case introduction
patient Yang Moumou went to the defendant's traditional Chinese medicine hospital for treatment on June 14, 2021 due to "lower and back trauma pain and limited movement for 2 hours". The defendant's traditional Chinese medicine hospital diagnosed Yang Moumou's hospital with lumbar fracture , with multiple contusions. During the hospital, the defendant hospital conducted an abdominal CT examination on June 6 and diagnosed it as a late-onset hematoma of the spleen. On June 18, 2021, the defendant had laparoscopic total splenectomy. During the operation, Yang Moumou had blood oxygen saturation and blood pressure and continued to drop to cardiac arrest. Finally, due to ineffective rescue, he was declared clinical death on the same day. The defendant hospital was diagnosed with pulmonary embolism, respiratory circulatory failure, cardiac arrest, ventricular fibrillation, traumatic spleen contusion and hematoma formation. On June 24, 2021, the Medical and Patient Dispute Mediation Center of a certain city commissioned a judicial appraisal center to identify the cause of Yang Moumou's death. The identification opinion was: Yang Moumou met the spleen rupture and caused acute hemorrhagic shock and caused acute respiratory failure and died.
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The plaintiff (Yang Moumou's family) believes that the defendant hospital is at fault, resulting in Yang Moumou's death. Because the two parties cannot reach an agreement, they sued the court and see the details.
Patient's opinion
Plaintiff believes: On June 14, 2021, Yang Moumou went to the defendant Laizhou Traditional Chinese Medicine Hospital for treatment and was hospitalized due to trauma. He underwent surgical treatment on June 18. At around 17:30 on the same day, the defendant notified the plaintiff Yang Moumou to die. Later, a judicial appraisal center commissioned a judicial appraisal center to identify the cause of Yang Moumou's death. The appraisal opinion was that the person being identified, Yang Moumou, was diagnosed with acute hemorrhagic shock caused by spleen rupture, causing acute respiratory and circulatory failure. The plaintiff believes that Yang Moumou died during the hospitalization treatment due to the defendant's fault, and the defendant should bear all liability for compensation.
Medical Party Views
Defendant Laizhou Traditional Chinese Medicine Hospital argued that in this case, there is only an autopsy and identification opinion, and medical fault judicial appraisal is required to further determine whether there is a fault in the defendant's behavior, and whether there is a causal relationship between the fault and the consequences of the damage. If there is a causal relationship, the defendant's degree of responsibility should be confirmed.
Judicial identification
A court entrusts a judicial scientific evidence appraisal center in Beijing to issue a judicial appraisal opinion on May 20, 2022. The appraisal opinion is: A certain Chinese medicine hospital has the following faults: 1. The patient died of heavy bleeding during splenectomy surgery. Considering that the medical prescription had improper operation, resulting in rupture of the capsule or torn and severe bleeding of the spleen pedicle. At the same time, it was not successfully clamped into splenary artery , resulting in bleeding recession. ; 2. The medical prescription found that there was adhesion in the spleen during the operation, and did not consider that the capsule may rupture and bleeding during the loosening of adhesion and pulling process, and the laparotomy was not turned on in time, which was at fault; 3. The medical prescription did not inform the alternative treatment plan, such as splenic artery embolization, such as open surgery, there was a fault of inadequate notification; 4. From the patient's autopsy conclusion, there must be major bleeding during the operation, and the medical prescription should be clear about the cause of death, but it was still recorded as pulmonary embolism, which violated the "Basic Standards for Writing Medical Records ", but the fault has no causal relationship with the patient's death. Conclusion: The defendant's traditional Chinese medicine hospital had medical faults during the diagnosis and treatment of the examinee Yang, which was causal and related to the death result of the examinee; the causal force between the diagnosis and treatment fault and the consequences of the damage is established, and the evaluation suggests that the evaluation range from the technical appraisal standpoint is between the same ~ the main cause degree.
Court opinion
This court believes that in this case, Yang Moumou died while visiting a hospital in a traditional Chinese medicine hospital. The judicial appraisal opinion issued by a judicial scientific evidence appraisal center in Beijing in accordance with the law determined that the defendant hospital had medical fault during the diagnosis and treatment of the person being identified, which was causal and related to the death result of the person being identified; the reason between the diagnosis and treatment fault and the consequences of the damage is established. The evaluation suggestion from the technical appraisal standpoint is equal to the main reasons. The plaintiff and the defendant have no objection to the judicial appraisal opinion and the appraisal opinion, and this court accepts it in accordance with the law. Based on the damage caused to the plaintiff by the defendant hospital's negligent medical behavior, this hospital confirmed that the defendant hospital should bear the main responsibility and the compensation coefficient is 70%.
Judgment result
September 29, 2022 Court judgment: The defendant, a Chinese medicine hospital, should compensate the plaintiff Yang Moumou for all losses of 898,560.95 yuan within three days from the date of the effectiveness of this judgment.
Lawyer analysis
1. Analysis of the causes of bleeding in splenomegaly.
In splenectomy, the most common serious complication is major bleeding. There are many causes of major bleeding. Common ones include: ⑴ Tearing the ligament bleeding near the spleen: When the separation of the spleen is insufficient, most people are eager to lift the spleen out for treatment of the spleen pedicle. This type of bleeding is mostly persistent, often leading to hemorrhagic shock. The preventive measure is to separate, cut off and ligate the attached ligaments as much as possible before lifting the spleen. ⑵ Adhesion and bleeding of splenic diaphragm ligament and diaphragm: Although the amount of bleeding is small and the speed is slow, if it continues, there will eventually be a large amount of blood loss. It is best to separate adhesions under direct vision during surgery. Careful inspection should be carried out after separation. If there is bleeding, suture should be promptly stopped. ⑶ Tearing the spleen and bleeding: It often occurs when the spleen is lifted out improperly, excessive pulling, and tearing occurs above the spleen and bleeding. If you operate carefully and avoid excessive force, it can be avoided. ⑷ Major bleeding of the spleen artery: During portal hypertension, the spleen is extremely congested and enlarged, and the spleen artery is thickened accordingly. When the pancreas and the caudal part are separated from the splenic artery, if the force is too strong, the splenic artery can be ligated, causing major bleeding. Therefore, when ligating the splenic artery (especially the first knot at the proximal end), the force is only closed to prevent excessive force from breaking. In case of this, you can press the proximal end of the spleen artery above the pancreatic body with your left finger, and then control the bleeding before processing. At the same time, when isolating the splenic artery, keep the surgical field clear and avoid blindly separating hemostatic forceps or clamping the blood stains to avoid piercing the lower splenic vein and causing greater bleeding. Once the spleen vein ruptures, it should be pressed immediately with gauze to stop bleeding more often.
2. Is the main responsibility for the identification of this case reasonable?
This case is a death caused by complications of splenectomy. The spleen is a blood-rich organ. Once bleeding complications occur, hemorrhagic shock will often occur during the operation, or even death on the operating table. Therefore, spleen rupture surgery has a risk of heavy bleeding due to the disease. Try not to take laparoscopic surgery, and it is safer to use traditional open laparoscopic surgery. The medical party in this case insisted on using laparoscopic surgery improperly. After the complications occurred during the operation, he took the act of forging the cause of death to try to evade medical responsibility. The examination was equivalent to the main responsibility, which played a certain punishment role and was not unjust.
3. How can the hospital avoid the tragedy of this case ?
Actively perform laparoscopic surgery, whether it is a hospital or a doctor, is very enthusiastic. This can not only improve the medical technology level and academic status, but also bring generous benefits. However, the technology is developed too quickly and the corresponding level is not enough, which makes it easy to cause complications. The immaturity of the technology allows patients to pay for it. Although it is a current situation that cannot be completely changed, it can still be improved after working hard to improve the technical level. For example, arranging more doctors to study in authoritative hospitals, asking more experts to walk, and surgeons to avoid blind confidence, etc.
At the same time, complications occur during surgery do not necessarily bear liability for compensation. As long as the diagnosis and treatment behavior meets the standards and does not constitute medical damage, even if it constitutes medical damage, the cause of death should not be forged and tried to evade medical responsibility. This is an immoral behavior.
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