaluate matters such as whether the necessary notification and explanation obligations have been fulfilled, and whether the opinions of patients and close relatives were solicited for the diagnosis and treatment methods adopted.

The court of first instance entrusted a judicial appraisal center to conduct appraisal, but the appraisal center believed that there were many alterations medical records including blood glucose check list (blood glucose monitoring table) and ultrasound examination report form (ultrasound medical imaging report sheet) and could not A clear appraisal opinion was made on the entrusted matter, so the appraisal process was terminated.

After verification, a hospital’s changes to patient medical records include:

(1) Li’s “blood glucose monitoring form” when he was hospitalized twice on March 24 and April 3 was altered. The "blood sugar monitoring chart" during the first hospitalization changed the blood sugar value after lunch on March 31 to 17.7. The original value was no longer visible, and all the blood sugar records from April 3 to April 8 were crossed out; The "blood glucose monitoring chart" during the second hospitalization changed the blood sugar value after breakfast on April 3, the fasting blood sugar value on April 7, and the blood sugar value at 23:00.

(2) html In the "Ultrasound Medical Imaging Report" on March 25, the value of "Pelvic Cavity" was changed to 62mm, and the original value is no longer visible; in the "Diagnostic Opinion", the value of "Ascites (mild)" was changed. ” was changed to “Ascites (moderate)”.

(3) html The "Skin, Sclera and Liver Enzymology" section of the "Admission Record for Internal Medicine Treatment of Advanced Schistosomiasis" that was hospitalized on March 24 was altered.

(4) html In the record of the first course of hospitalization on March 24, "1. Characteristics of the case: 1. Course of disease In the first course of illness record submitted by the patient's family, "2. Discussion of proposed diagnosis: 1. Abdominal distension for more than 5 years" was changed to "2. Discussion of proposed diagnosis: 1. Abdominal distension for more than 2 years" when submitted as evidence by a hospital. 5. In the course record of the first hospitalization, the ward round record of the department director on March 24, the same evidence, the one provided by the patient's family did not have the signature of the department director, but the one provided by a hospital did have the signature of the department director. 6. In the "Discharge Record of Internal Medicine Treatment for Advanced Schistosomiasis" on April 3, there were two alterations in the value of "liver function".

In the end, the court comprehensively considered that the doctor had tampered with the medical records, and the patient had the original disease before being hospitalized and was subsequently transferred to another hospital for treatment. Therefore, it is difficult to determine the degree of correlation between the diagnosis and treatment behavior of a certain hospital and the death of patients. In the end, the court determined that a hospital should bear 50% of the liability.

03 [Judicial Judgment]

Finally, based on the comprehensive liability ratio and various evidences, the court made a judgment: a hospital compensated the patient’s family for transportation expenses, funeral expenses, and death compensation in total of 435,138 yuan; it also compensated mental damage solatium of 220,000 yuan. The family of

was dissatisfied with the verdict and appealed. However, during the second trial, the parties involved did not submit new evidence. The court of second instance ultimately upheld the original verdict.

04 [Small Law Interpretation]

" Civil Code of the People's Republic of China " Article 1222 [Situations in which medical institutions are presumed to be at fault] If a patient is harmed during diagnosis and treatment activities and one of the following circumstances occurs, It is presumed that the medical institution is at fault:

(1) Violation of laws, administrative regulations, rules and other regulations related to diagnosis and treatment;

(2) Concealing or refusing to provide medical record information related to the dispute;

(3) Loss, forgery, tampering or Illegal destruction of medical records.

" Physician Law of the People's Republic of China " Article 24 Physicians who implement medical, preventive, and health care measures and sign relevant medical certification documents must conduct personal examinations and investigations, and fill in medical records and other medical documents in a timely manner in accordance with regulations. They must not conceal, Forging, tampering with or destroying medical records and other medical documents and related materials without authorization.

Article 9 of the " Medical Accident Handling Regulations " It is strictly prohibited to alter, forge, conceal, destroy or snatch medical records.

Article 15, Paragraph 3 of the " Regulations on the Prevention and Handling of Medical Disputes " No unit or individual may tamper with, forge, conceal, destroy or snatch medical records.

Article 45 If a medical institution tamperes with, forges, conceals, or destroys medical records, the directly responsible person in charge and other directly responsible personnel shall be given or ordered to have their posts reduced in grade or removed from their posts by the health administrative department of the people's government at or above the county level. As a sanction, the relevant medical personnel shall be ordered to suspend their professional activities for a period of not less than 6 months but not more than 1 year; if serious consequences are caused, the directly responsible person in charge and other directly responsible personnel shall be given or ordered to be dismissed, and the relevant medical personnel shall be dismissed from the original certificate. The department shall revoke the practice certificate; if a crime is constituted, criminal liability shall be pursued in accordance with the law.

To sum up, in this case, many changes in Li’s medical records include "Disease Course Record", "Admission Record", "Discharge Record", "Blood Glucose Monitoring Form", "Ultrasound Medical Imaging Report Form", etc. has constituted "tampering with medical records", and it can be presumed that the medical institution was at fault.

05 [Tips]

When schistosomiasis attacks, it will bring serious consequences. So, how can we prevent it in our daily life?

1. Avoid contact with potentially contaminated water sources;

2. When contacting suspected contaminated water sources in the wild, take personal protection, such as wearing long rubber boots, protective clothing impregnated with niclosamide or applying dibutyl phthalate oil ointment and other protective drugs;

3. When you have come into contact with water or food contaminated by parasites, seek medical screening as soon as possible and take proactive medication to prevent infection;

4. Pay attention to water safety and do not drink raw water, especially for young children due to the development of their immune system. Imperfect and weak resistance, pay attention to personal hygiene and wash hands frequently.