浅论医疗投诉之法律监督与权利救济

医疗机构、医务人员和患者是医疗卫生法律明确规定的利益共同体,但从部分法院近期裁判情况看,各地在认定患者是否具备行政诉讼原告资格方面存在明显差异。结合新《行政诉讼法》调整原告资格的双重背景和最高人民法院裁判精神,在医患关系有待改善和卫生执法水平尚待提高的情况下,应充分肯定患者与医疗投诉处理结果的利害关系,以发挥司法审判和复议审查在推动提升卫生执法水平与保障群众健康权益方面的双轮驱动作用。     

Pharmacist misconduct: the pitfalls of practice

This article identifies the changing role of pharmacists in the provision of health care and analyses 78 complaints against pharmacists over a recent 12-year period in New South Wales, finding that the majority of complaints were in relation to the oversupply of particular medications, from which some pharmacists made significant financial gains. A number of other areas of complaint were identified, including issues in relation to the recording and labelling of medications and the roles and responsibilities of pharmacists, dispensing errors, fraud, and sexual misconduct. As the roles of pharmacists continue to expand, with the growth of "compounding chemists", and the suggestion that pharmacists are now performing basic medical tasks which were once the domain of a general practitioner, it is increasingly important that pharmacy take its place in any debates about the provision and regulation of health services.     

Retail medical clinics: increasing access to low cost medical care amongst a developing legal environment

Retail medical clinics are an innovation in health care with the potential to increase access to low-cost basic health care services while changing the delivery model for routine, non-urgent medical care. However, the few states that attempted to directly regulate retail medical clinics have been met with criticism by the FTC due to the proposed legislations' anticompetitive undertones. The relationship between retail medical clinics and the host stores or pharmacies that house them has the potential to spark fraud and abuse concerns. Retail medical clinics must abide by state-specific regulation on scope of practice of the various mid-level practitioners who work for the clinics, particularly to minimize exposure to litigation and keep within the clinics' intended purpose of a supplement to primary care physician offices. The author concludes that the consumer benefits of cost and convenience, combined with the potential for growth and expanded consumer base from a retailers' perspective, make the legal challenge inherent in running a retail medical clinic well worth the effort.     

政府在信访工作中践行法治思维的探讨

信访工作中既要防止消极的拒民思维，又要防止过度的迁就思维，因为二者均为“人治”的思维方式。本文认为，信访工作中的法治思维是指：政府要从消极被动的守法者转变为积极主动的用法者；对于信访者的诉求要坚持法律的底线：政府要有作为诉讼主体进行依法维权的思维。政府在信访工作中践行法治思维的条件是：领导重视、经济发展、严格执行考核机制、信访干部职业化。此外。政府信访工作中践行法治思维还应处理好与治理思维的关系。     

Psychological Injury from Licensing Complaints Against Mental Health Practitioners

Today's mental health practitioners are subject to governmental (e.g., licensing boards) and legal (e.g., professional liability or malpractice) monitoring and regulation. Regrettably, the governmental and legal oversight of health care has proven to be tilted in favor of the service user, with frequent unfair processing and unjustifiably harsh penalties imposed on mental health practitioners—which often result in psychological injury. Stress and anxiety caused by a licensing complaint is common; and in this article, the psychological effects are set forth. It is concluded that there is no reason to expect relief from the risks of practice in the future, that is, typical licensing complaints plus added ethical issues are likely as the mental health professions evolve. This means that, whenever there is an indication of a possible complaint from a service user, today's mental health practitioner must, as part of the support services essential for practice, be prepared to rely on legal counsel.     

Practice guidelines and malpractice litigation: collision or cohesion?

Practice guidelines are standardized specifications for managing particular clinical problems and are intended to improve the outcomes of medical care by increasing adherence to standards of care. They are also meant to make medicine more cost-effective by eliminating unnecessary procedures. A relatively recent phenomenon, the practice guidelines now emerging will have implications for malpractice, which also intends to bring about better care. They will probably not revolutionize the procedures that courts use to determine negligence, but judges will integrate guidelines into their decision-making process. This development should be welcomed. Guidelines should prove to be useful as either inculpatory or exculpatory evidence of negligence. They are unlikely to generate much new litigation, although there is some potential for suits against those who issue guidelines, especially if guidelines are not revised as the technology of medical care changes.     

Health Status of Incarcerated Adolescents: Implications for Juvenile Justice Decision Making

Adolescents arriving in detention often bring with them significant medical, dental, and psychological problems. These issues have important implications for courts that must decide the best disposition for offending youths. Appropriate treatment benefits the individual by enhancing his/her well‐being and improving his/her chances of successful rehabilitation. Society also benefits by avoiding the higher cost of caring for neglected conditions later in life. A comprehensive health care program for detention facilities involves establishing standardized procedures that address both common adolescent problems plus those more peculiar to detainees. Health care professionals working in a correctional setting have unique duties such as clearing youths for boot camp, monitoring injuries, dealing with resistant patients, monitoring for safe activities, and planning aftercare for youths who may face impediments to accessing care such as poor motivation and poverty. Research concerning issues specific to the needs of incarcerated youths remains infrequent and should be undertaken by health care providers. This article provides an overview of medical issues confronting juvenile offenders that should be considered when a juvenile becomes involved in the juvenile justice system.     

论强制医疗启动程序决定主体

强制医疗制度是国家医疗保健制度的有机组成部分,强制医疗有广义与狭义之分。狭义的强制医疗,如实施危害行为的精神病患者、甲类传染病患者等;广义的强制医疗,包括预防接种、指定医保单位就医等。强制医疗程序启动的决定主体必须是国家赋予相应权力的机关,其他任何单位不具有这样的权力,因而无权决定强制医疗程序启动。强制医疗主体的确定取决于强制医疗对象的危害程度、广度及时间等因素。     

Prohibition of "gag clauses" in the Federal Employees Health Benefits Program--OPM. Notice of proposed rule making

The Office of Personnel Management (OPM) is proposing to amend the regulations to prohibit health benefit carriers participating in the Federal Employees Health Benefits (FEHB) Program from entering into contractual provisions with health care providers or health care workers that would include a provision for incentive payments as an inducement to reduce or limit communication with, or the delivery of health care services to, FEHB enrollees. The rule is intended to ensure providers' and health care workers' ability to communicate with, and advise patients of, any medically necessary treatment options.     

Freestanding emergency centers: regulation and reimbursement

The freestanding emergency center, which combines the functions of a doctor's office and a hospital emergency room, has emerged as a new provider of health care. These centers have generated considerable controversy over their role in the health care market. Proponents argue that freestanding emergency centers reduce costs by providing care in a more efficient manner and cause other health care providers such as hospital emergency rooms to reduce costs and improve service. Opponents argue that the centers create an additional layer of health care which duplicates existing services and increases total health care costs. This Note examines the controversial issues of licensure, regulation and reimbursement. The Note concludes that freestanding emergency centers can help to reduce health care costs and discusses the steps that should be taken to aid centers in achieving this goal. reduce health care costs and discusses the steps that should be taken to     

审判中心视角下的行政诉讼制度构造

"以审判为中心"的政法政策同样适用于行政诉讼制度改革,它要求法院发挥自身司法能力和司法制度能力,有效地介入涉法行政争议之中,并藉此保护法益。在行政诉讼中,司法权与行政权之间是法律监督上的国家权力结构关系。法院优位于行政机关,法院作为独立裁判者指挥诉讼管理关系和裁判过程。以审判为中心的行政诉讼制度构造,应最大限度地发挥法院司法能力在解决行政争议上的优位角色,应完整地发挥行政诉讼法的制度能力,即发挥立法、司法解释、司法组织及指导性案例的制度功能。行政诉讼司法准入、行政机关负责人出庭应诉、诉讼管辖、庭审制度等,是否体现了"以审判为中心"的制度改革方向,主要看其是否有利于行政争议的实质解决和法益有效保护。"多元化纠纷解决机制"政策和行政行为合法性审查为中心的行政诉讼制度,影响了法院的诉讼角色和功能。回归司法权和诉讼制度本质,宜在行政争议、行政行为和法益之间构造出一致性的诉讼结构关系;宜从组织和体制改革转向程序改革,发挥行政程序和司法程序在塑造司法公正和司法效率上的作用。     

PARTNERS IN THE PROCESS: HOW ATTORNEYS PREPARE THEIR CLIENTS FOR CUSTODY EVALUATIONS AND LITIGATION

We surveyed 113 family attorneys regarding what they did to prepare their clients for child custody evaluations and litigation. Findings revealed that participants saw child custody evaluations as useful on a variety of levels and effective in settling cases. In general, participants reported using professionally acceptable procedures, appropriately advocated for their clients, and dealt with complaints in a reasonable fashion. Referrals to mental health professionals in advance of a child custody evaluation were generally made to provide support rather than for evaluation or test preparation. Work product reviews by mental health consultants were infrequent, although such reviews were seen as highly useful by those who used them. Lastly, participants reported that allegations of parental alienation and domestic violence were often used to gain leverage in custody cases. Implications for practice are discussed for both attorneys and evaluators.     

Medical malpractice litigation: do the British have a better remedy?

Medical malpractice claims are filed nearly ten times more frequently in America than they are in Great Britain. British patients generally adopt a less adversarial stance toward medical malpractice than do American patients. This Article examines the British malpractice system, as compared with the American system, and explores the differences between the two, in terms of costs and fees, liability rules, statutory provisions, and judicial attitudes toward malpractice litigation. The Article also discusses British social and institutional factors, such as the "taint" of litigation and the National Health Service, and evaluates how these factors affect British malpractice litigation. The Article presents the alternative forums available to British patients in seeking satisfaction for their medical service complaints. The Article concludes with an evaluation of how these factors achieve the three societal objectives of malpractice litigation: reparation, emotional vindication and deterrence.     

The many faces of access: reasons for medically nonurgent emergency department visits

Investigating why people use the hospital emergency department (ED) for visits considered medically nonurgent can enhance our understanding of people's expectations of health care services, of their conceptions of prudent lay judgment, and of difficulties in negotiating the logistics of primary care services. This study identified reasons for such ED use from users' perspectives in both pediatric and adult visits. Respondents were asked to explain what brought them to the ED and to define an emergency. The study was conducted in two northeastern U.S. hospital EDs. The analysis drew on a convenience sample of 408 (331 pediatric, 77 adult users) face-to-face interviews that employed both open- and closed-ended questions. Findings indicate most patients had medical insurance and a regular place of care and most arrived by car or taxi. Twelve main themes emerged under three main categories: conceptions of needs, appropriateness, and preference for the ED. The findings indicate that various reasons for ED use may be construed as access issues. These include beliefs regarding limited availability of after-hour consultation services and of timely appointments at one's primary care site. Drawing on the findings, a typology that distinguishes between groups of users according to their preference for the ED, a level of congruence between their own reason and their definition of an emergency was developed. The typology suggests that people's concerns that influence their decision to come to the ED cannot be solved simply by expanding primary care services or by educational interventions. Its application yields recommendations for services and interventions.     

论行政公益诉讼制度的建构

构建行政公益诉讼制度的时机已经成熟,应当在《行政诉讼法》修改中规定。公益诉讼作为客观诉讼,不同于以利益救济为根本目的的一般诉讼,要综合考虑各种因素来确定范围,既不宜过宽,也要预留发展的空间。建议赋予检察机关和法律、法规确定的特定公益性社团依公民、法人和其他组织申请或单独提起行政公益诉讼的资格。要根据公益诉讼的特点,设置相应的程序,包括检察机关提起公益诉讼之前向行政机关提出检察建议的前置程序和临时禁令等。     

“案结事了”的司法观与裁判事实的可接受性

为了应对数量庞大的涉法涉诉上访问题,人民法院一直采取诸多措施予以遏制。然而,最令司法实务部门主政者关注的千方百计上京城形势依然严峻。案结事不了成为摆在司法实务部门主政者面前的难题。在治理上访问题上,最高司法实务部门漂移在两种理念之间,提出案结事了的新型司法观。案结事了的司法观作为价值目标与行动指南的统一体将调解作为首要的结案方式,改变了调解在当下法院纠纷解决机制中的定位,成为主导全国法院的不同于既往司法观的主流司法意识形态。这样一种司法观却使得裁判事实可接受性的来源建立在当事人对于自身权利的放弃以及模糊的事实认定的基础之上,改变了当下裁判事实可接受性的来源,危及了将来可能的裁判事实可接受性的来源。     

The role of the psychiatrist in evaluating a prison mental health system in litigation

Federal courts during the past 14 years have recognized that many prisons in the United States have provided constitutionally inadequate medical and psychiatric services. Our recent national survey indicates that at least 20 states have had at least one part of their correctional system included in a certified class action suit that alleged insufficient mental health services for inmates. This article reviews the role of the expert psychiatric witness during the phases of litigation that involve proposed remedial plans and compliance in implementing remedial plans. Available epidemiologic data about psychiatric disorders among prison inmates, standards for correctional mental health care, and various mental health system models are briefly reviewed. A comprehensive approach to evaluating proposed remedial plans and assessing issues of compliance with accepted plans is described. Special attention is directed toward psychiatric issues unique to a correctional system.     

功能、要素与内容:民事起诉状省思

民事起诉状的功能应当定位为起诉功能和准备功能,起诉功能是起诉状的本质功能。由此,起诉状要素应当分为必备记载事项和任意记载事项。起诉状对"当事人"的记载应当达到能够使得当事人特定的程度;对"诉讼请求"的记载应当做到原则性与灵活性相结合;起诉状对"事实与理由"的记载只要达到辨别本案的诉讼标的即可。     

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.