[Case Facts] Patient Liu Moumou was admitted to the Department of Nephrology at Zhangjiajie People's Hospital at 12:22 on February 28, 2022. The "Zhangjiajie People's Hospital Admission Notice" states:...1. Introduction to the environment and system...8. Those who need to stay wi

[Case Facts]

patient Liu Moumou was admitted to the Department of Nephrology at Zhangjiajie People's Hospital at 12:22 on February 28, 2022. The "Zhangjiajie People's Hospital Admission Notice" states:...1. Introduction to the environment and system...8. Those who need to stay with their care should not leave the patient. Minors are accompanied by guardians to prevent loss or accidents. ...If you already know the above notification, please sign it, and the plaintiff Robbzhen will sign it at the signing office of the escort. The notice date will be February 28, 2022. The admission record of Liu Moumou of

patient stated: name Liu Moumou, Department of Nephrology, Bed No. 28010, admission method: Help and send. Main complaint: The creatinine was found to increase by 5 days. Current medical history: During the re-examination of the outpatient clinic 5 days ago, the patient found that the creatinine was increased, which was 435.0umol/L, fearless cold and fever, no headache, dizziness, nausea and vomiting, no chest tightness, shortness of breath and chest pain, no frequent urination, urgency, urination and back pain, etc., no discomfort, no treatment outside the hospital, entered our hospital for treatment and accepted our department. The patient's mental, food and sleep were acceptable since the onset of the disease, and his urine and defecation were normal, and his weight had no significant changes recently. Past medical history: I have been hospitalized in the Department of Endocrinology in our hospital many times, and the examination was improved and finally diagnosed as "1.2 diabetes diabetes nephropathy chronic renal insufficiency CKD stage 4 renal anemia 2. lung infection 3. coronary atherosclerotic heart disease (old myocardial infarction PIC postoperative cardiac function II) 4. hypertension level 3 (high risk) 5. old cerebral infarction Death 6. Status after cholecystectomy 7. Prostate hyperplasia 8. Cerebral atrophy 9. Hyperuricemia 10. Simple renal cyst 11. Hepatic cyst 12. Postcirculation ischemia 13. Lacular cerebral infarction 14. Arteriosclerosis (stenosis (intracranial)) 15. Hypoproteinemia”, the condition of taking medication regularly outside the hospital is relatively stable, denied other chronic medical history, denied the history of drug allergies, had no history of contact with fever and overseas personnel in the past 14 days, and had not been to the high-risk epidemic area of ​​××. Admission diagnosis: 1. Diabetic nephropathy (CKD Stage 5 renal anemia) 2. Coronary atherosclerotic heart disease (PIC postoperative cardiac function II) 3. Hypertension grade 3 (high risk) 4. Type 2 diabetes 5. Old cerebral infarction 6. Post-cholectomy status 7. Prostate hyperplasia 8. Cerebral atrophy 9. Hyperuricemia 10. Simple renal cyst 11. Hepatic cyst 12. Post-circulation ischemia 13. Lacular cerebral infarction 14. Arterial sclerosis (stenosis (intracranial)) 15. Hypoproteinemia. Diagnosis and treatment plan: 1. Routine nephrology nursing, level 1 care, low-salt, low-fat high-quality protein diet; 2. Improve the three routines, liver and kidney function, electrolytes, myocardial enzymes, blood lipids, troponin , cerebral natriuretic peptide, electrocardiogram and other related examinations; 3. Tropical treatment for Shenkang kidney protection and other symptomatic treatment in treatment. The treatment plan will be further adjusted after the examination results are returned; 4. Declare the ill seriously and monitor vital signs; the patient's condition may worsen or worsen at any time, inform the family and improve the signature. Luo Bozhen signed the "Records of the Physicians and Patients' Interview" and the "Notice of Severe Sickness", respectively, and the time was 14:00 on February 28, 2022.

On the evening of March 1, the patient Liu Moumou was not accompanied by his family during his hospitalization in the 10th bed of the Nephrology Department. There was one doctor on duty and one nurse on duty that night in the Nephrology Department. From 12:5 to 3:19 on March 2, the nurse on duty in the Department of Nephrology did not enter the 10 beds where the patient Liu Moumou was staying for inspection.

Liu Moumou's ward is diagonally opposite the nurse's station. On March 2, 2022, 0:00:30, two nurses went in and out of Liu's ward for inspection. 03:15:39, Liu Moumou walked out of the ward and walked east to the end of the corridor. He opened the door on the right side of the corridor twice and returned. He returned to the ward at 03:18:18, and 03:19:07, press caller to call the medical staff. 03:19:49, the nurse on duty entered the ward to check. Since then, the nurse on duty has frequently entered and exited the ward, the dispensing room and the storage room. 03:30:57, the doctor on duty entered the ward, 03:31:47, the doctor on duty walked out of the ward. 03:43:46, the doctor on duty entered the ward, and the doctor on duty walked out of the ward. 03:46:18 The nurse on duty went to the nurse station to notify Liu's family that he was critically ill and asked his family to come to the hospital immediately. 03:48:12, the doctor on duty pushed the treatment cart into the ward. 03:49:36, the nurse on duty went to the rescue room to get the treatment cart to Liu's ward. At around 03:51:00, the nurse on duty went to the nurse station to contact doctors in ICU, cardiology and other departments.After receiving the notice from the medical staff of Zhangjiajie People's Hospital, Liu Xiaomou rushed to the hospital immediately. Liu Lian and Luo Bozhen rushed to the Zhangjiajie People's Hospital at 4:8, and Liu Yuting rushed to the Zhangjiajie People's Hospital at 4:11. 04:08:58, Luo Bozhen and Liu Lian rushed to Liu's ward one after another, and Liu Yuting rushed to Liu's ward. After the three plaintiffs arrived at the hospital, the medical staff communicated with the three plaintiffs. The doctor on duty introduced Liu Moumou's condition to the family, clearly informed Liu Moumou of being critically ill, and issued an critical illness notice to Liu Moumou, , requiring the patient's family to sign the critical illness notice.

During the medical staff's rescue of Liu Moumou, the Zhangjiajie People's Hospital asked Liu Moumou's family to sign on "Notice on Refusal or Give Upgrade of Medical Examinations in Zhangjiajie People's Hospital", stating: Dear patient, patient's family member or patient's legal guardian and authorized principal: According to the patient's current disease status, the doctor believes that the patient should undergo examination and recommends that the patient receive appropriate medical measures. However, the patient now refuses or gives up the following medical measures recommended by the medical staff of our hospital: give up rescue, refuses to transfer to the department, refuses to intubate, and refuses autopsy .

At 4:49 on March 2, Zhangjiajie People's Hospital announced that the patient Liu Moumou had died clinically. Regarding the cause of Liu Moumou's death, Zhangjiajie People's Hospital informed Liu Moumou's family that it might be a cardiac or cerebrovascular accident in an uncertain situation. After Liu Moumou's death, his family transported Liu Moumou's body out of the hospital and buried him three days later. Liu Moumou was born on June 9, 1955.. was a retired cadre of the Sangzhi County Transportation Bureau. . Liu Moumou's wife Luo Bozhen is a retired employee. Liu Moumou and Luo Bozhen have two children, Liu Lian and Liu Yuting.

On March 3, 2022, the Department of Nephrology of Zhangjiajie People's Hospital discussed the cause of Liu Moumou's death, and discussed that the cause of death was uremia combined with cerebrovascular accidents. The death record in Liu Moumou's hospitalization record records shows that the cause of death was uremia and cerebrovascular accident, resulting in heartbeat and respiratory arrest.

[Medical Appraisal]

This hospital has successively commissioned the judicial appraisal center of Xiangya Second Hospital and Hunan Xiangya Judicial Appraisal Center to conduct pre-trial judicial appraisal for whether there was any fault in the diagnosis and treatment activities of Zhangjiajie People's Hospital and its medical staff during the treatment of Liu Moumou's hospitalization, whether there was a causal relationship and causal force between the damage caused by the patient Liu Moumou's death and the damage caused by Liu Moumou's death.

Xiangya Second Hospital issued a notice of non-acceptance on the grounds that the deceased Liu Moumou had not been dissected, the cause of death could not be clarified, and the identification could not be completed, and all identification materials were returned .

Hunan Xiangya Judicial Appraisal Center After review, it was found that on the grounds that the autopsy had not been performed and that the doctor and patient could not reach an agreement on the cause of death. Based on the existing materials, it was impossible to obtain a clear appraisal opinion. made a notice of non-acceptance and returned the materials sent to the inspection together.

[Court Judgment]

This court believes that citizens' right to life and health is protected by law. This case is a civil dispute case caused by legal facts after the implementation of the Civil Code, and the provisions of the Civil Code are subject to it. This case is a medical responsibility dispute.

The plaintiff believes that the defendant had the following six faults in the medical treatment of the patient Liu :

1. The patient was able to walk out of the ward at 3:16 am on March 2 to ask the medical staff to tell him that he was unwell. The doctor entered the ward for the first time at 3:31, and the doctor left the ward at 3:32. After the patient told the defendant that he was discomfort, he stayed in the ward for only 50 seconds and left immediately. He did not take any medical measures in time, causing the patient's condition to worsen.

2. After the patient fell ill again, the defendant was late and did not enter the ward again until 3:43. After arriving at the ward, he only took simple medical measures, which was the same as the time when the plaintiff received the call . From 3:16 to 3:43, a full 27 minutes seriously delayed the patient's best treatment time and was one of the main reasons for the patient's death.

3. During the treatment of the patient, the defendant only took measures such as cardiopulmonary resuscitation and respiratory airbag assistance, and the surveillance video showed that the respiratory airbag entered the ward at 3:53, and no other active and effective medical measures were taken. The plaintiff believes that the defendant's serious delay in treatment time and simple treatment measures have not been followed up were one of the main reasons for the patient's death, and he should bear full liability for compensation for the patient's damage.

4. Nursing does not meet the requirements of first-level nursing , and fails to inspect first-level nursing patients every hour according to nursing requirements in accordance with Article 14 of the "Guidelines for Graded Nursing in Comprehensive Hospitals (Trial)". By viewing the surveillance video, the last time the nurse entered the ward was at 0:05 am that day, with a 3-hour interval between 3:19.

5, forged family signatures and medical records are not objective and untrue . The plaintiff did not sign the "Admission Record" at 16:00 on February 28, but the plaintiff's signature was included in the medical record. The signing time of the plaintiff Liu Yuting in "Notice of Critical Illness" was "3:30", and the plaintiff had not arrived at the hospital yet. "Death Record" "Patient was nauseated and vomited once at 3:28, ......35, the patient experienced a progressive decrease in blood pressure", which is seriously inconsistent with the fact that the defendant entered the ward twice.

6. The relevant regulations on autopsy were not informed to the plaintiff. At 4:08 am on March 2, after receiving the defendant's notice, the defendant asked his family to sign the "Notice of Refusal or Give Up Medical Examination". After the patient died, the defendant verbally informed the plaintiff that the cause of death may be caused by myocardial infarction, and the subsequent "Death Record" also states that the patient's cause of death was uremia and cerebrovascular accident. The defendant did not inform the plaintiff of the autopsy. Due to the failure of autopsy, judicial appraisal of medical fault cannot be conducted. Based on the above six reasons, the plaintiff believes that the defendant should be presumed to be fully liable for Liu Moumou's death. The defendant believed that the patient Liu Moumou had many diseases, complex conditions, poor functions of various organs, and a high possibility of sudden death in accidents. After the patient Liu Moumou called, the nurse on duty checked the patient as soon as possible, asked about the patient's condition, and gave the patient an oxygen treatment. The doctor on duty was notified, and the doctor on duty was given electrocardiogram monitoring, blood pressure, pulse, breathing, oxygen saturation, and blood pressure reduction. The patient was drawn and blood was improved to improve relevant examinations. The doctor on duty in the cardiology and critical care medicine department was invited to assist in the rescue of the patient. In combination with the patient's history of myocardial infarction, diabetes , and uremia, the cause of death was considered myocardial infarction and cerebrovascular accident. The defendant People's Hospital made relevant explanations during the trial in response to the defendant's six medical fault issues raised by the plaintiff.

The focus of the dispute in this case is: 1. Whether there is any relevant fault in the defendant Zhangjiajie People's Hospital; 2. The responsibility and size of the defendant Zhangjiajie People's Hospital; 3. How to calculate Liu Moumou's loss;

​1. Whether there is any relevant fault in the defendant Zhangjiajie People's Hospital; 1. l7

First, the plaintiff stated that the defendant's nursing care did not meet the first-level nursing requirements, and the defendant did not give a reasonable explanation. This hospital determined that the defendant Zhangjiajie People's Hospital had failed to provide nursing according to the first-level nursing requirements ;

Secondly, after the plaintiff's patient's on-duty patient came to the first time he entered the patient's ward, with a 12-minute interval. The defendant Zhangjiajie People's Hospital explained that the doctor on duty was studying treatment plans and prescription drugs. When the patient was in critical condition, the doctor on duty spent more than 10 minutes studying treatment plans and prescription drugs, which was enough to make the patient's family members suspicious that the hospital did not actively take treatment measures for the patient and delayed the patient's best treatment time.

Whether the medical behavior of Zhangjiajie People's Hospital was at fault is not determined because there was no medical fault identification in this case. However, as a medical unit that saves lives and helps the wounded, it should do its best to eliminate reasonable doubts about the hospital by the patient's family ;

Third, whether the defendant Zhangjiajie People's Hospital informed the patient's family of the relevant autopsy regulations .

The plaintiff believes that the defendant has not informed the plaintiff of the provisions on autopsy, and the defendant believes that he has informed the plaintiff of the autopsy regulations, that is, the "Notice on Refusal or Give Up Medical Examination" signed by the patient's family has regulations on informing the autopsy. The signature time of the "Notice of Refusing or Give Up Medical Examination" submitted by the defendant was 4:10 on March 2, while the hospital records declared the clinical death of the patient Liu Moumou at 4:49 on March 2. Judging from the content of the notice, the purpose of signing the notice is to inform the patient's family that refuses or gives up medical examinations and gives up rescue. If the hospital does not declare the patient's clinical death, it is unethical to inform the family that the autopsy is waived. Therefore, this hospital believes that the "Notice of Refusing or Give Up Medical Examination" submitted by the defendant is not equivalent to the autopsy notice. After Zhangjiajie People's Hospital announced that the patient Liu Moumou had died clinically, it did not inform the family of the autopsy regulations in accordance with the regulations, and was at fault.

2. The responsibility and size of the defendant Zhangjiajie People's Hospital.

In accordance with Article 1165 of the Civil Code, "If the perpetrator infringes upon his civil rights and interests due to fault, he shall bear tort liability. According to the provisions of the law, the perpetrator is presumed to be at fault and cannot prove that he is not at fault, he shall bear tort liability." Zhangjiajie People's Hospital has the fault of failing to care for the deceased Liu Moumou according to the first-level nursing standards, and shall bear the corresponding tort liability . After the death of the patient Liu Moumou, the hospital cannot determine the cause of the patient's death. The hospital shall bear the burden of proof for not informing the patient's family that there is no fault in the relevant autopsy regulations. The defendant Zhangjiajie People's Hospital only explained that after the death of the patient Liu Moumou, the patient's family had no medical dispute with the hospital, and the autopsy notice was clarified in the "Notice on Refusing or Give Up the Medical Examination".

Regarding the meaning of medical disputes, a narrow understanding refers to a dispute between doctors and patients who have inconsistent understanding of the medical consequences and causes, and raise a dispute between doctors and patients and holds accountable or compensates for losses to the health administrative department or judicial authorities. In a broad sense, any incident in which a patient or family member is dissatisfied with the patient's diagnosis and treatment process, believes that medical staff makes mistakes during the diagnosis and treatment process, causes adverse consequences or death to the patient, and requires the health administrative department or judicial authorities to hold them accountable or compensate for the losses, is collectively called a medical dispute before the truth is revealed.

When the cause of death of a patient is uncertain, there is a possibility of a medical dispute. The hospital is obliged to inform the patient's family of the relevant autopsy regulations.

According to Article 23 of the "HTML Regulations on Prevention and Handling of Medical Disputes" issued by the State Council, if a medical dispute occurs, medical institutions shall inform the patient or close relatives of the following matters: (1) Legal ways to resolve medical disputes; (2) Regulations on the sealing and unsealing of medical records and physical objects on site; (3) Regulations on the review and copying of medical records. If a patient with

dies, his or her close relatives should also be informed of the regulations on autopsy.

At the same time, according to Article 1222 of the Civil Code, "If a patient is damaged during the diagnosis and treatment process and is in any of the following circumstances, the medical institution is presumed to be at fault: (1) Violating the laws, administrative regulations , rules and other relevant diagnostic and treatment standards; (2) Concealing or refusing to provide medical records related to disputes; (3) Losing, forging, tampering or illegally destroying medical records", it is presumed to be at fault.

Because the defendant did not clearly inform the plaintiff of the provisions on autopsy, Liu Moumou did not conduct an autopsy after his death, resulting in the inability to conduct judicial appraisal. Since medical behavior involves medical professional knowledge, experts should judge this, so the judicial appraisal opinion is important evidence for the people's court to hear such disputes.

After the plaintiff's application, this court has successively entrusted the judicial appraisal center of Xiangya Second Hospital and Hunan Xiangya Judicial Appraisal Center in accordance with the law whether the diagnosis and treatment behavior of the medical courts of the Hunan Xiangya Judicial Appraisal Center was at fault, whether it had a causal relationship with the accident and participated in the assessment. The judicial appraisal center of Xiangya Second Hospital was unable to clarify the cause of death because Liu Moumou had not been dissected and believed that the appraisal could not be completed, and the Hunan Xiangya Judicial Appraisal Center believed that it was impossible to complete the appraisal because of the failure to perform an autopsy and that the doctor and patient could not reach an agreement on the cause of death. Based on the existing materials, it was impossible to obtain a clear appraisal opinion and would not be accepted.

At this point, whether the defendant's diagnosis and treatment behavior was at fault, whether Liu Moumou's death had a causal relationship with the defendant's diagnosis and treatment behavior, and the magnitude of the cause force, has no valid identification opinion to confirm.

Considering that Liu Moumou's age, he has fifteen underlying diseases, and has been suffering from many years of illness, the damage result of the patient Liu Moumou is not entirely caused by the defendant's fault, etc., the defendant Zhangjiajie People's Hospital is determined to bear 30% of the compensation liability for the patient Liu Moumou's losses.

Case number: (2022) Hunan 0802 Minchu No. 2123