一起医疗事故争议引发行政复议的分析与思考

医疗事故技术鉴定结论是处理医疗事故纠纷的重要依据,根据国务院《医疗事故处理条例》规定,对鉴定结论有异议,可要求重新鉴定和申请再次鉴定,但这两种情况存在较大的法律意义差别,同时在实践中也存在一些问题。本文从一起医疗事故鉴定引发的行政复议案出发,剖析了我国现行医疗事故鉴定制度存在的一些亟待解决的问题,并就鉴定评审制度及法律责任提出了相应的法律适用建议。     

剖宫产子宫切口部位妊娠引发纠纷分析

患者王某某，34岁。于2003年6月16日因停经56天、阴道不规则流血5天到A医院求诊，经检查诊断胚胎停止发育。手术医师将手术中易发生的并发症进行告知．夫妇双方签字后给予行清官术。手术过程顺利，术中宫缩好，检查吸出物为陈旧性血块及绒毛组织。术毕5分钟出现阴道流血约400毫升，色新鲜，     

剖宫产子宫切口部位妊娠引发纠纷分析

病例报告患者王某某,34岁。于2003年6月16日因停经56天、阴道不规则流血5天到A医院求诊,经检查诊断胚胎停止发育。手术医师将手术中易发生的并发症进行告知,夫妇双方签字后给予行清宫术。手术过程顺利,术中宫缩好,检查吸出物为陈旧性血块及绒毛组织。术毕5分钟出现阴道流血约400毫升,色新鲜,立即给予催产素、静脉输液、手法按摩子宫等处理,阴道流血迅速停止,观察8小时无异常回家,嘱其有异常及时复诊(门诊病历记载)。2003年7月16日,因阴道淋漓不断流血30天来院复查,患者孕3产1,1994年行剖宫产术,1998年行人工流产术。体格检查:T37℃,P76次/…     

Medical malpractice as reflected by the forensic evaluation of 4450 autopsies

A multicentre retrospective analysis of 4450 autopsies carried out due to suspicion of medical malpractice in 17 German institutes of forensic medicine from 1990 to 2000 was performed for the German Federal Ministry of Health. During the time period analysed an increase of cases could be mentioned. The main results of the study are: in the cooperating institutes the total number of autopsies due to suspected medical malpractice ranged from 1.4 to 20%. In more than 40% of the cases preliminary proceedings were started because the manner of death was certified as non-natural or not clarified. Hospital doctors were more affected by medical malpractice claims than doctors in private practice. However, the number of confirmed cases of medical malpractice was higher for doctors in private practice than for hospital doctors. Although surgery is still at the top of the disciplines involved in medical malpractice claims the number of confirmed surgical cases was below the average. Mistakes in care were confirmed to be above the average. Medico-legal autopsies are still a very sufficient method to evaluate cases of medical malpractice: 2863 cases could already be clarified by autopsy. Up to now there is no systematic registration of medical malpractice charges in Germany. A systematic registration should be initiated to build up and/or improve error reporting systems and, thus, to improve patient safety. Compared to other sources of medical malpractice claims (arbitration committees of the medical chambers, reference material of health and insurance companies, files of civil courts) the data of the present multicentre study are in so far unique as only lethal cases were evaluated and a complete autopsy report was available as basis of an expert opinion in alleged medical malpractice cases.     

违反告知义务引发医疗纠纷案例分析

告知义务是医师应尽的注意义务之一,在医疗损害赔偿诉讼中原告常以医师在医疗活动过程中未能履行告知义务造成病人损害而要求医疗机构承担赔偿责任。本文介绍了5例有关医师违反告知义务的医疗损害案件及人民法院审理结果,并对医师违反告知义务时如何判定其是否存在医疗过错以及医疗过错与损害后果之间的因果关系进行了分析和讨论,旨在为医疗损害司法鉴定提供参考。     

Medical malpractice charges in Germany--role of the forensic pathologist in the preliminary criminal proceeding

Medical malpractice charges from 1989 to 2002 were evaluated. A rising number of cases during this period is evident. The charges of practice falling below the standard of care (n = 285) were surveyed to determine who informed the prosecution, which clinical subjects are involved, what kind of charges can be found and whether such allegations can be appropriately assessed by means of a forensic autopsy. Forensic pathologists were found to be useful for ascertainment and interpretation of autopsy findings. If special questions arise, an additional expert opinion should be suggested by the forensic pathologist. There was no relevant shift in the range of subjects involved compared to former studies. The investigated charges might represent only a small fraction of cases of medical practice falling below the standard of care.