论医源性不合理医疗费鉴定与赔偿

目的探讨医源性不合理医疗费产生原因、表现形式,以及法医学鉴定与赔偿的可行性.方法随机抽取人身损害赔偿案件480例(自1996到2002年,每年8 0件,不包括1999年),对其医疗费进行全面的调查研究,并作统计分析.结果存在医源性不合理性医疗费的案件数逐年上升,有关费用数额也逐年增加.结论开展对医源性不合理医疗费的审查和鉴定,并追究侵权行为主体的法律责任具有必要性和可行性.     

浅谈人身损害赔偿的医疗费审定

一、医疗费审定在人身损害赔偿案件中的作用在我市的民事审判中，损害赔偿案件要求进行医疗费审定呈上升趋势。从我院法医室三年来进行人身损害、医疗费赔偿审查的案件来看，1995年33例，1996年64例，1997年为96例，共193件，经回执调查结果，原被告均服从鉴定者145例。有异议，办案人员进行部分调解顺利结案30例。7例得知鉴定主动放弃或降低原要求赔偿额，尚未采用鉴定即调解结案。余11例未得知最后处理结果。从以上可看出，要求医疗费审查，在民事案件中逐年成倍上升。在提高人身损害赔偿案件的审理水平，客观公正及时地审判好这类案件，…     

医源性肢体残废鉴定分析（附4例报告）

医源性肢体残废鉴定分析（附４例报告）卢斌例１：王甲，男，６５岁，因纠纷被王丙推倒跌伤左手，在亲友的调和下，当时王甲、王丙自愿达成协议：由王丙一次性赔偿３００元医疗费，由王甲自己到乡卫生院诊治。王甲收到医疗费后遂找＂打师＂诊治，诊为左肘关节脱位，手法复...     

从14例脊柱损伤看隐性损伤对评残的影响

医疗单位对损伤的救治会产生最直接的影响 ,特别是一部分今后可能涉及法律诉讼的损伤。笔者从近二年 30 6例伤残鉴定案件中筛选出 14例脊柱损伤的案件进行回顾性分析 ,发现机体损伤后 ,由于处置不当 ,致使伤者在原有的损伤基础上 ,形成新的损伤。在隐性损伤中 ,医源性原因所致的隐性损伤为主要原因之一。它对评残有直接的影响 ,应当引起同仁和医疗单位的重视。一般资料笔者以 1999年 1月～ 2 0 0 0年 11月在我院进行伤残鉴定的 30 6例案件为基础 ,采用《职工工伤与职业病致残程度鉴定》、《道路交通事故受伤人员伤残评定》和《江苏省人体损…     

浅谈医疗费的审查鉴定

浅谈医疗费的审查鉴定胡宗学医疗费的审查认定同其它法医学鉴定一样，要认真细致地阅卷，了解全部案情，在基础医学、临床医学的基础上，观察、分析损伤的形成机理、致伤物、并发症、后遗症、伤与疾病的关系等，作全面地审查鉴定，下面谈谈医疗费审查鉴定的步骤和方法；１...     

合并医源性损伤的损伤程度鉴定2例

医源性损伤是指医务人员在实施医疗措施时 ,对人体所造成的损伤。按医务人员在实施医疗措施时的过错情况 ,可分为有过错责任医源性损伤和无过错责任医源性损伤。前者属医疗差错或医疗事故 ,不在此文讨论之列 ;后者与原发性损伤密切相关 ,应列入损伤程度鉴定的范围。笔者列举 2例 ,与同仁共同探讨。案例资料案例 1　李某 ,男 ,19岁。某日被他人砍伤头部、左上肢。检见头顶部、左上臂、左腕 5 .0ｃｍ、5 .2ｃｍ、3.5ｃｍ创。其中左腕部伤有屈指肌腱断裂、收缩。医院在进行清创缝合的同时 ,对左腕部损伤进行了手术探查和肌腱吻合。手术切口长 4…     

合并医源性损伤的损伤程度鉴定2例

医源性损伤是指医务人员在实施医疗措施时,对人体所造成的损伤.按医务人员在实施医疗措施时的过错情况,可分为有过错责任医源性损伤和无过错责任医源性损伤.前者属医疗差错或医疗事故,不在此文讨论之列;后者与原发性损伤密切相关,应列入损伤程度鉴定的范围.笔者列举2例,与同仁共同探讨.     

对一起非医疗事故纠纷案二审改判理由的几点思考

案　情1997年 10月 2 0日 ,原告庞某某因疝气入住被告某县人民医院诊治。同月 2 2日 ,被告拟对原告进行手术 ,术前进行了普鲁卡因皮试 ,在实施硬膜外麻醉穿刺后 ,改为推入布比卡因和利多卡因。 10分钟后 ,原告突然四肢抽搐、呼吸急促 ,继之呼吸、心跳骤停。经抢救 ,原告呼吸、心跳恢复。原告经被告治疗至同年 12月 2 1日方能下床活动 ,行走时偶尔双腿颤抖。原告住院期间共支付给被告医疗费 335 0元 ,后因无钱支付医疗费 ,被告停止对其治疗。经原告家属要求 ,被告又继续为原告治疗。 1998年 8月 5日 ,被告通知原告出院 ,原告家属以原告未愈为…     

道路交通事故受伤人员后期医疗费评估的法医学探讨

目的　探讨 13 71例交通事故中受伤人员后期医疗费的影响因素 ,并为此类案例后期医疗费的法医学评估积累经验。　方法　设定影响因素参数为“评估时间、是否评残及后期有无手术” ,并行卡方检验。　结果　评估时间在 1月内者为 475例 ,3月内者 1118例 ;评估时间的不同、是否评残及后期有无手术等因素对后期医疗费的影响有显著性意义 (P <0 .0 1)。　结论　后期医疗费的法医学评估是必要的 ,原则上应依据“普及价格”并考虑多种影响因素综合评估     

建筑物砸伤人所有人或管理人担责

【案情】1995年10月,被告灵璧县高楼镇政府在高楼街十字街中心建造了一座高约5米的石牛塑像。由高楼镇建筑公司承建。2004年1月31日,家住灵壁县高楼镇仝郡村的石文、石毛磊父子俩,到街上出售自家加工的八宝粥,由于塑像基座上的大理石面板突然脱落,将人砸伤,经灵璧县高楼镇卫生院紧急抢救后送往江苏省睢宁县人民医院治疗,原告石文住院7天后出院,花去医疗费3888.34元,原告石毛磊住院13天,共花去医疗费11559.28元。石毛磊后转入灵璧县急救站继续治疗40天。医疗费由被告高楼镇政府支付。宿州市中级法院对原告石毛磊伤情进行鉴定,结论为十级伤残…     

Medicaid program; deduction of incurred medical expenses (spenddown)--HCFA. Final rule with comment period

This final rule with comment period permits States flexibility to revise the process by which incurred medical expenses are considered to reduce an individual's or family's income to become Medicaid eligible. This process is commonly referred to as "spenddown." Only States which cover the medically needy, and States which use more restrictive criteria to determine eligibility of the aged, blind, and disabled, than the criteria used to determine eligibility for Supplemental Security Income (SSI) benefits (section 1902(f) States) have a spenddown. These revisions permit States to: Consider as incurred medical expenses projected institutional expenses at the Medicaid reimbursement rate, and deduct those projected expenses from income in determining eligibility; combine the retroactive and prospective medically needy budget periods; either include or exclude medical expenses incurred earlier than the third month before the month of application (States must, however, deduct current payments on old bills not previously deducted in any budget period); and deduct incurred medical expenses from income in the order in which the services were provided, in the order each bill is submitted to the agency, by type of service. All States with medically needy programs using the criteria of the SS program may implement any of the provisions. States using more restrict criteria than the SSI program under section 1902(f) of the Social Security Act may implement all of these provisions except for the option to exclude medical expenses incurred earlier than the third month before the month of application.     

A French hospital sentenced for unreasonable obstinacy

On 2 June 2009, the Nimes administrative court condemned the Hospital of Orange (France) for unreasonable obstinacy after neonatal resuscitation. On 14 December 2002, an apparently stillborn child was resuscitated after approximately 30 minutes of foetal distress. Cardiac activity was recovered, but the child has since suffered from severe disabilities. The court did not find any fault committed by the hospital regarding maternal care. However, the hospital was sentenced to compensate for the injuries caused by unreasonable obstinacy. According to the court, the medical team should have taken into account the harmful neurological consequences of prolonged foetal distress. The court did not condemn the act of resuscitation itself, but its excessive length. This court ruling serves as a basis for reflection regarding the limits by which unreasonable obstinacy should be set.     

Medicare program; physician fee schedule update for calendar year 1996 and physician volume performance standard rates of increase for federal fiscal year 1996--HCFA. Final notice

This final notice announces the calendar year 1996 updates to the Medicare physician fee schedule and the Federal fiscal year 1996 volume performance standard rates of increase for expenditures for physicians' services under the Medicare Supplementary Medical Insurance (Part B) program as required by sections 1848 (d) and (f), respectively, of the Social Security Act. The fee schedule update for calendar year 1996 is 3.8 percent for surgical services, -2.3 percent for primary care services, and 0.4 percent for other nonsurgical services. While it does not affect payment for any particular service, there was a 0.8 percent increase in the update for all physicians' services for 1996. The physician volume performance standard rates of increase for Federal fiscal year 1996 are -0.5 percent for surgical services, 9.3 percent for primary care services, 0.6 percent for other nonsurgical services, and a weighted average of 1.8 percent for all physicians' services. In our July 26, 1995 proposed rule concerning revisions to payment policies under the Medicare physician fee schedule for calendar year 1996, we proposed using category-specific volume and intensity growth allowances in calculating the default Medicare Volume Performance Standard (MVPS). We received 20 comments on this proposal. Since this proposal is related to the MVPS and this notice deals with MVPS issues, we are responding to those comments in this notice instead of in the final rule for the fee schedule entitled "Medicare Program; Revisions to Payment Policies and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 1996" published elsewhere in this Federal Register issue.     

Has the cocaine epidemic arrived in the UK?

National surveys of the UK drug situation in 2000 found that cocaine was the most frequently seized Class A drug, with 25-40 tonnes of cocaine being smuggled into the UK each year. In the light of these findings, an audit of the analytical monitoring for cocaine abuse has been performed covering the period from 1996 to 2002. It was found that there has been a consistent upward trend in the percentage of requests found to be positive for cocaine over this 7-year study period, rising from 9.7% in 1996 to 22% in 2002. This data would suggest that the use of cocaine has increased dramatically over the past few years, indicating that the arrival of the "cocaine epidemic" has now started to become a reality in the UK.     

Medical malpractice reform and insurer claims defense: unintended effects?

In response to recent and past medical malpractice insurance crises, most states have implemented reforms meant to stabilize premiums and coverage availability. The importance of understanding whether these reforms implicitly affect the behavior and incentives of plaintiffs, attorneys, medical providers, and malpractice insurers in the intended way is crucial to policy makers, if they are to achieve their goal. This study specifically examines the effect of reforms on the claims defense efforts of insurers, given that defense expenses account for approximately 30 percent of malpractice premiums. Using state data for the period 1998-2002, we regress claims defense expenses against a variety of reform variables. These include seven tort reforms (noneconomic damage caps, punitive damage limits, attorney fee limits, modified collateral source rule, modified joint and several liability doctrine, mandatory pretrial screening, and statute of limitations) and two government-sponsored insurance mechanisms (joint underwriting associations and patient compensation funds). Claims defense expenses are found to be higher in the presence of noneconomic damage caps, punitive damage limits, and attorney fee limits--an unintended and counterproductive effect of reform--but are lower with mandatory pretrial screening and patient compensation funds.     

Inconceivable? Deducting the costs of fertility treatment

This Article considers whether infertile taxpayers can deduct their fertility treatment costs as medical expenses under Internal Revenue Code section 213 and whether they should be able to deduct them. Internal Revenue Code section 213 defines medical expenses as "amounts paid-for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." This definition is interpreted by reference to a baseline of normal biological functioning, which includes reproductive functioning. Most people conceive and bear children without having to incur expenses for fertility treatment. Expenses incurred to approximate the baseline of normal reproductive health are deductible, even if the taxpayer winds up better off, with a child, after the fertility treatment. The medical profession recognizes that infertility is a disease or condition. Infertility is a loss, just as a broken leg is a loss. Fertility treatment costs are thus medical expenses under section 213. In addition, given the existence of the medical expense deduction, taxpayers should be able to deduct the cost of fertility treatments, including IVF, egg donor, and surrogate procedures, under either an "ability-to-pay" or consequentialist normative approach. Reproduction is extremely important to most people. In addition, allowing taxpayers to deduct the costs of fertility treatment will encourage infertile taxpayers to elect the most effective treatment option and reduce the rate of risky multifetal pregnancies. This Article concludes that fertility treatment costs are deductible as medical expenses under current law and should be deductible as medical expenses.     

Employer comparable contributions to health savings accounts under section 4980G. Final regulations

This document contains final regulations providing guidance on employer comparable contributions to Health Savings Accounts (HSAs) under section 4980G in instances where an employee has not established an HSA by December 31st and in instances where an employer accelerates contributions for the calendar year for employees who have incurred qualified medical expenses. These final regulations affect employers that contribute to employees' HSAs and their employees.     

Determining adjusted income in HUD programs serving persons with disabilities: requiring mandatory deductions for certain expenses; and disallowance for earned income. Office of the Secretary, HUD. Final rule

This final rule amends HUD's regulations in part 5, subpart F, to include additional HUD programs in the list of programs that must make certain deductions in calculating a family's adjusted income. These deductions primarily address expenses related to a person's disability, for example medical expenses or attendant care expenses. The purpose of this amendment is to expand the benefits of these deductions to persons with disabilities served by HUD programs not currently covered by part 5, subpart F. Second, this rule adds a new regulatory section to part 5 to require for some but not all of these same programs the disallowance of increases in income as a result of earnings by persons with disabilities. HUD believes that making these deductions and disallowance available to persons with disabilities through as many HUD programs as possible will assist persons with disabilities in obtaining and retaining employment, which is an important step toward economic self-sufficiency. This rule follows publication of a August 21, 2000 proposed rule, and takes into consideration public comments received on the rule.     

Forensic Pathological Examination on 73 Medical Malpractice Cases of PediatricsCSCD

Objective: To analyse 73 medical malpractice cases of pediatrics for discussing the importance of forensic pathology in solving the issues such as medical malpractice of pediatrics. Methods: From January 2002 to August 2016, 73 medical malpractice cases of pediatrics with age of death between 28 days old and 10 years old were collected from Institute of Judical Expertise of Nanjing Medical University. The relationship between causes of death and related medical institutions was retrospectively analysed. Results: In 73 cases, the male to female ratio was 1.70:1, and ages of 28 days old to 1 year old were common (26 cases, 35.62%), followed by ages between 1 year old and 3 years old (21 cases, 28.77%). In 71 cases which had been determined the cause of death by postmortem examination, the main cause of death was disease, especially respiratory diseases (33 cases, 46.48%), followed by cardiovascular diseases (12 cases, 16.90%). In 75 medical institutes which involved with these medical malpractices, most were tertiary medical institutes (32, 42.67%), followed by the sub-secondary (excluding the secondary)medical institutions (23, 30.67%). The clinical diagnosis of 38 cases (52.05%) completely or mostly corresponded with the pathological findings. There were 35 cases (47.95%) undefined or misdiagnosed cases. Conclusion: Autopsy and forensic pathological examination contribute to determine causes of death, which not only provide scientific evidence for medical malpractice of pediatrics, but also enrich and develop clinical medical knowledge, and thus improve diagnosis and treatment level in a certain extent. © 2018 by the Editorial Department of Journal of Forensic Medicine.     

Woman wins claim for tax deductability of complementary/alternative medical expenses

On 30 April 2001, the Tax Court of Canada granted judgment in favour of a Victoria woman who claimed that she should be entitled to deduct from her taxable income, as legitimate "medical expenses," her expenses for vitamin supplements and for rehabilitative therapies such as massage and therapeutic touch.