1. The patient's statement
Plaintiff Li Moumou was admitted to the defendant x Hospital on April 24, 2017 and was admitted to the hospital: patella fracture, left knee injury . On the same day, I underwent internal fixation of the left patella fracture and reduced. I had an infection after the operation, but no results were found in the treatment. Now the left knee movement function is severely limited.
2. Medical Presentation Views
The defendant's treatment of the plaintiff conforms to the principles of treatment, and the defendant does not have any negligence or fault during the entire treatment process. Although this case has been appraised by the Medical Association, the defendant believes that the appraisal opinions of the Medical Association lack objectivity and scientificity, and their appraisal opinions should not be accepted.
The amount of compensation items claimed by the plaintiff is too high and has no legal basis. Even according to the appraisal opinion of the Medical Association, the defendant's participation factor is the same factor and shall bear no more than 50% of the responsibility at most. In summary, please refer to the collegial panel in accordance with the law.
3. Identification Opinions
On July 3, 2019, the Medical Association of x Province issued the Medical Impact No. x: Referring to the "Medical Accident Grading Standards (Trial)", the patient's disability level is level 8. The medical fault cause of medical reasons is the same. Medical nursing advice: Regular review and rehabilitation treatment based on the fracture healing.
4. Medical fault analysis
1. Based on the patient's main complaint history and physical examination when he was admitted to the hospital, combined with imaging examination, this case has surgical indications, and the incision reduction tension band is a common surgical method. The surgical plan and timing of the operation are in line with the conventional diagnosis and treatment regulations.
2. After the patient was admitted to the hospital, the patient underwent an incision reduction internal fixation surgery. The skin condition of the left knee was not clearly recorded during the preoperative examination. The preoperative examination was not comprehensive and did not comply with the diagnosis and treatment standards. The antibiotic was not used before surgery, which did not comply with the specification requirements of the "Guiding Principles for the Clinical Application of Antibiotics" on the prevention of incision infection.
3. The patient had mild fever on the second and third days after the operation. The axillary temperature was measured at 38℃ on the evening of the 8th day after the operation. Nursing records were taken with oral naproxen and warm water to cool down. However, there were no relevant records during the course of the disease, and the doctor did not further check and analyze the cause of the fever. Moreover, the patient lacked a temperature record before discharge, and it was impossible to confirm that the patient's temperature was normal when discharged. The doctor did not pay enough attention to the potential infection signs that may exist in the patient after surgery, and failed to give relevant examinations and differential diagnosis.
4. On the 2nd to 4th day after the operation, the doctor's order instructed to "hot and hot and wet compress" the incision site and the nursing "continuous ice compress" was implemented. The doctor's order and the execution of the medical order were not exactly the same, and the reason for the treatment measures was taken, and the course of the disease was not recorded. 5. According to the statements of both the doctor and the patient and the on-site investigation of the appraisal meeting, within 1 week after discharge, the patient developed fever, redness, swelling and pain in the surgical site. He contacted the doctor several times, but the doctor did not pay attention and did not ask the patient to come to the hospital immediately until the surgical incision was ulcerated and exudate 5 days later, and the patient came to the hospital for treatment. The failure to detect the surgical site infection earlier due to the negligence of the doctor, which caused certain delays to treatment, and the doctor was at fault.
5. There is a risk of infection in the surgical treatment of closed fractures, which is a consensus in the orthopedic community. The cause of postoperative infection in this case is still difficult to determine. According to the existing data, it is believed that the medical prescription is not properly sterile and has caused the infection to occur without relevant basis. Therefore, considering that the patient's infection after patella fracture was a complication that could be predicted but difficult to completely avoid in the operation, the doctor informed the patient of the risk of infection before the operation, and the patient signed and agreed to the operation.
6. After the infection occurs, the basic treatment measures taken by the doctor are to use antibiotics to fight the infection. Patellar is located subcutaneously, with less soft tissue covering on the surface and poor blood circulation. Once an infection occurs, it is difficult to treat and prolongs a long time. Sometimes multiple debridement surgeries are required, which will have serious impacts on fracture healing and knee joint function. This is due to the nature of the disease.
7. During the treatment of the patient, the medical prescription had irregular preventive antibiotic use, insufficient experience in postoperative observation and clinical treatment, and signs of incision infection appeared after discharge. The failure to pay attention to and prompt treatment when responding to the medical prescription has an adverse impact on the development of the patient's infection and is the reason for the difficulty in controlling the infection and delaying the disease.
5. Trial Opinions
In this case, according to the appraisal opinions made by the x Provincial Medical Association, this hospital believes that the defendant x Hospital should be determined to be at fault in the diagnosis and treatment process of Li Moumou, so the defendant x Hospital should bear the liability for compensation at a ratio of 50%. After review, Li Moumou's legal loss expenses are as follows:
medical expenses of 34,690 yuan, hospitalization food subsidy for 12,900 yuan, nutrition expenses of 12,000 yuan, loss of work fee of 60,000 yuan, nursing expenses of 33,000 yuan, disability compensation for 314,760.96 yuan (including dependents' living expenses 96,109.2 yuan), transportation expenses of 2,000 yuan, and mental damage compensation for 30,000 yuan, totaling RMB 499,350.96 (see the attached page for the specific calculation method).
6. The court ruled that
defendant x hospital compensated plaintiff Li Moumou 264675.48 yuan.
[Declaration] Judicial Judicial Case.
