医疗过错鉴定规则体系研究

当前对医疗过错认定的原则讨论和研究比较多,也比较明确,但是医疗过错认定的规则却缺乏,且由于医疗过错鉴定规则的缺位,导致无论是医学会的医疗鉴定,还是法医开展的医疗过错司法鉴定,都处于一种混沌不清的状态．由此也导致多次鉴定且结论各异的现象。构建科学合理的我国的医疗过错鉴定规则体系乃当务之急。我国的医疗过错鉴定规则体系包括医疗过错认定的一般规则、医疗过错认定的特殊规则和医疗过错认定的排除规则三部分。医疗过错鉴定规则体系需要不断在实践中总结、检验、完善和扩展。     

Investigation of drug-related deaths. An overview

Drug-related deaths encompass fatal overdoses, the medical derangements from chronic consumption, and violent death from the alteration of normal behavioral patterns. Determining the extent to which a drug contributed to a death necessitates correlation of all aspects of the death investigation; autopsy and toxicologic findings must be interpreted in the light of antecedent events, medical and social history, and thorough scene investigation. The approach to the medicolegal investigation of drug-related deaths is discussed along with some legal ramifications and certain potential problems of death certification.     

Reasonable charges for medical care or services. Department of Veterans Affairs. Interim final rule

This document amends the Department of Veterans Affairs (VA) medical regulations concerning "reasonable charges" for medical care or services provided or furnished by VA to a veteran: (1) For a nonservice-connected disability for which the veteran is entitled to care (or the payment of expenses of care) under a health plan contract; (2) For a nonservice-connected disability incurred incident to the veteran's employment and covered under a worker's compensation law or plan that provides reimbursement or indemnification for such care and services; or (3) For a nonservice-connected disability incurred as a result of a motor vehicle accident in a State that requires automobile accident reparations insurance. This document amends the regulations to update databases and other provisions for the purpose of providing more precise charges.     

论法学专家参加医疗事故鉴定过程的必要性

医疗事故鉴定在处理医疗纠纷的民事赔偿和行政处理以涉及医药卫生的刑事犯罪中具有重要地位和作用。医疗事故鉴定是涉及医学的法律问题,现行医疗事故争议完全由医学专家鉴定具有不公平性和合理性,应当由医学专家和法学专家共同鉴定。     

Medical care collection or recovery--VA. Notice

In a companion document published in the "Proposed Rules" section of this issue of the Federal Register, we proposed to amend VA's medical regulations concerning collection or recovery by VA for medical care or services provided or furnished to a veteran: (i) For a non-service connected disability for which the veteran is entitled to care (or the payment of expenses of care) under a health-plan contract; (ii) For a non-service connected disability incurred incident to the veteran's employment and covered under a worker's compensation law or plan that provides reimbursement or indemnification for such care and services; or (iii) For a non-service connected disability incurred as a result of a motor vehicle accident in a State that requires automobile accident reparations insurance. The proposed rule includes methodology for establishing charges for VA medical care or services. Using this methodology, information for calculating proposed charge amounts at individual VA facilities for inpatient facility charges, skilled nursing facility/sub-acute inpatient facility charges, outpatient facility charges, and physician charges is set forth below. If this methodology were adopted subsequently as a final rule, the applicable data in this document, designed for the period August 1998 through September 1999, would be used for the period from the effective date of the final rule through September 1999. Accordingly, interested parties may wish to retain this document for future reference.     

Rethinking the admissibility of medical treatises as evidence.

This Article examines the issues and questions which underlie the debate over the admission of "medical treatises" into evidence. The admissibility of this type of evidence is at issue most often in litigation involving complex medico-legal issues. This article outlines the evidentiary basis for admission of medical treatises and discusses the quality of medical treatises in an effort to determine what value to the fact-finder these treatises actually hold. The authors contend that there is an inherent untrustworthiness associated with medical treatises, but do not go so far as to suggest that medical treatises should never be admitted. The Article concludes that there is a need for greater caution in determining admissibility and recommends safeguards to better guarantee trustworthiness and reliability.     

The Alchemy of Accomplishing Medicine (sman sgrub): Situating the Yuthok Heart Essence (G.yu thog snying thig) in Literature and History

This essay examines historical and contemporary connections between Buddhist and medical traditions through a study of the Accomplishing Medicine (sman sgrub) practice and the Yuthok Heart Essence (G.yu thog snying thig) anthology. Accomplishing Medicine is an esoteric Buddhist yogic and contemplative exercise focused on several levels of “alchemical” transformation. The article will trace the acquisition of this practice from India by Tibetan medical figures and its assimilation into medical practice. It will propose that this alchemical practice forms the central nexus of connection between Tibetan medicine and the Buddhist Nyingma tradition, and that this little-studied link is not a marginal feature of Tibetan medicine but rather one that has had a significant shaping factor on each tradition throughout history.     

医事法论纲

鉴于医事法律立法的迟滞和理论研究的欠缺 ,应开辟独立的医事法研究领域。医事法具有三个特点 :( 1)缺乏完整的医事法典 ;( 2 )主要内容包括医事主体法、医事行为法 (含医事程序法 )和医事社会法三个方面 ;( 3 )医事法律关系中双方主体权利义务的不完全对等。医事法还具有三条基本原则 ,即先导义务原则 ;最少损害原则 ;生命伦理原则。     

Hazardous materials: revision to standards for infectious substances. Final rule

RSPA is revising transportation requirements for infectious substances, including regulated medical waste, to: adopt defining criteria and packaging requirements consistent with international standards; revise the current broad exceptions for diagnostic specimens and biological products; and authorize bulk packaging options for regulated medical waste consistent with requirements in international standards and DOT exemptions. These revisions will assure an acceptable level of safety for the transportation of infectious substances, and facilitate domestic and international transportation.     

Medical administration of radiation and radioactive materials--NRC. Final rule

The Nuclear Regulatory Commission is amending its regulations to clarify that the medical administration of radiation or radioactive materials to any individual, even an individual not supposed to receive a medical administration, is regulated by the NRC's provisions governing the medical use of byproduct material rather than by the dose limits in the NRC's regulations concerning standards for protection against radiation. The rule does not represent a change in policy, but is necessary to indicate clearly that this is the NRC's policy and to clarify the relationship of NRC's regulations.     

Modification of certain medical standards and procedures and duration of certain medical certificates. Final rule

This rule extends the duration of first- and third-class medical certificates for certain individuals. A first-class medical certificate is required when exercising airline transport pilot privileges and at least a third-class medical certificate when exercising private pilot privileges. Certain conforming amendments to medical certification procedures and some general editorial amendments are also adopted. The intent of this action is to improve the efficiency of the medical certification program and service provided to medical certificate applicants.     

新生儿医疗纠纷相关因素的初探

目的　从法医学和管理学的角度初步探讨新生儿科医疗纠纷的防范与处理。　方法　收集华中科技大学同济医学院法医学系 1994— 2 0 0 2年 8年间 2 7例新生儿尸体解剖案例 ,进行回顾性分析研究。　结果　 2 7例新生儿尸体解剖案例中 ,男性患儿 12名 ,女性患儿 15名 ,平均年龄 18.2 2天。其中围产期 10例。其家属要求均为查明死因。经过鉴定 ,其中医疗事故为 0例 (3 7.0 3 % ) ,不是医疗事故 17例 (62 .97% )。　结论　新生儿医疗纠纷的防范应从医方、患方以及国家与社会 3方面努力进行防范 ;在处理方面 ,及时的尸体解剖和病理检查是解决医疗纠纷一种行之有效的方法。     

Medical device warning letter pilot. Food and Drug Administration, HHS. Notice

The Food and Drug Administration (FDA) is initiating a pilot program involving the medical device industry that is a continuation of the "medical device industry initiatives." This pilot concerns the issuance of warning letters for quality system, premarket notification submission (510(k)), and labeling violations. This pilot is intended to optimize resource utilization, enhance communication between industry and FDA, and provide firms with incentives to promptly correct violations or deficiencies. The pilot includes eligibility criteria and procedures for the issuance of warning letters.     

Natural rubber-containing medical devices; user labeling--FDA. Final rule

The Food and Drug Administration (FDA) is issuing a final rule requiring labeling statements on medical devices, including device packaging containing natural rubber that contacts humans. The rule requires labeling of medical devices containing natural rubber latex that contacts humans to state: "Caution: This Product Contains Natural Rubber Latex Which May Cause Allergic Reactions."; labeling of medical devices containing dry natural rubber that contacts humans to state: "This Product Contains Dry Natural Rubber."; labeling of medical devices containing natural rubber latex in their packaging that contacts humans to state: "Caution: The Packaging of This Product Contains Natural Rubber Latex Which May Cause Allergic Reactions."; labeling of medical devices containing dry natural rubber in their packaging that contacts humans to state: "The Packaging of This Product Contains Dry Natural Rubber."; and that the claim of hypoallergenicity be removed from the labeling of medical devices that contain natural rubber. These requirements are being established in response to numerous reports of severe allergic reactions and deaths related to a wide range of medical devices containing natural rubber.     

美国医疗差错的概念、定义与特征本

医疗差错已经是一个全世界的问题。越是现代化的国家 ,这一问题就显得越为严重 ,在美国因医疗差错导致患者死亡已占死因的第 8位。在我国 ,一直习惯使用医疗事故的概念 ,而医疗事故又在《刑法》里有明确的罪责。随着中国经济日益与世界接轨 ,法律制度中的一些概念性问题也在逐步朝向国际统一方向发展。因此 ,对于医疗差错的明确统一定义 ,就显得十分很重要。本文主要介绍美国法律方面的相关规定。一、医疗差错是当今的世界性问题1999年 ,美国医学研究所 (ＩＯＭ ,ｔｈｅＩｎｓｔｉｔｕｔｅｏｆＭｅｄｉｃｉｎｅ )估计 ,每年有 980 0 0人死于…     

中毒死亡案件的法医学分析

目的分析中毒性死亡案件和与中毒死亡有关的医疗纠纷案件的法医学特点,探讨此类案件的防护重点和鉴定要点。方法对四川大学法医学院1985～2004年106例中毒死亡尸体剖验病理材料进行回顾性统计分析。结果性别:男性61例,女性45例,男女比例1.36:1;年龄:以21～40岁年龄组(60.38%)为主;死亡方式:意外死亡最多见(52.83%),其次为自杀(33.02%)和他杀(14.15%);死亡原因:CO中毒、有机磷类中毒、毒鼠强及药物中毒多见(72.64%);医疗纠纷:发生医疗不当12例(11.32%),7例为医源性中毒性医疗纠纷,5例为中毒后在医院抢救中发生的医疗纠纷,主要发生于乡镇医院和县级医院(83.33%)。结论加强毒物的管理、提高安全意识、加强法制教育、增加生产安全等是减少中毒性死亡的重要手段。提高城乡医疗水平,加强中毒急诊抢救临床技能是防止中毒性医疗纠纷的关键。     

医疗损害证明责任分配规则研究

证明责任在医疗损害赔偿纠纷中发挥着风险分配的重要作用,我国近十年的立法充分利用证明责任分配规则来体现立法政策的转变。早期立法体现的证明责任倒置规则导致了大量的非合理性医疗行为,这在更大范围内损害患者的利益。《侵权责任法》矫正了这种倾向,《侵权责任法》根据各种具体情形,规定了更为详细的归责要件,相应地,证明责任分配规则也更加详细具体,较好地分配了医疗风险,平衡了医患双方的诉讼负担。     

U.S. Navy and Marine Corps recruit training deaths in San Diego, California, 1973-1985; a review of 31 cases.

The deaths of military recruits associated with training activities nearly always fall under close scrutiny from relatives of the deceased recruit and the media. The literature contains isolated case reports of recruit deaths but no comprehensive reviews of all deaths at a single training facility. The purpose of this study is to describe the circumstances and causes of all recruit deaths occurring at the Naval Training Command and the Marine Corps Recruit Depot in San Diego, California, from 1973 through 1985. Thirty-one male recruits died in training during this period; eight died from medical conditions not detected by preenlistment questioning or examination. In five of these cases, the conditions were probably known to the recruit but were not listed on a medical history form. Seven recruits died in incidents related to training, and there were six cases of "sudden cardiac death," as well as eight deaths caused by infectious diseases.     

Physical qualification of drivers; medical examination; certificate. Federal Motor Carrier Safety Administration (FMCSA), DOT. Final rule

This document updates and simplifies the medical examination form that is currently used to determine the physical qualification of commercial motor vehicle (CMV) drivers operating in interstate commerce. The FMCSA takes this action in response to numerous requests from medical examiners to update and simplify the medical examination form that is currently used. This action is intended to reduce the incidence of errors on such forms and to provide more uniform medical examinations of CMV drivers engaged in interstate commerce. The current Federal physical qualification standards tested by medical examiners and recorded on the form will not be revised in this rulemaking.