刍议医疗损害技术鉴定二元化现状的应因之道

《侵权责任法》颁布实施已经2年多,国家立法机关及最高人民法院迟迟没有出台关于医疗损害技术鉴定的法律解释。一些省、直辖市出台了地方性规定,但做法各不相同,理论上并没有彻底解决鉴定二元化的问题。目前部分地区医疗损害司法鉴定似乎出现一种无序状态,严重影响了医疗损害争议案件的解决,急需尽快完善顶层设计,规范鉴定机制,尽快结束鉴定的二元化局面,为医疗损害争议案件诉讼的解决提供保障。     

不断完善医疗纠纷赔偿机制的思考

本文对海南省推行全省统一的医疗责任保险方案实施两年来,在运行过程中存在的问题与对策从医院层面进行分析,认为医疗纠纷通过医责险赔偿仍面临诸多矛盾和问题。主要表现在：一是保险公司的逐利性和医院对投保的初衷存在巨大差异,购买医责险并非医院自愿;二是医责险在理赔中困难重重,该赔不赔、随意压价、限制受理范围等等导致调解失败,医院没有真正从医疗纠纷中解脱出来,“医闹”问题仍困扰医院;三是保险方案设计和保费调整系数不合理,医院承担的保费过高,而赔偿过低,未能达到风险转嫁的目的。作者提出不断完善医疗纠纷赔偿机制,尝试建立医疗风险互助金制度。     

医学生对病历书写基本规范的认知差异及干预研究

为提高医学生病历书写技能、掌握病历书写要求和法律规定,本研究以《侵权责任法》第七章医疗损害责任和《病历书写规范》为依据,评估、干预、提高医学生的病历书写技能和法律意识。结果显示,实习生与在校生有统计学差异,干预前后的在校生对病历书写规范及医疗损害法律制度的认知有统计学差异。研究认为,在校生经针对性、综合性、规范化的病历书写规范培训后,能有效掌握病历书写规范的要求和法律制度。建议病历书写规范的培训应该常规化、制度化、规范化,纳入教学计划,提高医学生的病历书写技能和法律意识,减少病历记录不良和记录瑕疵,防范医疗纠纷。     

270起医疗机构卫生行政处罚案件分析

在芜湖市医疗机构不断发展壮大的同时,存在着许多医疗违法情况,然而政府监管及处罚措施单一,因此需进一步加大对医疗市场的监管和处罚力度,为广大人民群众的健康保驾护航。本文通过分析芜湖市卫生监督所近3年时间查处的部分医疗机构违法案件,掌握目前医疗机构存在的一些违法问题,为进一步探讨高效的医疗机构监管措施提供依据。     

浅析深圳市处理医患纠纷的新模式——仲裁

既往由医疗损害引起的狭义医患纠纷的处理模式包括协商解决、行政调解、民事诉讼。现阶段我国医患纠纷的数量日益增多,有必要推出更多的解决途径。深圳市新推出的医患纠纷仲裁模式则更为医患双方认可,其最大优点是同时可以兼顾中立性、权威性与高效率,但单独采用这种模式仍有一些问题,理想的模式是强制推行医疗损害责任保险制度,采用仲裁模式解决医患纠纷。     

Cautioning jurors regarding co-witness discussion: the impact of judicial warnings

Abstract

The research seeks to identify the most common problem areas and associated treatment needs of incarcerated and recently released offenders, to determine the importance of prison-based treatment and to assess the motivation of offenders towards treatment. Interviews were scheduled with representatives of three participant categories: drug-involved incarcerated offenders (n=18), recently released prisoners (n=15) and treatment staff members (n=18), resulting in 1971 statements. Using the qualitative software package WinMAX98, these expressions were categorized in a tree structure, after a codification process of the raw material. The results suggest that there is a difference in opinion between offenders and service providers with regard to the most important problems related to incarceration and re-entry. The findings further indicate that released offenders struggle more often than incarcerated offenders with problems concerning their psychological status. Therefore, the need for continuous through-care and aftercare is apparent, as is the necessity to assess the participants’ support expectancies and their individual needs. Motivating offenders to take part in (prison-based) treatment initiatives and aftercare is a major challenge, which can be accomplished by cooperation and partnerships between the criminal justice system and community-based treatment providers.     

Hope in the treatment of sexual offenders: the potential application of hope theory

Abstract

The present paper attempts to demonstrate how hope theory is conceptually consistent with current positive approaches to sexual offender treatment. Hope theory and its components of goals, pathways thinking, and agentic thinking is reviewed as defined by Snyder and his colleagues. A theoretical relationship exists between the role of hope and many aspects of sexual offending and treatment. Developmental course, attachment style, and the formation and maintenance of coping styles are reviewed as they relate to hope and sexual offending. A framework by which to apply hope theory to pre-treatment, treatment, and more specifically, self-management or relapse prevention for sexual offenders is proposed. Emphasis is placed on the use of techniques that target hope components, particularly in pre-treatment programs.     

Moral judgement,cognitive distortions and empathy in incarcerated delinquent and community control adolescents

Abstract

Immature moral judgements, cognitive distortions and low empathy could contribute to criminal offending and are often targeted in interventions aimed at reducing risk of recidivism. We compared 58 delinquent 13–18-year-olds, incarcerated in youth homes in Sweden (29 males, 29 females) with 58 (29 males, 29 females) community control adolescents individually matched on age, gender, ethnicity and socio-economic position. Self-report questionnaires examined moral judgement, cognitive distortions, and empathy. Delinquent adolescents exhibited less mature moral judgements and more cognitive distortions than control adolescents. However, no association between delinquency status and self-reported empathy was found. In addition, girls reported more mature moral judgements, less cognitive distortions and more empathy than boys did. Moral judgement and empathy were positively correlated and both measures were negatively correlated with cognitive distortions. Our data support the idea that moral judgement and cognitive distortions are important treatment targets for juvenile delinquents, whereas empathy may be less meaningful to address directly.     

Personal,background and treatment characteristics associated with offending after residential treatment: A 13-year follow up in adolescent males

Abstract

We report on delinquency for 270 males after residential treatment in a juvenile justice institution in the Netherlands. We describe personality characteristics, relations with peers, school and family, as well as treatment characteristics. Next, we describe post-release offending based on reconviction data, and relate this to background characteristics, differentiating between serious and violent offending. In doing so, we distinguish between incidental offenders, chronic offenders and desisters.     

The Treatment Engagement Rating scale (TER) for forensic outpatient treatment: Description,psychometric properties,and norms

Abstract

The Treatment Engagement Rating scale (TER) is a Dutch therapist rating instrument for treatment engagement (TE) of forensic outpatients. It yields scores for nine components of TE, which are aggregated in a total score. Following an analysis of the concept of TE, the TER is described, and various psychometric analyses of data from a forensic outpatient sample are reported. The nine component scores were found to constitute a homogeneous scale with good internal consistency (α=0.93, n=328) and adequate inter-rater reliability (intraclass correlation coefficient (ICC)=0.76, n=99). The validity of the TER is supported by correlations of 0.47, 0.66, and 0.91 (n=328) with measures for the motivation to engage in treatment. Applications for the TER in clinical practice and research are suggested.